Issues in Biomedical Ethics – serie

Simona Giordano investigates the moral concerns raised by current clinical options available for transgender and gender diverse children and adolescents. From the time young children express gender incongruent preferences and attitudes, up to the time in which older adolescents might apply for medical or surgical treatment, moral questions are likely to be asked: should children be enabled to express themselves freely inside and outside the domestic environment? What are the implications of the choices that parents might make early on? How should clinicians respond to distress around sexual anatomy? Is it ethical to suspend pubertal development? What level of evidence should we seek for medications to be used in paediatric care? What are the risks and benefits of various forms of hormonal treatment? Is it ethical to defer surgical interventions till adulthood? Giordano provides a detailed ethical analysis of these and many other questions that are likely to arise at various stages of a person's life and proposes a moral formula to answer these questions, as well as others, that are likely to arise in a fast-changing landscape. Children and Gender combines a detailed ethical analysis with an accurate clinical description of gender development and available clinical pathways.

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy.

Mary Anne Warren explores a theoretical question which lies at the heart of practical ethics: what are the criteria for having moral status? In other words, what are the criteria for being an entity towards which people have moral obligations? Some philosophers maintain that there is one intrinsic property--for instance, life, sentience, humanity, or moral agency. Others believe that relational properties, such as belonging to a human community, are more important. In Part I of the book, Warren argues that no single property can serve as the sole criterion for moral status; instead, life, sentience, moral agency, and social and biotic relationships are all relevant, each in a different way. She presents seven basic principles, each focusing on a property that can, in combination with others, legitimately affect an agent's moral obligations towards entities of a given type. In Part II, these principles are applied in an examination of three controversial ethical issues: voluntary euthanasia, abortion, and the moral status of animals.

ISSUES IN BIOMEDICAL ETHICS General Editors: John Harris, University of Manchester; Søren Holm, University of Copenhagen. Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London. North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany. The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just healthcare trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the authors lined up for the series. It promises to become the leading channel for the best original work in this burgeoning field. this volume: The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kinds of children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, ovarian tissue transfer, and post-menopausal pregnancy. The central focus of the volume is the interface between reproductive choice and public regulation. 'The Future of Human Reproduction is a roadmap for twenty-first century reproductive technologies written by leading thinkers in the field for philosophers, policy makers, and clinicians. However, it will perhaps be equally useful for parents and other members of our most important social institutions, as we struggle to cope with the rapidly changing reproductive horizon.' Glenn McGee, University of Pennsylvania Center for Bioethics

ISSUES IN BIOMEDICAL ETHICS General Editors: John Harris, University of Manchester; S(ren Holm, University of Copenhagen. Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London. North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany. The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just health care trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the contributors to the series. It promises to become the leading channel for the best original work in this burgeoning field. this book: Lainie Friedman Ross presents an original and controversial examination of the moral principles that guide parents in making health care decisions for their children, and the role of children in the decision-making process. She opposes the current movement to increase child autonomy, in favour of respect for family autonomy. She argues that children should be included in the decision-making process but that parents should be responsible for their children's health care even after the children have achieved some threshold level of competency. The first half of the book presents and defends a model of decision-making for children's health care; the second half shows how it works in various practical contexts, considering children as research subjects and as patients, organ donorship, and issues relating to adolescent sexuality. Implementation of Ross's model would result in significant changes in what informed consent allows and requires for paediatric health care decisions. This is the first systematic medical ethics book that focuses specifically on children's health care. It has important things to say to health care providers who work with children, as well as to ethicists and public policy analysts.

ISSUES IN BIOMEDICAL ETHICS General Editors: John Harris, University of Manchester; S(ren Holm, University of Copenhagen. Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London. North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany. The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just health care trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the contributors to the series. It promises to become the leading channel for the best original work in this burgeoning field. this book: Testing and screening for HIV and AIDS give rise to ethical, legal, and social issues of the most controversial and delicate kind. An international team of eighteen doctors, philosophers, and lawyers present a fresh and thorough discussion of these issues; they aim to show the way to practical advances but also to give an accessible guide to the debates for readers new to them. The contributors pay particular attention to the sensitive nature of the information yielded by a test for HIV antibody. They consider such questions as these: Are we under an obligation to disclose our HIV status if known? Can there be a moral justfication for the breaching of confidentiality in certain circumstances? Should health care professionals be forced to undergo HIV testing? Is there a right to remain in ignorance of one's HIV status? Consideration of such questions illuminates not only public policy and medical practice in connection with HIV and AIDS, but also broader issues about professional ethics and individual rights in other medical and social contexts. The breadth and depth of the research represented and the lucidity of the arguments put forward make this a key resource for academic researchers and healthcare professionals alike.

