bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Reform and the Safety Net: Big Opportunities; Major Risks
Authors: Siegel Bruce , Regenstein Marsha , Shin Peter
Published: January 2007

Millions of Americans are dependent on what is often called the “safety net.” These loosely-organized networks of health and social service providers serve the many Americans who are uninsured, dependent on public coverage, or for a variety of reasons unable to access other private systems of care. The Institute of Medicine (IOM) report, America’s Health Care Safety Net: Intact but Endangered, called attention to both the fragility and the resilience of this health care safety net. The IOM report underscored the critical importance of the safety net to the health and well-being of millions of individuals and called for efforts to strengthen it and improve the nation’s ability to monitor its viability. Given this central role, any health care reform efforts need to be fully informed by an understanding of what the safety net includes, how it is financed, and how it is responding to a series of challenges it now faces.
Why Can’t We Do What They Do? National Health Reform Abroad
Authors: Jost Timothy Stoltzfus
Published: January 2007

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.

At the same time, the U.S. spends more on health care - both per capita and as percentage of gross domestic product (GDP) - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations.
Where Do We Go from Here: Is There Any Hope for Real Health Care Reform?
Authors: Southby Richard F.
Published: January 2007

As indicated in the title, the focus of this essay is on where we should go from here and not the how, which is addressed by other authors in this issue. I am assuming that there is probably a general consensus as to where we should be heading with health care reform, but there may well be some strong differences as to how this can or should be attained.

In the summer of 1966, a year after the enactment of “Medicare,” I listened to Harry Becker, then the Executive Director of the New York Academy of Medicine, discuss the significance of the new health legislation and further changes that were likely in the near future. His analysis was that, after numerous attempts over many years, the United States was finally on the verge of implementing universal health insurance for all Americans. The next step would be health insurance for children, “Kiddicare.”
Numbers Matter: A Guide to Cost and Coverage Estimates in Health Reform Debates
Authors: Lambrew Jeanne M.
Published: January 2007

Health reform proposals tend to be rich with details and dimensions. The primary goal of health reform is typically to extend health coverage to people who lack it. Yet even the most similar of plans differ in terms of exactly who is targeted for assistance, the means by which assistance is delivered, and the type of health coverage promoted. Moreover, the Byzantine nature of the existing U.S. health system means that any reform plan can appear complex. The plan that aims for a new, simple health system will require radical changes to achieve it, while the plan that strives to be the least disruptive will have extensive rules that target assistance while maintaining the existing sources of coverage. Indeed, some have argued that the complexity inherent in meaningful reform is an impediment to reform itself.
In the Shadow of 9/11: Health Care Reform in the 2004 Presidential Election
Authors: Jacobs Lawrence R. , Illuzzi Michael
Published: January 2007

Health care reform is an important issue in the 2004 presidential elections and is receiving serious attention from the Democratic and Republican candidates. Changes in the economy that fuelled increased productivity and depressed job growth have also shifted more of the costs of medical care and insurance onto employees. The rising costs of insurance premiums and health care are far outpacing the general inflation rate and workers’ wages. Meanwhile, state governments reacted to widening budget deficits from 2001 to 2003 by reducing Medicaid eligibility and benefits. These changes in employer-based health insurance and government policy have contributed to the largest rise in the share of Americans without health insurance in a decade. In 2002, the uninsured numbered 43.6 million and, according to the Congressional Budget Office, 57 to 59 million non-elderly people are uninsured at some point over the course of a year.
Crowd-Out and the Politics of Health Reform
Authors: Feder Judith
Published: January 2007

Critics of the gaps in our nation’s health insurance decry the absence of a health insurance “system” and the resulting “patchwork” of private and public insurance that leaves so many Americans unprotected. There is no question that these gaps are unconscionable; but they are also no accident. They are the result of policy and political choices with substantial consequences for those who remain uncovered. In my view, (based on experience as well as the excellent scholarship of others) the fundamental political barrier to universal coverage is that our success in insuring most of the nation’s population has “crowded out” our political capacity to insure the rest. This paper will explain how we arrived at the mix of private and public insurance we now have, how that mix impedes efforts to achieve universal coverage, and how “crowd-out” affects strategy for improving coverage in the future.
Litigation in Clinical Research: Malpractice Doctrines versus Research Realities
Authors: Morreim E. Haavi
Published: January 2007

