Thomas H. Murray - Böcker

Why are fiberglass vaulting poles and hinged skates accepted in sport - while performance-enhancing drugs are forbidden? Are the rules that forbid them arbitrary? Should we level the playing field by allowing all competitors to use drugs that allow them to run faster or longer, leap higher, or lift more? In this provocative exploration of what draws us to sport as participants and spectators, Thomas Murray argues that the values and meanings embedded within our games provide the guidance we need to make difficult decisions about fairness and performance-enhancing technologies.Good Sport reveals what we really care about in sport and how the reckless use of biomedical enhancements undermines those values. Implicit in sports history, rules, and practices are values that provide a sturdy foundation for an ethics of sport that celebrates natural talents and dedication. You see these values when the Paralympics creates multiple level playing fields among athletes with different kinds of impairments. They appear again in sports struggles to be fair to all when an extraordinary woman athlete emerges who appears to possess a mans hormone profile and muscles. They are threatened when the effort to assure athletes a fair chance to win without doping is subverted by cheating or by corruption, as in the case of Russias state-supported doping operation.Performance-enhancing drugs distort the connection between natural talents, the dedication to perfect those talents, and success in sport. Explaining the fundamental role of values and meanings, Good Sport reveals not just what we champion in the athletic arena but also, more broadly, what we value in human achievement.

"The volume deserves our serious attention. The authors have provided us an invaluable primer about the HGP and its implications for the future of American health care." —Jurimetrics"This book does make a real contribution . . . in explaining why the genetics revolution holds so much promise and why it is so difficult to bring that promise to fruition." —The Journal of Legal Medicine". . . marked by a forward-looking, analytically and empirically grounded thematic coherence. The editors' carefully crafted template and contributions successfully focus and organize the material." —Annals of Internal Medicine"Excellent" —Canadian Medical Association Journal"The editors have done a very good job integrating the contents into a very useful and readable information source." —Choice" . . . this highly focused book is a well-written, thoughtful, and insightful consideration of the HGP and is valuable reading for anyone concerned with the future of our country's medical infrastructure." —Science Books & Films (**Highly recommended)"A distinguished group of scientists, lawyers, and scholars have written a coherent, readable account of the legal, medical, ethical, and policy issues many (if not all) of us will be wrestling with on both a personal and a public level , as a result of current genetic research." —Library Journal"Each of the contributors is a distinguished authority on the topic. Ethicists, especially, will find well-developed presentation of issues, with exposition of the differing ethical assumptions in tension in the society debate." —Doody's Health Sciences Book Review Home PageHow will the science of gene mapping and gene manipulation affect health care? Leading scholars explore the clinical, ethical, legal, and policy implications of the Human Genome Project for the forms of health care, who delivers it, who receives it, and who pays for it.

Thomas Murray's graceful and humane book illuminates one of the most morally complex areas of everyday life: the relationship between parents and children. What do children mean to their parents, and how far do parental obligations go? What, from the beginning of life to its end, is the worth of a child? Ethicist Murray leaves the rarefied air of abstract moral philosophy in order to reflect on the moral perplexities of ordinary life and ordinary people. Observing that abstract moral terms such as altruism and selfishness can be buried in the everyday doings of families, he maintains that ethical theory needs a richer description than it now has of the moral life of parents and children. How far should adults go in their quest for children? What options are available to women who do not want to bear a child now? Should couples be allowed to reject a child because of genetic disability or 'wrong' gender? How can we weigh the competing claims of the genetic and the rearing parents to a particular child? "The Worth of a Child" couples impressive learning with a conversational style.Only by getting down to cases, Murray insists, can we reach moral conclusions that are unsentimental, far-sighted, and just. In an era of intense public and private acrimony about the place and meaning of 'family values', his practical wisdom about extraordinary difficult moral issues offers compelling reading for both experienced and prospective parents, as well as for ethicists, social and behavioral scientists, and legal theorists.

This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and 'first contact' through to either recovery or to long-term illness, death and dying.