Mary Anne Warren explores a theoretical question which lies at the heart of practical ethics: what are the criteria for having moral status? In other words, what are the criteria for being an entity towards which people have moral obligations? Some philosophers maintain that there is one intrinsic property--for instance, life, sentience, humanity, or moral agency. Others believe that relational properties, such as belonging to a human community, are more important. In Part I of the book, Warren argues that no single property can serve as the sole criterion for moral status; instead, life, sentience, moral agency, and social and biotic relationships are all relevant, each in a different way. She presents seven basic principles, each focusing on a property that can, in combination with others, legitimately affect an agent's moral obligations towards entities of a given type. In Part II, these principles are applied in an examination of three controversial ethical issues: voluntary euthanasia, abortion

The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kinds of children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, ovarian tissue transfer, and post-menopausal pregnancy. The central focus of the volume is the interface between reproductive choice and public regulation.

Transplantation is a medically successful and cost-effective way to treat people whose organs have failed--but not enough organs are available to meet demand. Ethics and the Acquisition of Organs is concerned with the major ethical problems raised by policies for acquiring organs. The main topics are the rights of the dead, the role of the family, opt in and opt out systems, the conscription of organs, living organ donation from adults and children, directed donation and priority for donors, and the sale of organs.In this ground-breaking work, T. M. Wilkinson uses concepts from moral and political theory such as autonomy, rights, posthumous interests, justice, and well-being, in a context informed by the clinical, legal, and policy aspects of transplantation. The result is a rigorous philosophical exploration of real problems and options. He argues that the ethics of acquiring organs for transplantation is not only of great intellectual interest, but also of practical importance. As such, this book will be of profit not only to students and academics who work in applied ethics and bioethics, but also to the lawyers, policy-makers, clinicians, and lobby groups interested in transplantation.

This volume explores the ethics of making or expanding families through adoption or technologically assisted reproduction. For many people, these methods are separate and distinct: they can choose either adoption or assisted reproduction. But for others, these options blend together. For example, in some jurisdictions, the path of assisted reproduction for same-sex couples is complicated by the need for the partner who is not genetically related to the resulting child to adopt this child if she wants to become the child's legal parent. The essays in this volume critically examine moral choices to pursue adoption, assisted reproduction, or both, and highlight the social norms that can distort decision-making. Among these norms are those that favour people having biologically related children ('bionormativity') or that privilege a traditional understanding of family as a heterosexual unit with one or more children where both parents are the genetic, biological, legal, and social parents of these children. As a whole, the book looks at how adoption and assisted reproduction are morally distinct from one another, but also emphasizes how the two are morally similar. Choosing one, the other, or both of these approaches to family-making can be complex in some respects, but ought to be simple in others, provided that one's main goal is to become a parent.

Lainie Ross presents a rigorous critical investigation of the development of policy governing the involvement of children in medical research. She examines the shift in focus from protection of medical research subjects, enshrined in post-World War II legislation, to the current era in which access is assuming greater precedence. Infamous studies such as Willowbrook (where mentally retarded children were infected with hepatitis) are evidence that before the policy shift protection was not always adequate, even for the most vulnerable groups. Additional safeguards for children were first implemented in many countries in the 1970s and 1980s; more recent policies and guidelines are trying to promote greater participation. Ross considers whether the safeguards work, whether they are fair, and how they apply in actual research practice. She goes on to offer specific recommendations to modify current policies and guidelines. Ross examines the regulatory structures (e.g. federal regulations and institutional review boards), the ad hoc policies (e.g. payment in pediatric research and the role of schools as research venues), the actual practices of researchers (e.g. the race/ethnicity of enrolled research subjects or the decision to enroll newborns) as well as the decision-making process (both parental permission and the child's assent), in order to provide a broad critique. Some of her recommendations will break down current barriers to the enrolment of children (e.g. permitting the payment of child research subjects; allowing healthy children to be exposed to research that entails more than minimal risk without requiring recourse to 407 panels); whereas other recommendations may create new restrictions (e.g., the need for greater protection for research performed in schools; restrictions on what research should be done in the newborn nursery). The goal is to ensure that medical research is done in a way that promotes the health of current and future children without threatening, to use the words of Hans Jonas, 'the erosion of those moral values whose loss . . . would make its most dazzling triumphs not worth having'.