Human clinical research trials, by which corporations, universities, and research scientists bring new drugs, devices, and procedures into the practice and marketplace of medicine, have become a huge business. The National Institutes of Health (NIH) doubled its spending over the past five years, while in the private sector the top twenty pharmaceutical companies have more than doubled their investment in research and development over a roughly comparable period. To date, some twenty million Americans have participated in clinical research trials that now are as common in the private practice setting as in academia.

For many years human clinical trials received relatively little public attention. In the wake of several well-publicized research abuses, Congress created in 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to formulate recommendations to protect human research subjects. The Commission’s 1979 Belmont Report helped to guide the Institutional Review Boards (IRBs) that review the ethics of federally funded research.
Conserving Scarce Resources: Willingness of Health Insurance Enrollees to Choose Cheaper Options
Authors: Hurst Samia A. , Teagarden J. Russell , Garrett Elizabeth , Emanuel Ezekiel J.
Published: January 2007

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits.
Governing the Globalization of Public Health
Authors: Taylor Allyn L.
Published: January 2007

The number and the scale of transboundary public health concerns are increasing. Infectious and non-communicable diseases, international trade in tobacco, alcohol, and other dangerous products as well as the control of the safety of health services, pharmaceuticals, and food are merely a few examples of contemporary transnationalization of health concerns. The rapid development and diffusion of scientific and technological developments across national borders are creating new realms of international health concern, such as aspects of biomedical science, including human reproductive cloning, germ-line therapy, and xenotransplantation, as well as environmental health problems, including climate change, biodiversity loss, and depletion of the ozone layer. Growth in international trade and travel, in combination with population growth, has served to increase the frequency and intensity of health concerns bypassing or spilling over sovereign boundaries.

Although health has traditionally been seen an area of limited multilateral cooperation, there is growing awareness that contemporary globalization has led to the proliferation of cross border determinants of health status and is undermining the capacity of nation states to protect health through domestic action alone.
Tobacco Control Legislation: Tools for Public Health Improvement
Authors: Hodge James G. , Eber Gabriel B.
Published: January 2007

Government’s responsibility to safeguard the public’s health through law has been part of the social contract since ancient times. Cicero declaredsalus populi suprema lex esto- “the safety of the people is the supreme law”. Disraeli proclaimed that protecting the public’s health is the first duty of the statesman. Of the ten most important public health achievements of the 20th century in the US., seven are directly related to legal interventions, including legislative interventions. As new and existing risks to health risks emerge internationally, governments have consistently used the law as a tool to define the goals of public health, direct public health authorities to accomplish these goals, and equip them with the power and resources to do so.

Tobacco control represents a salient example of how law can be used to ensure health. Like other public health laws, tobacco control laws have historic grounds. Government and other policymakers have enacted laws to control tobacco use for hundreds of years. The Russian church forbade tobacco use as an “abomination.”
Evolutionary Ethics, Aggression, and Violence: Lessons from Primate Research
Authors: de Waal Frans B. M.
Published: January 2007

This paper is unusual for this journal because most readers do not deal professionally with animals. Information from primatology, however, is relevant to consideration of violence between people. I will focus mainly on aggression and peacemaking among nonhuman primates, but will address related topics as well. I do not use the term “aggression” to refer only to violent behavior, but to any overt conflict between individuals. Although I am a professor of psychology, I am a biologist by training. When I was a student many years ago, the major scholarly work on this topic was Konrad Lorenz’s On Aggression. It set into motion contemporary research on aggression from a biological perspective by making the controversial claim that aggression is an instinct not only in animals, but also in human beings. My own research and that of others suggests a slightly different view, namely, that aggression between individuals is a last resort when conflict resolution fails.
Is There Value in Identifying Individual Genetic Predispositions to Violence?
Authors: Wasserman David
Published: January 2007