As the population ages and the health care system focuses on cost-containment, family caregivers have become the frontline providers of most long-term and chronic care. Patient care at home falls mainly on untrained and unprepared family members, who struggle to adjust to the new roles, responsibilities, and expenses. Because the culture of family caregivers-their values, priorities, and relationships to the patient-often differs markedly from that of professionals, the result can be conflict and misunderstanding. In The Cultures of Caregiving, Carol Levine and Thomas Murray bring together accomplished physicians, nurses, social workers, and policy experts to examine the differences and conflicts (and sometimes common ground) between family caregivers and health care professionals-and to suggest ways to improve the situation. Topics addressed include family caregivers and the health care system; cultural diversity and family caregiving; the changing relationship between nurses, home care aides, and families; long-term health care policy; images of family caregivers in film; and the ethical dimensions of professional and family responsibilities.The Cultures of Caregiving provides needed answers in the contemporary crisis of family caregiving for a readership of professionals and students in medical ethics, health policy, and such fields as primary care, geriatrics, oncology, nursing, and social work. Contributors: Donna Jean Appell, R.N., Project DOCC: Delivery of Chronic Care; Jeffrey Blustein, Ph.D., Albert Einstein College of Medicine and Barnard College; Judith Feder, Ph.D., Georgetown University; Gladys Gonzalaz-Ramos, M.S.W., Ph.D., New York University School of Social Work and NYU Medical School; David A. Gould, Ph.D., United Hospital Fund in New York City; Eileen Hanley, R.N., M.B.A., St. Vincent's Hospital Manhattan / Saint Vincent Catholic Medical Centers, New York City; Maggie Hoffman, Project DOCC: Delivery of Chronic Care; Alexis Kuerbis, C.S.W., Mount Sinai Medical Center; Carol Levine, M.A., United Hospital Fund, in New York City; Jerome K. Lowenstein, M.D., New York University Medical Center; Mathy Mezey, R.N., Ed.D., New York University; Thomas H. Murray, Ph.D., The Hastings Center, Garrison, New York; Judah L. Ronch, Ph.D., LifeSpan DevelopMental Systems; Sheila M. Rothman, Ph.D.,Columbia University Mailman School of Public Health; Rick Surpin, Independence Care System.

Genetic Ties and the Family brings together experts in history, law, ethics, philosophy, psychology, social work, and sociology to explore the tension between biological and social conceptions of parentage. The contributors consider the effect of DNA-based paternity testing on family relationships and discuss the ethical, legal, and social implications. These essays reflect the changing concepts of parenthood, along with social factors that heighten conflict, such as single-parent adoption, gay and lesbian parents, child support laws, and new reproductive technologies. Building on scholarship of the last quarter century-including the latest developments in law and social science research-this volume will inform the development of legislation regulating genetic testing and the use of test results in establishing parental rights. Contributors: Lori B. Andrews, J.D., Chicago-Kent College of Law; Elizabeth Bartholet, J.D., Harvard Law School; Jeffrey Blustein, Ph.D., Albert Einstein College of Medicine; Nancy E. Dowd, J.D., Levin College of Law, University of Florida; Michael Grossberg, Ph.D., Indiana University; Dorothy Nelkin, B.A., New York University; Jeffrey Parness, J.D.,North Illinois University College of Law; Dianne Scott-Jones, Ph.D., Boston College; Daniel Wulff, Ph.D., Raymond A. Kent School of Social Work, University of Louisville.

As the population ages and the health care system focuses on cost-containment, family caregivers have become the frontline providers of most long-term and chronic care. Patient care at home falls mainly on untrained and unprepared family members, who struggle to adjust to the new roles, responsibilities, and expenses. Because the culture of family caregivers-their values, priorities, and relationships to the patient-often differs markedly from that of professionals, the result can be conflict and misunderstanding. In The Cultures of Caregiving, Carol Levine and Thomas Murray bring together accomplished physicians, nurses, social workers, and policy experts to examine the differences and conflicts (and sometimes common ground) between family caregivers and health care professionals-and to suggest ways to improve the situation. Topics addressed include family caregivers and the health care system; cultural diversity and family caregiving; the changing relationship between nurses, home care aides, and families; long-term health care policy; images of family caregivers in film; and the ethical dimensions of professional and family responsibilities.The Cultures of Caregiving provides needed answers in the contemporary crisis of family caregiving for a readership of professionals and students in medical ethics, health policy, and such fields as primary care, geriatrics, oncology, nursing, and social work. Contributors: Donna Jean Appell, R.N., Project DOCC: Delivery of Chronic Care; Jeffrey Blustein, Ph.D., Albert Einstein College of Medicine and Barnard College; Judith Feder, Ph.D., Georgetown University; Gladys Gonzalaz-Ramos, M.S.W., Ph.D., New York University School of Social Work and NYU Medical School; David A. Gould, Ph.D., United Hospital Fund in New York City; Eileen Hanley, R.N., M.B.A., St. Vincent's Hospital Manhattan / Saint Vincent Catholic Medical Centers, New York City; Maggie Hoffman, Project DOCC: Delivery of Chronic Care; Alexis Kuerbis, C.S.W., Mount Sinai Medical Center; Carol Levine, M.A., United Hospital Fund, in New York City; Jerome K. Lowenstein, M.D., New York University Medical Center; Mathy Mezey, R.N., Ed.D., New York University; Thomas H. Murray, Ph.D., The Hastings Center, Garrison, New York; Judah L. Ronch, Ph.D., LifeSpan DevelopMental Systems; Sheila M. Rothman, Ph.D.,Columbia University Mailman School of Public Health; Rick Surpin, Independence Care System.