The goals of healthcare and health policy, and the health-related dilemmas facing policy makers, professionals, and citizens are extensively analysed and debated in a range of disciplines including public health, sociology, and applied philosophy. Health and the Good Society is the first full-length work that addresses these debates in a way that cuts across these disciplinary boundaries. Alan Cribb's core argument is that clinical ethics needs to be understood in the context of public health ethics. This entails healthcare ethics embracing 'the social dimension' of health in two overlapping senses: first, the various respects in which health experiences and outcomes are socially determined; and second, the ways in which health-related goods are better understood as social rather then purely individual goods. This broader approach to the ethics of healthcare includes a concern with the social construction of both healthcare goods and the roles, ideals, and obligations of agents; that is to say it focuses upon the 'value field' of health-related action and not only upon the ethics of action within this value field. This groundbreaking book thus seeks to 'open up' the agenda of healthcare ethics both methodologically and substantively: it argues that population-oriented perspectives are central to all healthcare ethics, and that everybody has some share of responsibility for securing health-related goods including the good of greater health equality. One of its major conclusions is that the rather limited tradition of health education policy and practice needs a complete re-think.

Simona Giordano presents the first full philosophical study of ethical issues in the treatment of anorexia and bulimia nervosa. Beginning with a comprehensive analysis of these conditions and an exploration of their complex causes, she then proceeds to address legal and ethical dilemmas such as a patient's refusal of life-saving treatment. Illustrated with many case-studies, Understanding Eating Disorders is an essential tool for anyone working with sufferers of these much misunderstood conditions, and for all those ethicists, lawyers, and medical practitioners engaged with the widely relevant issues they raise.

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 cases from different countries and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles.

The concept of reproductive health promises to play a crucial role in improving women's health and rights around the world. It was internationally endorsed by a United Nations conference in 1994, but remains controversial because of the challenge it presents to conservative agencies: it challenges policies of suppressing public discussion on human sexuality and regulating its private expressions. Reproductive Health and Human Rights is designed to equip healthcare providers and administrators to integrate ethical, legal, and human rights principles in protection and promotion of reproductive health, and to inform lawyers and women's health advocates about aspects of medicine and healthcare systems that affect reproduction.Rebecca Cook, Bernard Dickens, and Mahmoud Fathalla, leading international authorities on reproductive medicine, human rights, medical law, and bioethics, integrate their disciplines to provide an accessible but comprehensive introduction to reproductive and sexual health. They analyse fifteen case-studies of recurrent problems, focusing particularly on resource-poor settings. Approaches to resolution are considered at clinical and health system levels. They also consider kinds of social change that would relieve the underlying conditions of reproductive health dilemmas. Supporting the explanatory chapters and case-studies are extensive resources of epidemiological data, human rights documents, and research materials and websites on reproductive and sexual health. In explaining ethics, law, and human rights to healthcare providers and administrators, and reproductive health to lawyers and women's health advocates, the authors explore and illustrate limitations and dysfunctions of prevailing health systems and their legal regulation, but also propose opportunities for reform. They draw on the values and principles of ethics and human rights recognized in national and international legal systems, to guide healthcare providers and administrators, lawyers, governments, and national and international agencies and legal tribunals. Reproductive Health and Human Rights will be an invaluable resource for all those working to improve services and legal protection for women around the world. Updates to this book, and information on translations to French, Spanish, Portuguese, Chinese and Arabic are now available at www.law.utoronto.ca/faculty/cook/ReproductiveHealth.html

The goals of healthcare and health policy, and the health-related dilemmas facing policy makers, professionals, and citizens are extensively analysed and debated in a range of disciplines including public health, sociology, and applied philosophy. Health and the Good Society is the first full-length work that addresses these debates in a way that cuts across these disciplinary boundaries. Alan Cribb's core argument is that clinical ethics needs to be understood in the context of public health ethics. This entails healthcare ethics embracing 'the social dimension' of health in two overlapping senses: first, the various respects in which health experiences and outcomes are socially determined; and second, the ways in which health-related goods are better understood as social rather then purely individual goods. This broader approach to the Cthics of healthcare includes a concern with the social construction of both healthcare goods and the roles, ideals, and obligations of agents; that is to say it focuses upon the 'value field' of health-related action and not only upon the ethics of action within this value field. This groundbreaking book thus seeks to 'open up' the agenda of healthcare ethics both methodologically and substantively: it argues that population-oriented perspectives are central to all healthcare ethics, and that everybody has some share of responsibility for securing health-related goods including the good of greater health equality. One of its major conclusions is that the rather limited tradition of health education policy and practice needs a complete re-think.