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success.
Firearms, Violence, and the Potential Impact of Firearms Control
Authors: Zimring Franklin E.
Published: January 2007

This paper organizes the question of gun controls as violence policy under two quite different headings. The first issue to be discussed is the relationship between gun use and the death rate from violent crime. The second question is whether and how firearms control strategies might reduce the death rate from violence. When we review the evidence on the relationship between guns and violence, it seems clear that gun use, usually handgun use, increases the death rate from violence by a factor of three to five. Nobody in mainstream social science or criminology argues against such weapon effects these days, although some are more skeptical of the magnitude estimated than others (one example is Lance Stell; please see his essay in this issue). Thus the problem is both genuine and important.
The Production of Criminal Violence in America: Is Strict Gun Control the Solution?
Authors: Stell Lance K.
Published: January 2007

“Strict gun control”(SCG) has no clear meaning,so it is necessary to clarify it.I define SGC as an array of legally sanctioned restrictions designed to impose firearm scarcity on the general population. SGC’s public policy goal, gun scarcity, commonly rests on the predicates that “dangerous criminal control” is not the central problem for reducing the problem of criminal gun violence but rather that it is the social prevalence of the distinctively-lethal instruments (guns) by which both supposedly “good citizens” as well as violent criminals inflict a staggeringly high percentage of injury and death.

Professor Zimring (who also has an essay published in this issue) is one SGC’s most distinguished, prolific and comprehensive theorists. He has advocated for handgun scarcity among the general population since at least 1969.
Controlling Communications That Teach or Demonstrate Violence: “The Movie Made Them Do It”
Authors: BeVier Lillian R.
Published: January 2007

Violence sells, Americans have what sometimes seems to be an insatiable appetite for it. Depictions and descriptions of violence saturate our culture. songs urge us to rape women, kill police officers, and commit suicide. Movies portray-indeed they glorifyviolence as an intrinsic element of every imaginable plot line.

Despite substantial evidence that an individual’s repeated exposure to portrayals of violence is associated with significantly increased likelihood that the individual will commit aggressive acts against others, no legal regime currently regulates such portrayals either on television, in music, in movies, or in video games. Neither Congress, the Federal Communications Commission, the Federal Trade Commission, nor any state legislature has yet mustered the political will to impose substantial or systematic legal constraints upon producers or purveyors of violent images. Official censorship is rightly to be feared, but unreflective invocations of our commitment to freedom of speech provide incomplete justification for our legal regime’s apparent indifference to the possibility that media-induced violence may impose substantial costs on innocent victims.
Preventive Confinement of Dangerous Offenders
Authors: Morse Stephen J.
Published: January 2007

How to respond justly to the dangers persistent violent offenders present is a vexing moral and legal issue. On the one hand, we wish to reduce predation; on the other, we want to treat predators fairly. The central theme of this paper is that it is difficult to achieve both goals without compromising one of them, and that both are being seriously undermined. I begin by explaining the legal theory, doctrine and practice governing dangerous offenders (DO) and demonstrate that the law leaves a gap in the ability to confine them. Next I explore the means by which the law has overtly or covertly sought to fill the gap. Many of these measures, especially the new form of civil commitment for sexual predators, dangerously conflate moral and medical categories. I conclude that pure preventive detention is more common than we usually assume, but that this practice violates fundamental assumptions concerning liberty under the American constitutional regime.
Why Not Retribution? The Particularized Imagination and Justice for Pregnant Addicts
Authors: Eckenwiler Lisa
Published: January 2007

The Law is a grim, unsmiling thing, Not Justice, though. Justice is witty and whimsical and kind and caring.

