This debate-style reader is designed to introduce students to controversies in bioethics. The "yes" and "no" readings, which represent the arguments of leading philosophers and social commentators, discuss topics such as death and dying; choices in reproduction; children and bioethics and genetics. Adopters can use the student Web site Dushkin Online for study support and to find related Web sites.

Table of Contents:
PART 1. Medical Decision Making ISSUE 1. Is Informed Consent Still Central to Medical Ethics? YES: Robert M. Arnold and Charles W. Lidz, from "Informed Consent: Clinical Aspects of Consent in Health Care," in Warren T. Reich, ed., Encyclopedia of Bioethics, vol. 3, rev. ed. (Simon & Schuster, 1995) NO: Robert M. Veatch, from "Abandoning Informed Consent," Hastings Center Report (March--April 1995) Physician Robert M. Arnold and professor of psychiatry and sociology Charles W. Lidz assert that informed consent in clinical care is an essential process that promotes good communication and patient autonomy despite the obstacles of implementation. Professor of medical ethics Robert M. Veatch argues that informed consent is a transitional concept that is useful only for moving toward a more radical framework in which physicians and patients are paired on the basis of shared deep social, moral, and institutional values. ISSUE 2. Can Family Interests Ethically Outweigh Patient Autonomy? YES: John Hardwig, from "What About the Family?" Hastings Center Report (March--April 1990) NO: Jeffrey Blustein, from "The Family in Medical Decisionmaking," Hastings Center Report (May--June 1993) John Hardwig, an associate professor of medical ethics, argues that the prevalent ethic of patient autonomy ignores family interests in medical treatment decisions. He maintains that physicians should recognize these interests as legitimate. Bioethicist Jeffrey Blustein contends that although families can be an important resource in helping patients make better decisions about their care, the ultimate decision-making authority should remain with the patient. ISSUE 3. Does Direct-to-Consumer Advertising of Medication Enhance Patient Autonomy? YES: Alan F. Holmer, from "Direct-to-Consumer Prescription Drug Advertising Builds Bridges Between Patients and Physicians," Journal of the American Medical Association (January 27, 1999) NO: Matthew F. Hollon, from "Direct-to-Consumer Marketing of Prescription Drugs," Journal of the American Medical Association (January 27, 1999) Alan F. Holmer, an attorney and head of the Pharmaceutical Research and Manufacturers of America, argues that advertising of medication empowers consumers by educating them about health conditions and possible treatments. Matthew F. Hollon, a physician, believes that advertising of medication is designed to increase consumer demand, rather than for educational purposes, and has little public health value. PART 2. Death and Dying ISSUE 4. Are Some Advance Directives Too Risky for Patients? YES: Christopher James Ryan, from "Betting Your Life: An Argument Against Certain Advance Directives," Journal of Medical Ethics (vol. 22, 1996) NO: Steven Luttrell and Ann Sommerville, from "Limiting Risks by Curtailing Rights: A Response to Dr. Ryan," Journal of Medical Ethics (vol. 22, 1996) Psychiatrist Christopher James Ryan argues that advance directives that refuse active treatment in situations when a patient's incompetence is potentially reversible should be abolished because healthy people are likely to underestimate their desire for treatment should they become ill. Geriatricians Steven Luttrell and Ann Sommerville assert that respect for the principle of autonomy requires that individuals be permitted to make risky choices about their own lives and that ignoring autonomous choices made by competent adults reinstates the outmoded notion of medical paternalism. ISSUE 5. Should Physicians Be Allowed to Assist in Patient Suicide? YES: Marcia Angell, from "The Supreme Court and Physician-Assisted Suicide The Ultimate Right," The New England Journal of Medicine (January 2, 1997) NO: Kathleen M. Foley, from "Competent Care for the Dying Instead of Physician-Assisted Suicide," The New England Journal of Medicine (January 2, 1997) Physician Marcia Angell asserts that a physician's main duties are to respect patient autonomy and to relieve suffering, even if that sometimes means assisting in a patient's death. Physician Kathleen M. Foley counters that if physician-assisted suicide becomes legal, it will begin to substitute for interventions that otherwise might