The series:General Editors: John Harris, University of Manchester; Soren Holm, University of Manchester.Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London.North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany.The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just health care trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the contributors to the series. It promises to become the leading channel for the best original work in this burgeoning field. This book:Testing and screening for HIV and AIDS give rise to ethical, legal, and social issues of the most controversial and delicate kind. An international team of eighteen doctors, philosophers, and lawyers present a fresh and thorough discussion of these issues; they aim to show the way to practical advances but also to give an accessible guide to the debates for readers new to them. The contributors pay particular attention to the sensitive nature of the information yielded by a test for HIV antibody. They consider such questions as these: Are we under an obligation to disclose our HIV status if known? Can there be a moral justification for the breaching of confidentiality in certain circumstances? Should health care professionals be forced to undergo HIV testing? Is there a right to remain in ignorance of one's HIV status? Consideration of such questions illuminates not only public policy and medical practice in connection with HIV and AIDS, but also broader issues about professional ethics and individual rights in other medical and social contexts. The breadth and depth of the research represented and the lucidity of the arguments put forward make this a key resource for academic researchers and healthcare professionals alike.

ISSUES IN BIOMEDICAL ETHICSGeneral Editors: John Harris, University of Manchester; Soren Holm, University of Manchester.Consulting Editor: Ranaan Gillon, Director, Imperial College Health Service, London.North American Consulting Editor: Bonnie Steinbock, Professor of Philosophy, SUNY, Albany.The late twentieth century has witnessed dramatic technological developments in biomedical science and the delivery of health care, and these developments have brought with them important social changes. All too often ethical analysis has lagged behind these changes. The purpose of this series is to provide lively, up-to-date, and authoritative studies for the increasingly large and diverse readership concerned with issues in biomedical ethics--not just health care trainees and professionals, but also social scientists, philosophers, lawyers, social workers, and legislators. The series will feature both single-author and multi-author books, short and accessible enough to be widely read, each of them focused on an issue of outstanding current importance and interest. Philosophers, doctors, and lawyers from several countries already feature among the contributors to the series. It promises to become the leading channel for the best original work in this burgeoning field. this book: Lainie Friedman Ross presents an original and controversial examination of the moral principles that guide parents in making health care decisions for their children, and the role of children in the decision-making process. She opposes the current movement to increase child autonomy, in favour of respect for family autonomy. She argues that children should be included in the decision-making process but that parents should be responsible for their children's health care even after the children have achieved some threshold level of competency.The first half of the book presents and defends a model of decision-making for children's health care; the second half shows how it works in various practical contexts, considering children as research subjects and as patients, organ donorship, and issues relating to adolescent sexuality. Implementation of Ross's model would result in significant changes in what informed consent allows and requires for paediatric health care decisions.This is the first systematic medical ethics book that focuses specifically on children's health care. It has important things to say to health care providers who work with children, as well as to ethicists and public policy analysts.

Simona Giordano presents the first full philosophical study of ethical issues in the treatment of anorexia and bulimia nervosa. Beginning with a comprehensive analysis of these conditions and an exploration of their complex causes, she then proceeds to address legal and ethical dilemmas such as a patient's refusal of life-saving treatment. Illustrated with many case-studies, Understanding Eating Disorders is an essential tool for anyone working with sufferers of these much misunderstood conditions, and for all those ethicists, lawyers, and medical practitioners engaged with the widely relevant issues they raise.