Rohinton Misuy, A Fine Balance;

When the South Carolina Supreme Court upheld the conviction and twelve-year sentence of Regina McKnight, it affirmed that state 's commitment to bring the full force of the law to the punishment of pregnant women who use drugs. Prosecutors linked the delivery of Ms.McKnight 's stillborn baby to her use of cocaine, and argued successfully for a finding of homicide by child abuse. The McKnight judgment follows the South Carolina Supreme Court decision in the case of Cornelia Whitner. Whitner was sentenced to prison for illegal drug use during pregnancy on the grounds that the viable fetus is a child under the state s criminal child endangerment statute.

On the basis of constitutional concerns such as due process and privacy, worries that criminal prosecutions may thwart public policy goals such as keeping families together and promoting the health of women and children, and findings that legislatures did not intend to include the fetus in the scope of drug laws or child abuse and neglect laws, criminal prosecution has been resisted in most jurisdictions.
Ending Concerns about Undue Inducement
Authors: Emanuel Ezekiel J.
Published: January 2007

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.

Despite their long history and pervasiveness, charges of undue inducement in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges.
Natural Settings Trials — Improving the Introduction of Clinical Genetic Tests
Authors: Freund Carol L. , Clayton Ellen W. , Wilfond Benjamin S.
Published: January 2007

Many new genetic tests are used in clinical practice, and the number of available tests is growing. Two important health policy questions arise as these genetic tests become available. The first question, whether a new test should be made available, has been the focus of much recent discussion. The second question concerns defining the appropriate standards surrounding the use of these tests, including patient selection, education, informed consent, test interpretation and counseling.

Genetic tests currently move from the research arena, where strategies are put in place to minimize risks,into the clinical context where the practice of medicine is more variable and the risks to patients less understood. In the research setting, risks can be minimized through safeguards including education, consent, and counseling. The frequency and magnitude of psychosocial and clinical risks canbe assessed. In the clinical setting, however, these safeguards may not be used consistently, creating unknown risksfor patients (see table).
Research Ethics and Misguided Moral Intuition
Authors: Miller Franklin G.
Published: January 2007

The term therapeutic misconception was coined
by Paul Appelbaum and his colleagues to describe the tendency of patients enrolled in clinical trials to confuse research participation with the personal clinical attention characteristic of medical care. It has not been recognized that an analogous therapeutic misconception pervades ethical thinking about clinical research with patient-subjects. Investigators and bioethicists often judge the ethics of clinical research based on ethical standards appropriate to the physician-patient relationship in therapeutic medicine. This ethical approach to clinical research constitutes a misconception because it fails to appreciate the ethically significant differences between clinical research and clinical care.

In this article I argue that the assumption that the ethical principles governing the practice of therapeutic medicine should also apply to clinical research with patient- subjects produces incoherence in research ethics and erroneous guidance concerning certain controversial research designs.
Evaluation of the Condom Distribution Program in New South Wales Prisons, Australia
Authors: Dolan Kate , Lowe David , Shearer James
Published: January 2007

Male to male unprotected anal sex is the main route of HIV transmission in Australia. The Australian Study of Health and Relationships, a large, representative population survey of sexual health behaviors, found that six percent of males in the general population have engaged in homosexual activity. These findings were consistent with studies in Europeand North America. Condoms have been shown to reduce the transmission of HIV in the community. Barriers to the use of condoms include access,stigma,and cost? Nevertheless, increased condom use has been reported among homosexual males, sex workers and injecting drug users although recent declines in condom use among homosexuals has presented new challenges in HIV prevention.

The prevalence of male to male sexual activity may be higher in prison than in the general population. Sexual activity in prison can be consensual and non-consensual involving both homosexual / bisexual and heterosexual men.
Benign Neglect or Neglected Abuse: Drug and Alcohol Withdrawal in U.S. Jails
Authors: Fiscella Kevin , Pless Naomi , Meldrum Sean , Fiscella Paul
Published: January 2007

Two days following her arrest, a forty-four-year-old woman died in jail from aspiration pneumonia secondary to Untreated opiate withdrawal. The New York State Commission of Corrections concluded in its final report that had adequate medical evaluation and treatment been afforded, her death would have been prevented.