The United States has the first and the farthest-reaching newborn genetic screening program in the world. In recent years, individual states have expanded their newborn screening programs to include many more genetic conditions, as new medical knowledge and new testing technologies have become available. The contributors to this provocative collection study the complex ethical and policy challenges present in the changing newborn screening environment and offer guidance to professionals, policymakers, and the general public. Experts from the fields of bioethics, genetics, pediatrics, public health, health policy, law, and political science identify and analyze four social and ethical issues critical to newborn screening policy: the distribution of costs and benefits; information, consent, and privacy; consultation and decision making; and race, ethnicity, and socioeconomic status. In the process, the contributors capture the difficulties of trying to forge ethical public policy at the intersection of parental concerns, new technologies, and economic interests. Contributors: Andrea Bonnicksen, Ph.D., Northern Illinois University; Jeffrey R. Botkin, M.D., M.P.H.,University of Utah; Ned Calonge, M.D., M.P.H., Department of Public Health and Environment, Denver; Toby Citrin, J.D., University of Michigan School of Public Health; Ellen Wright Clayton, M.D., M.S., J.D., Vanderbilt University; Jannine De Mars Cody, Ph.D., University of Texas Health Science Center; Anne Marie Comeau, Ph.D., University of Massachusetts Medical School; James R. Eckman, M.D., Emory University School of Medicine; Scott D. Grosse, Ph.D., National Center on Birth Defects and Developmental Disabilities; Bruce Jennings, M.A., Yale School of Public Health; Donna E. Levin, J.D., Massachusetts Department of Public Health; Michele A. Lloyd-Puryear, M.D., Ph.D., U.S. Department of Health and Human Services; Marie Y. Mann, M.D., M.P.H., U.S. Department of Health and Human Services; Karen J. Maschke, Ph.D., The Hastings Center; Stephen M. Modell, M.D., M.S., University of Michigan School of Public Health; Virginia A. Moyer, M.D., M.P.H., Baylor College of Medicine and Texas Children's Hospital; Lainie Friedman Ross, M.D., Ph.D., University of Chicago; Joseph Telfair, Dr.P.H., M.S.W., M.P.H., University of North Carolina at Greensboro; Steven M. Teutsch, M.D., M.P.H.,Merck & Co., Inc.; Bradford L. Therrell, Ph.D., University of Texas Health Science Center; Benjamin S. Wilfond, M.D., University of Washington

This book brings together an interdisciplinary group of experts in bioethics, sports, law, and philosophy to examine the need for regulating such athletic performance-enhancing technologies as steroids and gene doping. The use of performance-improving drugs in sports dates back to the early Olympians, who took an herbal tonic before competitions to augment athletic prowess. But the permissibility of doing so came into question only in the twentieth century as the popularity of anabolic steroid use and blood doping among athletes grew. Sports officials and others-aided by the development of technologies to test participants for proscribed substances-became concerned over the physical safety of athletes and competitive fairness in sporting events.In exploring the culture, ethics, and policy issues surrounding doping in competitive athletics, the contributors to this volume detail the history and current state of drug use in sports, analyze the distinctions between acceptable and unacceptable usages, evaluate the ethical arguments for and against permitting athletes to avail themselves of new means of improving athleticism, and discuss possible future doping technologies and the issues that they are likely to raise. They explain how and why some athletes resort to doping and assess what the fair opportunity principle means in theory and practice and how it relates to the concept of an equal opportunity to perform. This frank discussion of doping in sports includes accounts by former elite athletes and offers an illuminating exchange over the meaning and value of natural talents and genetic hierarchies and the essence of fair competition.

News of financial entanglements among biomedical companies and researchers has increasingly called into question the worth and integrity of medical studies, nearly three-fifths of which are funded by industry. This volume assesses the ethical, quantitative, and qualitative questions posed by the current financing of biomedical research. The ten essays collected here reflect the wide range of opinions about perceived financial conflicts of interest in medical studies. The opening section provides an overview of the issue, describing the origins of, and concerns raised by, dubious financial arrangements; explaining how certain common situations intensify problematic funding structures; weighing the risks and benefits of commercialized research funding; and detailing the nature, extent, and consequences of the present relationship among academe, government, and industry in the health sciences. The second section compares how the idea of conflicts of interest differs in biomedical research, legal work, and journalism. It includes a challenging look at the term itself and an argument for managed financial incentives.The final section describes and analyzes the existing regulatory regime, poses questions and directions for future self and external regulation, and provides perspectives from a third-party research company. This considered, balanced discussion will interest scholars of bioethics, public health, and health policy.