enhance the quality of life for dying patients. ISSUE 6. Should Truth-Telling Depend on the Patient's Culture? YES: Leslie J. Blackhall, Gelya Frank, Sheila Murphy, and Vicki Michel, from "Bioethics in a Different Tongue: The Case of Truth-Telling," Journal of Urban Health (March 2001) NO: Mark Kuczewski and Patrick J. McCruden, from "Informed Consent: Does It Take a Village? The Problem of Culture and Truth Telling," Cambridge Quarterly of Healthcare Ethics (2001) Leslie J. Blackhall, Gelya Frank, and Sheila Murphy, from the University of Southern California, and Vicki Michel from the Loyola Law School, advise clinical and bioethics professionals facing truth-telling dilemmas to make room for the diverse ethical views of the populations they serve. Philosopher Mark Kuczewski and bioethicist Patrick J. McCruden argue that by insisting on informed consent or an appropriate waiver process, the health care system respects cultural differences rather than stereotyping them. ISSUE 7. Should Doctors Be Able to Refuse Demands for "Futile" Treatment? YES: Steven H. Miles, from "Informed Demand for 'Non-Beneficial' Medical Treatment," The New England Journal of Medicine (August 15, 1991) NO: Felicia Ackerman, from "The Significance of a Wish," Hastings Center Report (July--August 1991) Physician Steven H. Miles maintains that physicians' duty to follow patients' wishes ends when the requests are inconsistent with what medical care can reasonably be expected to achieve, when they violate community standards of care, and when they consume an unfair share of collective resources. Philosopher Felicia Ackerman contends that it is ethically inappropriate for physicians to decide what kind of life is worth prolonging and that decisions involving personal values should be made by the patient or family. PART 3. Choices in Reproduction ISSUE 8. Should Abortions Late in Pregnancy Be Banned? YES: M. LeRoy Sprang and Mark G. Neerhof, from "Rationale for Banning Abortions Late in Pregnancy," Journal of the American Medical Association (August 26, 1998) NO: David A. Grimes, from "The Continuing Need for Late Abortions," Journal of the American Medical Association (August 26, 1998) Physician M. LeRoy Sprang and osteopathic physician Mark G. Neerhof assert that late-term abortion is needlessly risky, inhumane, and ethically unacceptable. They state that all abortions of 23 weeks or later should be considered unethical unless the fetus has a lethal condition or the mother's life is endangered. While acknowledging that early abortion is safer, simpler, and less controversial, physician David A. Grimes contends that late-term abortion is fundamentally important to women's health because some medical conditions of both women and fetuses cannot be diagnosed early in pregnancy and because of the prevalence of incest and rape. ISSUE 9. Should Pregnant Women Be Punished for Exposing Fetuses to Risk? YES: Jean Toal, from Majority Opinion, Cornelia Whitner, Respondent, v. State of South Carolina, Petitioner (July 15, 1997) NO: Lynn M. Paltrow, from "Punishment and Prejudice: Judging Drug-Using Pregnant Women," in Julia E. Hanigsberg and Sara Ruddick, eds., Mother Troubles: Rethinking Contemporary Maternal Dilemmas (Beacon Press, 1999) In a case involving a pregnant woman's use of crack cocaine, a majority of the Supreme Court of South Carolina ruled that a state legislature may impose additional criminal penalties on pregnant drug-using women without violating their constitutional right of privacy. Attorney Lynn M. Paltrow argues that treating drug-using pregnant women as criminals targets poor, African American women while ignoring other drug usage and fails to provide the resources to assist them in recovery. PART 4. Children and Bioethics ISSUE 10. Should Adolescents Make Their Own Life-and-Death Decisions? YES: Robert F. Weir and Charles Peters, from "Affirming the Decisions Adolescents Make About Life and Death," Hastings Center Report (November--December 1997) NO: Lainie Friedman Ross, from "Health Care Decisionmaking by Children: Is It in Their Best Interest?" Hastings Center Report (November--December 1997) Ethicist Robert F. Weir and pediatrician Charles Peters assert that adolescents with normal cognitive and developmental skills have the capacity to make decisions about their own health care. Advance directives, if used appropriately, can give older pediatric patients a voice in their care. Pediatrician Lainie Friedman Ross counters that parents should be responsible for making their child's health care decisions. Children