A forty-six-year-old male with a history of alcohol dependence was arrested for trespassing and held in the county jail. Three days later he became agitated and aggressive. Following physician orders, deputies placed him in restraints. He subsequently vomited and seized. Fifteen minutes later, he experienced respiratory arrest and died.

These cases highlight a serious, but neglected problem in jails across the country: inadequate assessment and treatment of drug and alcohol withdrawal among arrestees. In this article, we show that untreated drug or alcohol withdrawal is associated with adverse outcomes including needless pain and suffering, medical morbidity, and in some instances, death.
Legal Barriers to Implementing Recommendations for Universal, Routine Prenatal HIV Testing
Authors: Wolf Leslie E. , Lo Bernard , Gostin Lawrence O.
Published: January 2007

Administraation of antiretroviral therapy to women during pregnancy, labor and delivery, and to infants postnatally can dramatidy reduce mother-to- child HIV transmission (MTCT). However, pregnant women need to know that they are HIV-infected to take advantage of antiretroviral therapy, and many women do not know their HIV status. One-half of HIV-infected infants in the United States were bornto women who had not been tested for HIV or for whom the time of testing was not known. Although fewer than 400infants are infected perinatally in the United States each year, that number could be reduced even further through policies aimed at HIV testing during pregnancy.

The reasons toadopt such a policy are strong: the pathophysiology of perinatal transmission is clear, prophylaxis is effective and safe, and the intended beneficiaries of the intervention - babies - cannot protect themselves.
Confounding Extremities: Surgery at the Medico-Ethical Limits of Self-Modification
Authors: Bridy Annemarie
Published: January 2007

Controversy swept the U.K. in January of 2000 over public disclosure of the fact that a Scottish surgeon named Robert Smith had amputated the limbs of two able-bodied individuals who reportedly suffered from a condition known as apotemnophilia. The patients, both of whom had sought and consented to the surgery, claimed they had desperately desired for years to live as amputees and had been unable, despite considerable efforts, to reconcile themselves psychologically to living with the bodies with which they were born. Both surgeries were successful, and both patients, who had undergone psychiatric evaluation prior to the amputations, subsequently reported having no regrets. In the wake of a wave of sensationalistic stories in the media, the hospital at which the surgeries had been performed, the Falkirk and District Royal Infirmary, banned any future surgeries of the kind. Outraged local politicians promptly announced their intention to pass laws banning the procedure outright. One member of Scottish Parliament declared the surgery obscene and asserted that the whole thing is repugnant and legislation needs to be brought in now to outlaw this.
A Human Germline Modification Scale
Authors: Adams Harry
Published: January 2007

With progress in genetic research advancing as it is, a host of novel theoretical and practical challenges are thereby being raised. From a bioethical perspective, it is easy to get the feeling that, because of this rapid progress, many fundamental concepts that should be in place arent yet in place. This lack may be felt especially in relation to human gene modification. with the Human Genome Projects (HUGOS) potential to yield innumerable applications, one of the things that should be in place is a set of fundamental conceptual guidelines demarcating the kinds of genetic modifications (I will use this term to stand both for various kinds of genetic therapies and enhancements) that should count as ethically acceptable and legally permissible. In this paper, my goal is to articulate such guidelines, specifically for the set of all possible human germline (rather than somatic) modifications.
Courts Protect Ninth Circuit Doctors Who Recommend Medical Marijuana Use
Authors: Christenson Vonn
Published: January 2007

On October 14, 2003, the Supreme Court announced that it would not review a Ninth Circuit Appeals Court ruling that enjoined the federal government from punishing doctors who recommend medical use of marijuana to their patients. The Ninth Circuit case, Conan v.Walters, drew a fine line in distinguishing betweendispensing information and dispensing controlled substances, and held that [p]hysicians must be able to speak frankly and openly to patients under the First Amendments. Although unauthorized use and distribution of marijuana is prohibited, the court found that a doctor s recommendation does not itself constitute illegal conduct that doctors should be free to recommend the use of medical marijuana if based on sincere medical judgment, without fear of retaliation by a government probe or prosecution.
Bioethics and the National Security State
Authors: Moreno Jonathan D.
Published: January 2007

it is mandatory that in building up our strength, we enlarge upon our technical superiority by an accelerated exploitation of the scientific potential of the United States and our allies. National Security Council, NSC-G8: United States Objectives and Program for National Security April 14, 1950