The place of drugs in American society is a problem more apt to evoke diatribe than dialog. With the support of the Na­ tional Science Foundation's program on Ethics and Values in Science and Technology, and the National Endowment for the Humanities' program on Science, Technology, and Human Values, * The Hastings Center was able to sponsor such dialog as part of a major research into the ethics of drug use that spanned two years. We assembled a Research Group from leaders in the scientific, medical, legal, and policy com­ munities, leavened with experts in applied ethics, and brought them together several times a year to discuss the moral, legal and social issues posed by nontherapeutic drug use. At times we also called on other experts when we needed certain issues clarified. We did not try to reach a consensus, yet several broad areas of agreement emerged: That our society's response to nontherapeutic drug use has been irrational and inconsistent; that our attempts at control have been clumsy and ill-informed; that many complex moral values are entwined in the debate and cannot be reduced to a simple conflict between individual liberty and state paternalism. Of course each paper should be read as the statement of that particular author or authors. The views expressed in this book do not necessarily represent the views of The Hastings Center, the National Science Foundation, or the National En­ dowment for the Humanities.

The fate of seriously ill newborns has captured the atten­ tion of the public, of national and state legislators, and of powerful interest groups. For the most part, the debate has been cast in the narrowest possible terms: "discrimination against the handicapped"; "physician authority"; "family autonomy." We believe that something much more profound is happening: the debate over the care of sick and dying babies appears to be both a manifestation of great changes in our feelings about infants, children, and families, and a reflection of deep and abiding attitudes toward the newborn, the handi­ capped, and perhaps other humans who are "less than" nor­ mal, rational adults. How could we cast some light on those feelings and attitudes that seemed to determine silently the course of the public debate? We chose to enlist the humanities-the dis­ players and critics of our cultural forms. Rather than closing down the public discussion, we wanted to open it up, to illuminate it with the light of history, religion, philosophy, literature, jurisprudence, and humanistically oriented sociol­ ogy. This book is a first effort to place the hotly contested Baby Doe debate into a broader cultural context.

The fate of seriously ill newborns has captured the atten­ tion of the public, of national and state legislators, and of powerful interest groups. For the most part, the debate has been cast in the narrowest possible terms: "discrimination against the handicapped"; "physician authority"; "family autonomy." We believe that something much more profound is happening: the debate over the care of sick and dying babies appears to be both a manifestation of great changes in our feelings about infants, children, and families, and a reflection of deep and abiding attitudes toward the newborn, the handi­ capped, and perhaps other humans who are "less than" nor­ mal, rational adults. How could we cast some light on those feelings and attitudes that seemed to determine silently the course of the public debate? We chose to enlist the humanities-the dis­ players and critics of our cultural forms. Rather than closing down the public discussion, we wanted to open it up, to illuminate it with the light of history, religion, philosophy, literature, jurisprudence, and humanistically oriented sociol­ ogy. This book is a first effort to place the hotly contested Baby Doe debate into a broader cultural context.

The place of drugs in American society is a problem more apt to evoke diatribe than dialog. With the support of the Na­ tional Science Foundation's program on Ethics and Values in Science and Technology, and the National Endowment for the Humanities' program on Science, Technology, and Human Values, * The Hastings Center was able to sponsor such dialog as part of a major research into the ethics of drug use that spanned two years. We assembled a Research Group from leaders in the scientific, medical, legal, and policy com­ munities, leavened with experts in applied ethics, and brought them together several times a year to discuss the moral, legal and social issues posed by nontherapeutic drug use. At times we also called on other experts when we needed certain issues clarified. We did not try to reach a consensus, yet several broad areas of agreement emerged: That our society's response to nontherapeutic drug use has been irrational and inconsistent; that our attempts at control have been clumsy and ill-informed; that many complex moral values are entwined in the debate and cannot be reduced to a simple conflict between individual liberty and state paternalism. Of course each paper should be read as the statement of that particular author or authors. The views expressed in this book do not necessarily represent the views of The Hastings Center, the National Science Foundation, or the National En­ dowment for the Humanities.

This volume presents articles which focus on the ethical evaluation of performance-enhancing technologies in sport. The collection considers whether drug doping should be banned; the rationale of not banning ethically contested innovations such as hypoxic chambers; and the implications of the prospects of human genetic engineering for the notion of sport as a development of ’natural’ talent towards human excellence. The essays demonstrate the significance of the principles of preventing harm, ensuring fairness and preserving meaning to appraise whether a particular performance enhancer is acceptable in the context of sport. Selected essays on various forms of human enhancement outside of sport that highlight other principles and concepts are included for comparative purpose. Sport enhancement provides a useful starting point to work through the ethics of enhancement in other human practices and endeavors, and sport enhancement ethics should track broader bioethical debates on human enhancement. As a whole, the volume points to the need to consider the values and meanings that people seek in a given sphere of human activity and their associated principles to arrive at a morally grounded and reasonable approach to enhancement ethics.