Contributors

In addition to referring to the Cambridge Quarterly of Healthcare Ethics, the letters “CQ” have another meaning. Since 1912, “CQ” has been recognized as the international radio signal for alerting attention. This journal's goal has always been to alert you to the most important issues in bioethics, and none is more vital to the future of our field than how we define our professional community.

The recent history of the Canadian healthcare system has been increasingly one of shortages. There are delays for services that impose risk and hardship, disparities between the accessibility of healthcare for rural versus urban populations, and a lack of adequate coverage for or access to prescription drugs, diagnostic services, and homecare. Add to these problems shortages of healthcare providers—in particular, physicians and nurses—and state-of-the-art equipment, and we can understand the universal agreement that the Canadian healthcare system must change. The only question is how. Some argue for modifications within the basic framework of a one-tier single-payer system; others for more radical reform that will allow for infusions of money by expedients such as user fees, extra billing, or a full-blooded second tier where one can buy any healthcare one wants.I am indebted to Don Brown for comments and discussion.

Bioethicists currently working in the United Kingdom demonstrate—as indeed do the very best of their colleagues internationally—an eagerness to engage in two extremely different but complementary approaches to their subject. First, they readily become involved in discussions of concrete bioethical issues that are of great concern to the medical profession, legislators, and the wider U.K. public. Second, perhaps because they recognize the importance of the “first-order” questions that exercise the public imagination, they show themselves commendably willing to turn their critical gaze onto the very methods and frameworks they use to address those questions. The first approach we can properly call “bioethical,” whereas we might term the second approach “metabioethical.”

Last year we reported that there are no professorships in medical ethics in Finland. This year we are happy to report that a chair in medical ethics (albeit temporary) has now been advertised at the University of Turku. We also gave details about the attempts to come up with a law on assisted reproduction. As predicted, there were problems, and eventually the proposal was withdrawn, leaving Finland still without a law on assisted reproduction. The talk on large-scale genetic databases has been surprisingly quiet, and even the report published by the Parliament's working group on this matter, implying that a population database should be created, went virtually unnoticed. In this year's contribution, we address the issues of male circumcision, stem cell research, and, within the field of research ethics, the problem of defining medical research.

The past year in bioethics in Australia has been relatively predictable. We continue to struggle with rising healthcare costs, though thankfully not on par with numerous other countries due to a relatively positive economic outlook. We are still fighting difficulties associated with higher medical indemnity costs, which have again caused many physicians to leave private practice, particularly in high-risk and specialty practice areas. In response, the federal government (following a shuffle of ministerial positions including that of the federal health minister) delayed the imposition of the medical indemnity levy for physicians until mid 2005. In May, the Australian Law Reform Commission and the Australian Health Ethics Commission issued their final joint report on genetic testing entitled “Essentially Yours” and endorsed use of genetic tests by insurance companies, despite the concerns of some geneticists and many members of the public about their scientific reliability. However, they also advocated the establishment of the Human Genetics Commission of Australia (HGCA) to oversee such uses of genetic tests in terms of both scientific and actuarial reliability, and debates continue over the implementation of this and a number of their other recommendations. And state governments continue to phase in smoking bans in public places, with most implementing full bans in enclosed restaurants and cafes and planning to require provision of nonsmoking areas in all pubs within the next year.Thanks to Fiona Mackenzie for research assistance.

In the past few years, a second phase of biomedical ethics in Japan has begun to surface with a succession of governmental guidelines and laws regulating biomedical technology. Although this rush of guidelines exemplifies a heightened awareness concerning ethical standards for healthcare research, it also invites several practical, political, and procedural problems.

This article focuses on healthcare ethics discussions in Estonia. We begin with an overview of the reform policies that the healthcare institutions have undergone since the region regained independence from the Soviet Union in 1991. The principles of distributing healthcare services and questions regarding just what ethical healthcare should look like have received abundant coverage in the national media. An example of this is the exceptionally public case of V—a woman with leukemia whose expensive drugs the national health insurance fund refused to compensate. In our subsequent discussion, we focus on a grand-scale local healthcare and research project—the Estonian Genome Project—that attempts to include 1 million DNA samples into one database.The following article has benefited from the participation in the projects “The Ethical, Legal and Social Aspects of Human Genetic Databases: A European Comparison,” financed between 2002 and 2004 by the European Commission's Fifth Framework Programme (#QLG6-CT-2001-00062), and “The Ethics of Genetic and Medical Information,” financed between 2002 and 2004 by the Nordic Academy for Advanced Study (NorFa). We gratefully acknowledge their support.

In Croatia, the subject of medical ethics, or bioethics, was introduced into the curriculum in the early 1990s at the medical schools of the University of Rijeka and the University of Zagreb. Today, bioethics education has become a basic part of undergraduate medical education not only in Rijeka and Zagreb but also in Osijek.

In this article I focus on two issues concerning bioethics in Argentina: reproductive health and ethics in research. Although these topics are quite dissimilar, they share a particular feature: their special relationship with context.

Brazilian bioethics became consolidated in the 1990s. It was during this time that teaching and research centers were instituted, associative groups were created, and the first papers of Brazilian authors were published. In Brazil, the first years of teaching and research in bioethics were marked by a strong influence of the United States, particularly in the theoretic and thematic fields. Among the main topics of discussion were subjects related to the end of life and to research involving human beings, and bioethics was then chiefly influenced by Tom Beauchamp and James Childress's theory of the four principles.

These CQ Sources were compiled by Bette Anton.

I am in general a great admirer of the work of Savulescu and Harris (S&H), not because I think their conclusions are often right but because they state these conclusions and their arguments very clearly. In their joint paper “The Creation Lottery,” they do, nevertheless, tendentiously overstate their case both with regard to the conclusions that flow from identifying natural reproduction as a creation lottery (CL) and in seeing their exchange as an example of good method in bioethics. In the following short comment I want to point to some of the problematic areas in S&H's arguments.

Schneiderman, Teetzel, and Gilmer offer an amusing but misleading response to my article on medical futility (CQ Vol 11, No 2). Although I did make note of the falloff in citations to medical futility in Medline and Bioethicsline after 1995, my analysis focused on the precipitous rise in professional publications on the concept in the period from 1988 to 1995—a trend confirmed by the authors' own search results. I certainly did not argue, either explicitly or implicitly, that the discussion of medical futility was over. I made limited use of this citation survey—to raise a question about what sparked so much professional debate after 1988. This seems to me an entirely appropriate methodology.

D. Micah Hester thinks the residency match system helps sustain the divide between the haves and the have-nots in healthcare. He believes that the match system channels talent away from the have-nots in a more or less systematic way, damaging moral values in physicians as it goes. As a way of making inroads against these effects, he has asked whether assigning medical school graduates to residencies at random would distribute talent and educational opportunity more broadly and promote desirable moral values. I pointed out what I think are serious limitations of this proposal, and Hester has extended me the courtesy of a reply. Yet with that reply, I find that he has made it even more difficult to defend a lottery approach to residency assignment.

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].

Garrett Hardin, Ph.D.—biologist, environmental ethicist, and lightning rod for controversy for over four decades—died in a double suicide with his wife in September 2003 at his longtime home in Santa Barbara, where he was a Professor Emeritus of Human Biology at the University of California. Both Hardins had been ill for some time and in fact were leaders in the local chapter of the Hemlock Society, the “right-to-die” advocacy organization.

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 ([email protected]) regarding books they would like to see reviewed or books they are interested in reviewing.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.