Innovation within the armed forces will rest on experimentation with new approaches to warfare, strengthening joint operations, exploiting U.S. intelligence advantages, and takingfull advantage of science and technology. George W Bush, The National Security Strategy of the United States of America, September 17,2002
Does Ethical Theory Have a Future in Bioethics?
Authors: Beauchamp Tom L.
Published: January 2007

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.

I make no presumption that bioethics is integrally linked to philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms.
Clinical Ethics and the Road Less Taken: Mapping the Future by Tracking the Past
Authors: Rubin Susan B. , Zoloth Laurie
Published: January 2007

Clinical ethics, like the broader field of bioethics from which it emerged, is at a critical crossroads in its development, with conflicting paths ahead. It can either claim its distinctive place in the clinical arena, insisting unapologetically on certain minimal standards of professional training, practice and competence, addressing head on debates about various models of and methodological approaches to consultation, and establishing a shared vision of the purpose and meaning of the enterprise of clinical ethics itself. Or, it can devolve into a hobby that untrained, albeit interested, and generally well intentioned individuals can dabble in for fun or even profit, as they see fit, and without regard to the deep history and rich disciplinary roots of the field, the serious debates in the academic literature of bioethics, the foundational case histories and legal theories, or even any sense of professional accountability.
The Future of Empirical Research in Bioethics
Authors: Sugarman Jeremy
Published: January 2007

Empirical research in bioethics can be defined as the application of research methods in the social sciences (such as anthropology, epidemiology, psychology, and sociology) to the direct examination of issues in [bioethics]. As such, empirical work is a form of descriptive ethics, focused on describing a particular state of affairs that has some moral or ethical relevance. For example, empirical research can help to describe cultural beliefs about the appropriateness of providing health-related information, such as the diagnosis of a life-threatening illness, which informs deliberations about the extent to which it is morally important for clinicians to provide comprehensive information to patients in different cultural contexts. Similarly, empirical research can delineate popular attitudes and experiences related to contentious issues such as abortion, cloning, stem-cell research, and physician-assisted suicide to enlighten discussions and policy formulations regarding them.
Public Health Ethics: From Foundations and Frameworks to Justice and Global Public Health
Authors: Kass Nancy E.
Published: January 2007

Public health ethics in the future will be distinguished from public health ethics in the past by this new subfield being labeled as such, acknowledged, and called upon for service. Ethical dilemmas have been present throughout the history of public health. The question of whether to force Henning Jacobson to be immunized in 1905 in accordance with the 1902 Massachusetts smallpox vaccination law was one of ethics as well as law. How Thomas Parran, Surgeon General in 1936, chose to respond to a raging syphilis epidemic in the United States in the early part of the 2W century raised considerable moral debate in determining the appropriate public health response for a government? More recently, questions have arisen concerning the appropriate reach of government in controlling HIV banning smoking, or promoting healthy lifestyles. Debates over government infringement, morality, and justice recur throughout the history of public health.
Accounting for Culture in a Globalized Bioethics
Authors: Marshall Patricia , Koenig Barbara
Published: January 2007

As we look to the future in a world with porous borders and boundaries transgressed by technologies, an inevitable question is:Can there be a single, global bioethics? Intimately intertwined with this question is a second one: How might a global bioethics account for profound - and constantly transforming - sources of cultural difference? Can a uniform, global bioethics be relevant cross-culturally? These are not simple questions, rather, a multi-dimensional answer is required. It is important to distinguish between two meanings of bioethics: the academic discipline of bioethics as opposed to bioethics as a set of (increasingly globalized) practices governing clinical care and scientific research. There is growing evidence to support the notion of a shared global understanding of bioethics as a field of inquiry focused on the moral dimensions of science and biomedicine.
FACE Facts: Why Human Genetics Will Always Provoke Bioethics
Authors: Juengst Eric T.
Published: January 2007