need to develop virtues, such as self-control, that will enhance their long-term, not just immediate, autonomy. ISSUE 11. Do Parents Harm Their Children When They Refuse Medical Treatment on Religious Grounds? YES: American Academy of Pediatrics, from "Religious Objections to Medical Care," Pediatrics (February 1997) NO: Mark Sheldon, from "Ethical Issues in the Forced Transfusion of Jehovah's Witness Children," The Journal of Emergency Medicine (vol. 14, no. 2, 1996) The Committee on Bioethics of the American Academy of Pediatrics states that all children deserve medical treatment that is likely to prevent substantial harm, suffering, or death, regardless of the parents' religious objections to treatment. Professor of philosophy Mark Sheldon assesses the case of Jehovah's Witness parents who refuse to allow their children to undergo blood transfusions and concludes that they cannot be said to be truly harming or neglecting their children. Rather, they are placing their children's spiritual interests above worldly ones. PART 5. Genetics ISSUE 12. Should Human Stem Cell Research Be Banned? YES: Robert P. George, from "Don't Destroy Human Life," The Wall Street Journal (July 30, 2001) NO: David Baltimore, from "Don't Impede Medical Progress," The Wall Street Journal (July 30, 2001) Robert P. George, a professor of jurisprudence at Princeton University, argues that harvesting stem cells from discarded embryos is equivalent to killing a human being, and therefore the practice should be banned. David Baltimore, president of the California Institute of Technology and a Nobel Prize winner for his career research, contends that promising stem cell research should not be impeded by a view that considers a tiny mass of cells that has never been in a uterus to be a human being. ISSUE 13. Should Information From Genetic Testing Be Available to Employers and Insurers? YES: Andrew Sullivan, from "Promotion of the Fittest," The New York Times Magazine (July 23, 2000) NO: Thomas H. Murray, from "Genetics and the Moral Mission of Health Insurance," Hastings Center Report (November--December 1992) Columnist Andrew Sullivan sees no ethical difference between using genetic information to predict future workplace performance and using other means to do so. Sullivan argues that genetic information is more reliable and less discriminatory than other types of information. Thomas H. Murray, a professor of biomedical ethics, contends that actuarial fairness the insurance industry's standard fails to accomplish the social goals of health insurance and that genetic tests should not be used to deny people access to health insurance. PART 6. Human and Animal Experimentation ISSUE 14. Should Animal Experimentation Be Permitted? YES: Jerod M. Loeb et al., from "Human vs. Animal Rights: In Defense of Animal Research," Journal of the American Medical Association (November 17, 1989) NO: Tom Regan, from "Ill-Gotten Gains," in Donald Van DeVeer and Tom Regan, eds., Health Care Ethics: An Introduction (Temple University Press, 1987) Jerod M. Loeb and his colleagues, representing the American Medical Association's Group on Science and Technology, assert that concern for animals, admirable in itself, cannot impede the development of methods to improve the welfare of humans. Philosopher Tom Regan argues that conducting research on animals exacts the grave moral price of failing to show proper respect for animals' inherent value, whatever the benefits of the research. ISSUE 15. Is Sham Surgery Ethically Acceptable in Clinical Research? YES: Thomas B. Freeman et al., from "Use of Placebo Surgery in Controlled Trials of a Cellular-Based Therapy for Parkinson's Disease," The New England Journal of Medicine (September 23, 1999) NO: Ruth Macklin, from "The Ethical Problems With Sham Surgery in Clinical Research," The New England Journal of Medicine (September 23, 1999) Physician Thomas B. Freeman and his colleagues contend that their study of fetal-tissue transplantation, which used imitation, or sham, surgery in one group of patients, will establish whether this treatment is beneficial or not. Furthermore, this treatment will benefit thousands of patients with Parkinson's disease if proven effective. Philosopher Ruth Macklin concludes that sham surgery is ethically unacceptable, particularly in the case of fetal-tissue transplantation, because it does not minimize harm to subjects, a fundamental principle underlying research ethics. PART 7. Bioethics and Public Policy ISSUE 16. Should Health Insurance Be Based on Employment? YES: William