The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because our beliefs about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments.

It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate.

Furthermore, rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk.

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.

Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals.

A recent message on one of the e-mail bulletin boards sent by a college student read, “I believe that the AIDS virus was developed in government labs for the purpose of controlling black folks.” In September 1990, Essence, an African American magazine with a circulation of 900,000, had as a lead article “AIDS: Is It Genocide?” In 1991, the New York Times quoted Clarence Page, African American columnist and Pulitzer prize winner: “You could call conspiracy theories about AIDS and drugs fringe ideas, but they seem, to have a large following among the black intelligentsia. … [And] you find it at all levels.” In April 1992, Lorene Gary explained in Newsweek “Why it's not just paranoia.” In that same month, another New York Times article reported: “Bizarre as it may seem to most people, many black Americans believe that AIDS and the health measures used against it are part of a conspiracy to wipe out the black race.”4 In February 1992, Science quoted Peter Breggin, director of the Center for the Study of Psychiatry in Bethesda, Maryland, as saying that research on violence “cloaks the intention to identify problem black children and then … prescribe pacifying drugs.”

The culture of giving birth in Brazil has changed drastically since 1970. The caesarean section, once known as a life-saving medical procedure to be used under extraordinary circumstances, is now perceived by the medical profession and their female patients as a safe, painless, modern, and ideal form of birth for any pregnant woman. Brazil has the world's highest percentage of caesarean deliveries. The widespread use of C-sections has become a cultural phenomenon whose boundaries extend far beyond the medical arena. Medical practitioners have appropriated cultural values regarding the female body and sexuality, rein-forced a blind fascination with technology, and medicalized women's fear of labor to justify their preference for surgical births. By narrowing ethical concerns to the doctor-patient relationship and drawing on the notion of the patient's best Interest, physicians defend their practice as appropriate and even desirable.

Philosophy, including moral philosophy, is the distillation of the spirit of an era. As society and science develop, sooner or later a given philosophy will gradually change form so that the resulting metamorphosis will better meet the needs of the society at that time. Traditional Chinese ethical thought is an outcome of the Chinese closed natural economy and ancient low-level science and is suitable for traditional Chinese medicine. Its superstable structure and character, which have evolved over more than 2,000 years, are rooted deeply in the minds of the Chinese people; hence, it is difficult for them to accept new bioethical views and to adapt to the developments of modern medicine and the changes in society. In China, owing to the strongly rooted values of the old tradition, the consequences of modern medicine have produced an alienating phenomenon that deviates from the goals of modern medicine and leads to conflicts between ethics and science, between old medical ethics and new medical ethics.

In this essay I will examine why the truth is so important to human communication in general, the types of truth, and why truth is only a relative value. After those introductory points, I will sketch the ways in which the truth is overridden or trumped by other concerns in the clinical setting. I will then discuss cases that fall into five distinct categories. The conclusion emphasizes the importance of truth telling and its primacy among secondary goods in the healthcare professional-patient relationship.

The right to conceive and bear children has been protected both in law and in policy. Human society has from its earliest time valued children and defended procreation as a basic right.

Modern health technology offers the possibility of conception to the estimated 2.5 million infertile couples who may wish to have children. For these persons, infertility treatment offers the hope of having children, an activity deemed basic and essential in human society.

In general, the state has been reluctant to directly interfere in the reproductive decisions of individuals. However, the state may act to increase or reduce access to reproductive services in a variety of ways. For example, recent legislation regulating fertility clinics affects the distribution of assisted reproductive technology (ART) in the United States. The purpose of this paper is to describe this legislation, project its probable effects on the distribution of ART services, and analyze these effects based on distributive theories of justice.

So much philosophical theory is irrelevant for the practice of ethics! How many wasted volumes of tortuous arguments and counterarguments have been written in search of an elusive theory of ethics that could be applied deductively, without modification, to produce “correct” answers under all circumstances to any ethical problem? The practice of ethics is much closer to the common sense casuistry approach outlined by Jonsen and Toulmin, in which we work from. intuitively grasped, paradigm, cases by way of analogy to provide presumptive answers to more complex problems. Alasdair Maclntyre argued however that we cannot trust such individualistic intuitive judgements. Thus we should start by looking at his critique of modern ethics.

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma.

At the September 1992 Birth of Bioethics conference observing the 30th anniversary of the Seattle kidney dialysis program, Warren Reich discussed the “bilocated” birth of the term bioethics. He showed that the term bioethics was coined in Michigan by Van Rensselaer Potter and that the term was also apparently conceived of independently at about the same time in 1970–1971 in Washington, D.C., by Andre Hellegers and Sargent Shriver. Potter's work, like many similar works in the early 1970s, was concerned with the growing global biological crisis of human overpopulation, the destruction of species, and how to respond to these. He prefaced his book Bioethics with a “Bioethical Creed for Individuals,” outlining duties to respond to this crisis in a meaningful and scientific way. Hellegers and Shriver used the neologism to name the new Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. The Center was to study concerns somewhat different from Potter's: the technological revolution in healthcare and its impact on reproduction, investigator-patient relations, and medical ethics.

Hospital ethics committees must be knowledgeable if they are to perform consultations, advise administrators on policy, or offer educational programs. Because the membership of the committee is interdisciplinary, with most drawn from the healthcare professions, the individuals who join cannot be expected to bring knowledge of bioethies with them. Therefore, a new committee must spend time developing expertise before it can appropriately serve the hospital community. Although the need for committee self-education is generally recognized, it is seldom discussed in any detail. When discussed at all, expertise in bioethies is usually described as composed of a familiarity with an identifiable body of knowledge and mastery over techniques of moral reasoning. It is assumed that a committee can develop this expertise early in its life through a short course of study.