Over the last decade, more U.S. taxpayers money has been spent trying to anticipate and address the bioethical issues raised by advances in human genetics than any other set of issues in the field. Does this make sense? Not everyone in bioethics thinks so. Some think there are more important topics, like issues of health care justice, that will be neglected if the field continues to follow the money to dwell on the moral challenges of a relatively small community of research scientists. Others decry genetic exceptionalism as inappropriately singling out this scientific enterprise for criticism and regulation, when the same issues are faced even more acutely in other parts of the biomedical world. Human genetics is not accelerating as fast as pharmacology, for example, or as easy to abuse as virology, or as philosophically challenging as neurology.
Bioethics: A Field in Transition
Authors: Faden Ruth R.
Published: January 2007

Bioethics is clearly a field in transition, if not confusion. Bioethics began as a scholarly, reflective, academic enterprise. Increasingly, however, some in bioethics are not as interested in producing scholarship as they are in practicing bioethics by providing services to institutions and clients.

Bioethics also began as an interdisciplinary line of inquiry, with its major contributors all trained in some established discipline. We were and for the most part still are a field composed of theologians, philosophers, lawyers, physicians, nurses, and social scientists who work in bioethics. Today, however, some young people actually aspire to be bioethicists. Increasingly, they have the option of being trained directly in bioethics, without any other disciplinary background.

We are not the first field to find itself engaged in these kinds of transitions. In this short piece, I consider very briefly how two fields--health psychology and epidemiology- have approached similar branch points.
Law & Bioethics: From Values to Violence
Authors: Wolf Susan M.
Published: January 2007

Debate over the relationship of law and bioethics is growing - what the relationship has been and what it should be in the future. While George Annas has praised law and rights-talk for creating modern bioethics, Carl Schneider has instead blamed law for hijacking bioethics and stunting moral reflection. Indeed, as modern bioethics approaches the 40-year mark, historians of bioethics are presenting divergent accounts. In one account, typified by Albert Jonsen, bioethics largely grew out of philosophy and theology, not law. In another account, law has deeply shaped bioethics from the start, forging its central commitment to the rights of patients and research subjects and the fields imposition of broad fiduciary responsibilities on health care professionals and researchers.

In addition to debating how to properly describe laws historical relationship to bioethics, commentators have argued over whether laws influence in bioethics is now good or bad.
Passing on the Right: Conservative Bioethics is Closer Than it Appears
Authors: Charo R. Alta
Published: January 2007

In August 2001,just after President Bush announced his stem cell funding policy and the creation of a new Presidents Council on Bioethics PCB), the new chair of the PCB, Leon Kass, set out his philosophy for constructing public bioethics bodies: There are several ways of running commissions, he said. One is to stack it with your people, make them homogenous, and force a consensus. Another is to make them heterogeneous, so that you can only come to the lowest common denominator. We re not going to adopt either . We are going to allow the debate to be developed and heard.

Now, three years, sixteen meetings, and five reports later, there are nagging questions about whether this council indeed has allowed the debate to be developed and heard. And the charge of politicizing public bioethics to a degree heretofore unknown and stifling the voices of dissenting members comes not from the political left but from President Bushs own appointees, including one scientist who was dismissed from further service.
Pain, Impairment, and Disability in the AMA Guides
Authors: Robinson James P. , Turk Dennis C. , Loeser John D.
Published: January 2007

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two.

