These CQ Sources were compiled by Bette Anton.

Although this case raises what are commonly called “cultural issues,” it does so in two rather different ways: first, an explicit question of what Shari’a, or Islamic law, teaches regarding bodily mutilation and, second, the most appropriate manner of conveying information in the idiom of the culture. It is necessary for an ethics committee or consultant who is dealing with such a case to obtain accurate information and, if possible, to ascertain how best to communicate that information.

The Borg are always confident that humans will be assimilated into their collective hive and therefore that, as they say, “resistance is futile.” In Star Trek, of course, the humans always successfully resist. Elizabeth Fenton and John Arras, like the Borg, resist the idea that humans are uniquely special as well as the utility of the human rights framework for global bioethics. I believe their resistance to human rights is futile, and I explain why in this essay. Let me begin with their subtitle, because we do seem to agree that popular culture is a powerful aid to understanding human actions and motivations.

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.

The case of Mrs. J is interesting not only because of the difficult questions that the clinical ethicist must confront but also because of the intriguing way in which such cases make Western clinicians and ethicists confront their own oft-unspoken cultural ethical norms and presuppositions.

To submit a case that has been reviewed by an ethics committee or to submit papers on related topics in clinical ethics, readers are invited to contact Ruchika Mishra, editor of “Ethics Committees at Work,” at: [email protected].

It is clear from George Annas's response to our arguments that he has misunderstood and misrepresented our positions on several key points. We suspect that this may be due in part to significant differences between our respective agendas and points of view, so we begin this exchange with an exploration of these differences.

Thirty years later we seem no closer to a consensus on the ethics of sterilizing profoundly mentally compromised young girls than was Judge Blumenfeld.

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.

As is often the case with healthcare treatment dilemmas, it matters in what “voice” an ethical difficulty is related. In this instance, the voice of the healthcare team is clearly heard as the patient’s medical condition is described. The voice of the patient is heard as she cries out in pain. The patient’s son’s voice is heard as he identifies the religious guidelines that must be observed in his mother’s care. Finally, it is the voice of the Hospital Ethics Committee that is heard as it deliberates the questions brought to it.

The heart-rending story of Mrs. J raises many complex ethical issues. Key elements include suffering, disagreement, culture, religion, perspective, and facts. Overarching concerns include whose voices and stories should count, the connection of pain with suffering, and how healthcare ethics committees should respond.

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.

There is nothing more humbling to one’s inner moral compass than to realize that you do not initially know what is right or wrong! I found myself in just such a situation after reading the above case. Much has been written, both in the professional literature and the popular media, about the “Ashley Treatment” since Gunther and Diekema published their article in 2006. It is unclear if others in the United States or around the world have, to any significant degree, adopted growth attenuation therapy and/or surgical intervention for children with severe neurological compromise, but the case quoted above suggests that hospital ethics committees may also be struggling with these decisions. An informal survey of pediatric endocrinologists, mentioned in a recent article on the topic, claims that many physicians are facing this dilemma as well.

Through one of their members, the ethics committee was fortunate to have access to a prominent Muslim scholar, Abdulaziz Sachedina, and asked for clarification regarding Islamic beliefs regarding eye removal.

Should a 9-year-old, severely mentally disabled child undergo extensive operations to limit her growth, prevent development of sexual characteristics, and alter appearance, all in the interests of protecting her from other alleged harms and allowing her to be cared for by her family? I think we should resist engaging with this question, and I think the ethics committee was wrong to accept the burden of making the decision regardless of the outcome they arrived at.

The principle of autonomy, through various court rulings, gradually became part of medical practice and tradition in the second half of the 1800s, notably when the emergence of surgical anaesthesia began to raise serious questions regarding informed consent. In fact, surgical anaesthesia was initially used not only to avoid pain but also to combat patients’ resistance to operations.

I am inclined to agree with Arthur Caplan that a less invasive means than was employed in the case of Ashley X would have been preferable. But, such means do not, as yet, exist. Given these circumstances, what are the issues that the bioethics committee needs to consider prior to making a recommendation to the surgeon?