Lainie Ross presents a rigorous critical investigation of the development of policy governing the involvement of children in medical research. She examines the shift in focus from protection of medical research subjects, enshrined in post-World War II legislation, to the current era in which access is assuming greater precedence. Infamous studies such as Willowbrook (where mentally retarded children were infected with hepatitis) are evidence that before the policy shift protection was not always adequate, even for the most vulnerable groups. Additional safeguards for children were first implemented in many countries in the 1970s and 1980s; more recent policies and guidelines are trying to promote greater participation. Ross considers whether the safeguards work, whether they are fair, and how they apply in actual research practice. She goes on to offer specific recommendations to modify current policies and guidelines. Ross examines the regulatory structures (e.g. federal regulations and institutional review boards), the ad hoc policies (e.g. payment in pediatric research and the role of schools as research venues), the actual practices of researchers (e.g. the race/ethnicity of enrolled research subjects or the decision to enroll newborns) as well as the decision-making process (both parental permission and the child's assent), in order to provide a broad critique. Some of her recommendations will break down current barriers to the enrolment of children (e.g. permitting the payment of child research subjects; allowing healthy children to be exposed to research that entails more than minimal risk without requiring recourse to 407 panels); whereas other recommendations may create new restrictions (e.g., the need for greater protection for research performed in schools; restrictions on what research should be done in the newborn nursery). The goal is to ensure that medical research is done in a way that promotes the health of current and future children without threatening, to use the words of Hans Jonas, 'the erosion of those moral values whose loss . . . would make its most dazzling triumphs not worth having'.

To what extent should parents be allowed to use reproductive technologies to determine the characteristics of their future children? And is there something morally wrong with parents who wish to do this? Choosing Tomorrow's Children provides answers to these (and related) questions. In particular, the book looks at issues raised by selective reproduction, the practice of choosing between different possible future persons by selecting or deselecting (for example) embryos, eggs, and sperm. Wilkinson offers answers to questions including the following. Do children have a 'right to an open future' and, if they do, what moral constraints does this place upon selective reproduction? Should parents be allowed to choose their future children's sex? Should we 'screen out' as much disease and disability as possible before birth, or would that be an objectionable form of eugenics? Is it acceptable to create or select a future person in order to provide lifesaving tissue for an existing relative? Is there a moral difference between selecting to avoid disease and selecting to produce an 'enhanced' child? Should we allow deaf parents to use reproductive technologies to ensure that they have a deaf child?

Public health is an important and fast-developing area of ethical discussion. In this volume a range of issues in public health ethics are explored using the resources of moral theory, political philosophy, philosophy of science, applied ethics, law, and economics.The twelve original papers presented consider numerous ethical issues arise within public health ethics. To what extent can the public good or the public interest justify state interventions that impose limits upon the freedom of individuals? What role should the law play in regulating risks? Should governments actively aim to change our preferences about such things as food, smoking or physical exercise? What are public goods, and what role (if any) do they play in public health? To what extent do individuals have moral obligations to contribute to protecting the community or the public good? Where is it appropriate to concentrate upon prevention rather than cure? Given the fact that we cannot be protected from all harm, what sorts of harm provide a justification for public health action? What limits do we wish to place upon public health activities? How do we ensure that the interests of individuals are not set aside or forgotten in the pursuit of population benefits? An excellent line-up of authors from North America, Europe, and the UK tackle these questions.

Medical care and biomedical research are rapidly becoming global. Ethical questions that once arose only in the narrow context of the physician-patient relationship in relatively prosperous societies are now being raised across societies, cultures, and continents. For example, what should be the "standard of care" for clinical trials of medical innovations in poorer countries? Are researchers obligated to compare new therapies or drugs with the best known ones available, or can they use as a benchmark the actual treatments (or lack of treatments) available to poor people? Should pharmaceutical companies seeking to lower the costs of new drug trials be allowed to enrol citizens of less developed countries in them even when those individuals cannot afford and will not be eligible for the resulting drugs? More generally, should the norms of medicine and research be the same across cultures or can they adapt to local social, economic, or religious conditions? Global Bioethics gathers some of the world's leading bioethicists to explore many of the new questions raised by the globalization of medical care and biomedical research. Among the topics covered are the impact of globalization on the norms of medical ethics, the conduct of international research, the ethics of international collaborations, challenges to medical professionalism in the international setting, and the relation of religion to global bioethics.