S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV, from "Why We Should Keep the Employment-Based Health Insurance System," Health Affairs (November/December 1999) NO: Uwe E. Reinhardt, from "Employer-Based Health Insurance: A Balance Sheet," Health Affairs (November/December 1999) Insurance and policy analysts William S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV assert that the employment-based health care system in the United States offers a solid, proven foundation on which to base any reform and that attempts to break the link between employment and health insurance coverage may greatly increase the number of uninsured Americans. Economist Uwe E. Reinhardt argues that, on balance, the debits of the employer-based health insurance system outweigh the credits and that a parallel system detached from the workplace could eventually absorb the current system. ISSUE 17. Should Health Care for the Elderly Be Limited? YES: Daniel Callahan, from "Limiting Health Care for the Old?" The Nation (August 15, 1987) NO: Amitai Etzioni, from "Spare the Old, Save the Young," The Nation (June 11, 1988) Philosopher Daniel Callahan maintains that since health care resources are scarce, people who have lived a full natural life span should be offered care that relieves suffering but not expensive life-prolonging technologies. Sociologist Amitai Etzioni argues that rationing health care for the elderly would encourage conflict between generations and would invite restrictions on health care for other groups. ISSUE 18. Should Patient-Centered Medical Ethics Govern Managed Care? YES: Norman G. Levinsky, from "Truth or Consequences," The New England Journal of Medicine (March 26, 1998) NO: Brendan Minogue, from "The Two Fundamental Duties of the Physician," Academic Medicine (May 2000) Physician Norman G. Levinsky argues that withholding beneficial care from patients for the financial benefit of any party other than the patient is a violation of medical ethics. Philosopher Brendan Minogue asserts that physicians must balance the interests and wishes of the patient with the welfare of the health care system in which they practice and must stop viewing the case manager as the unavoidable but unwanted child within the family of medicine. ISSUE 19. Should There Be Payment for Body Parts? YES: Michael B. Gill and Robert M. Sade, from "Paying for Kidneys: The Case Against Prohibition," Kennedy Institute of Ethics Journal (March 2002) NO: David J. Rothman, from "The International Organ Traffic," The New York Review of Books (March 26, 1998) Philosopher Michael B. Gill and surgeon Robert M. Sade contend that the current ban on paying for kidneys ought to be overturned because there is no significant moral difference between the allowable policy of paying for blood and tissues and paying for kidneys and because the arguments that payment is intrinsically wrong or exploitive are flawed. Historian David J. Rothman asserts that trafficking in organs for transplantation is motivated by greed and subverts the ethical principles of the medical profession. ISSUE 20. Should Doctors-in-Training Be Unionized? YES: Andrew C. Yacht, from "Collective Bargaining Is the Right Step," The New England Journal of Medicine (February 10, 2000) NO: Jordan J. Cohen, from "White Coats Should Not Have Union Labels," The New England Journal of Medicine (February 10, 2000) Physician Andrew C. Yacht argues that doctors-in-training, like other workers, should have the right to organize and to bargain collectively for better working conditions in hospitals so that they can provide enhanced care for their patients. Physician and medical educator Jordan J. Cohen asserts that doctors-in-training are primarily students, not employees, and that union activities would negatively affect the educational experience. ISSUE 21. Should Public Health Be Given Sweeping Powers Over Individual Liberty in a Bioterrorist Threat? YES: Lawrence O. Gostin, from "Law and Ethics in a Public Health Emergency," Hastings Center Report (March--April 2002) NO: George J. Annas, from "Bioterrorism, Public Health, and Human Rights," Health Affairs (November/December 2002) Law and public health professor Lawrence O. Gostin states that the threat of bioterrorism makes it imperative to reframe the balance between individual interests and society's need to protect itself so that the common good prevails. Law professor George J. Annas contends that taking human rights seriously is our best defense against terrorism and fosters public health on both a federal and global scale.