Embryonic stem cell research holds unique promise for developing therapies for currently incurable diseases and conditions, and for important biomedical research. However, the process through which embryonic stem cells are obtained involves the destruction of early human embryos. Katrien Devolder focuses on the tension between the popular view that an embryo should never be deliberately harmed or destroyed, and the view that embryonic stem cell research, because of its enormous promise, must go forward. She provides an in-depth ethical analysis of the major philosophical and political attempts to resolve this tension. One such attempt involves the development of a middle ground position, which accepts only types or aspects of embryonic stem cell research deemed compatible with the view that the embryo has a significant moral status. An example is the position that it can be permissible to derive stem cells from embryos left over from in vitro fertilisation but not from embryos created for research. Others have advocated a technical solution. Several techniques have been proposed for deriving embryonic stem cells, or their functional equivalents, without harming embryos. An example is the induced pluripotent stem cell technique. Through highlighting inconsistencies in the arguments for these positions, Devolder argues that the central tension in the embryonic stem cell debate remains unresolved. This conclusion has important implications for the stem cell debate, as well as for policies inspired by this debate.

Public health is an important and fast-developing area of ethical discussion. In this volume a range of issues in public health ethics are explored using the resources of moral theory, political philosophy, philosophy of science, applied ethics, law, and economics. The twelve original papers presented consider numerous ethical issues arise within public health ethics. To what extent can the public good or the public interest justify state interventions that impose limits upon the freedom of individuals? What role should the law play in regulating risks? Should governments actively aim to change our preferences about such things as food, smoking or physical exercise? What are public goods, and what role (if any) do they play in public health? To what extent do individuals have moral obligations to contribute to protecting the community or the public good? Where is it appropriate to concentrate upon prevention rather than cure? Given the fact that we cannot be protected from all harm, what sorts of harm provide a justification for public health action? What limits do we wish to place upon public health activities? How do we ensure that the interests of individuals are not set aside or forgotten in the pursuit of population benefits? An excellent line-up of authors from North America, Europe, and the UK tackle these questions.

This is the first book in bioethics that explains how it is that you actually go about doing good bioethics. Bioethics has made a mistake about its methods, and this has led not only to too much theorizing, but also fragmentation within bioethics. The unhelpful disputes between those who think bioethics needs to be more philosophical, more sociological, more clinical, or more empirical, continue. While each of these claims will have some point, they obscure what should be common to all instances of bioethics. Moreover, they provide another phantom that can lead newcomers to bioethics down blind alleyways stalked by bristling sociologists and philosophers. The method common to all bioethics is bringing moral reason to bear upon ethical issues, and it is more accurate and productive to clarify what this involves than to stake out a methodological patch that shows why one discipline is the most important. This book develops an account of the nature of bioethics and then explains how a number of methodological spectres have obstructed bioethics becoming what it should. In the final part, it explains how moral reason can be brought to bear upon practical issues via an 'empirical, Socratic' approach.

Transplantation is a medically successful and cost-effective way to treat people whose organs have failed--but not enough organs are available to meet demand. Ethics and the Acquisition of Organs is concerned with the major ethical problems raised by policies for acquiring organs. The main topics are the rights of the dead, the role of the family, opt in and opt out systems, the conscription of organs, living organ donation from adults and children, directed donation and priority for donors, and the sale of organs. In this ground-breaking work, T. M. Wilkinson uses concepts from moral and political theory such as autonomy, rights, posthumous interests, justice, and well-being, in a context informed by the clinical, legal, and policy aspects of transplantation. The result is a rigorous philosophical exploration of real problems and options. He argues that the ethics of acquiring organs for transplantation is not only of great intellectual interest, but also of practical importance. As such, this book will be of profit not only to students and academics who work in applied ethics and bioethics, but also to the lawyers, policy-makers, clinicians, and lobby groups interested in transplantation.

To what extent should parents be allowed to use reproductive technologies to determine the characteristics of their future children? And is there something morally wrong with parents who wish to do this? Choosing Tomorrow's Children provides answers to these (and related) questions. In particular, the book looks at issues raised by selective reproduction, the practice of choosing between different possible future persons by selecting or deselecting (for example) embryos, eggs, and sperm. Wilkinson offers answers to questions including the following. Do children have a 'right to an open future' and, if they do, what moral constraints does this place upon selective reproduction? Should parents be allowed to choose their future children's sex? Should we 'screen out' as much disease and disability as possible before birth, or would that be an objectionable form of eugenics? Is it acceptable to create or select a future person in order to provide lifesaving tissue for an existing relative? Is there a moral difference between selecting to avoid disease and selecting to produce an 'enhanced' child? Should we allow deaf parents to use reproductive technologies to ensure that they have a deaf child?