This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain (Chapter 18) of the American Medical Association sGuides to the Evaluation of Permanent Impairment, 5thedition AMA Guides 5thOur purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings.
Toward Rational Criminal HIV Exposure Laws
Authors: Galletly Carol L. , Pinkerton Steven D.
Published: January 2007

Criminal law and the proceedings surrounding it work, at least in theory, much like an author works when writing a play or a novel. Both the lawyer and the writer follow traditional formulae that allow them to create and express a vision of reality. When done well, the reality created is virtually seamless. This, however, is the point at which law and literary works diverge. Although we embrace creativity in literary endeavors, we would prefer that the foundation of our legal system be something more substantial. Unfortunately, where US. criminal HIV exposure statutes are concerned, there appears to be little if any concrete connection between proscribed behaviors and what we know about HIV transmission risk. Twenty-four states in the U.S. make it a criminal offense for a person who has HIV to expose another to the virus through consensual sexual activities. The relationship between the activities prohibited by these laws and actual risk of virus transmission is tenuous at best.
Medication Errors in Family Practice, in Hospitals and after Discharge from the Hospital: An Ethical Analysis
Authors: Clark Peter A.
Published: January 2007

The issue of death due to medical errors is not new. We have all heard horror stories about patients dying in the hospital because of a drug mix-up or a surgery patient having the wrong limb amputated. Most people believed these stories were the exception to the rule until November 1999, when the Institute of Medicine (IOM) issued a report entitled To Err Is Human: Building A Safer Health System. This report focused on medical errors and patient safety in U.S. hospitals. The report indicated that as many as 44,000 to 98,000 people die each year in hospitals as a result of medical errors. These numbers suggest that more Americans are killed in U.S.hospitals every 6 months than died in the entire Vietnam War, and some have compared the alleged rate to fully loaded jumbo jets crashing every other day. This report was not without its critics.
Error Reduction, Patient Safety and Institutional Ethics Committees
Authors: Meaney Mark E.
Published: January 2007

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety (HCR) in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery.
Biobanking: International Norms
Authors: Knoppers Bartha Maria
Published: January 2007

While the socio-ethical and legal issues surrounding clinical genetics have long been the subject of international interest, the thorny questions of genetic research and biobanking are more recent. Add to this the fact that national guidelines and laws usually precede international policymaking, and the delay in international approaches is understandable. In that regard, the United Nations Educational, Scientific and Cultural Organization’s 1997 Universal Declaration on the Human Genome and Human Rights is unique in its prospective guidance on genetic research. Also, it is in the very nature of international normative instruments to be general, except on specific issues considered to be in the interest of humanity, such as research into human reproductive cloning or access to AIDS drugs.
Informed Consent and Biobanks
Authors: Clayton Ellen Wright
Published: January 2007

Biomedical research has always relied on access to human biological materials and clinical information, resources that when combined form biobanks. In the past, it appears that investigators sometimes used these resources with relatively little oversight, and without the consent of the individuals from whom these materials and information were obtained. Several developments in the last ten to fifteen years have converged to place greater emphasis on the role of individual consent in the creation and use of biobanks. The most important by far is the power of information technology, which has transformed our lives in almost every domain. In the research setting, it is now easy to abstract information from electronic medical records. Computers make it possible to analyze enormous datasets and have contributed in essential ways to the dramatic increases in our understanding of genomics and other areas of biomedical science.
Harnessing the Benefits of Biobanks
Authors: Andrews Lori B.
Published: January 2007

We have a thriving biotechnology industry in the United States. There are over 1,450 biotechnology companies developing diagnostic and treatment technologies in medicine, creating more nutritional foods, and innovating new industrial processes. Yet this $28.5 billion sector of the economy is not without controversy. The “bio” in biotechnology comes from living, biological entities - people, plants, animals, and even bacteria. In the realm of biobanking, people are the source of the raw material for the discovery of genes for research, diagnosis, and therapy, raising a host of issues about rights and responsibilities, fiduciary duties and societal obligations.
Cyberbanks and Other Virtual Research Repositories
Authors: Majumder Mary Anderlik
Published: January 2007

Few things seem more a part of the material world than biological specimens. Yet the processes by which collections of specimens are assembled, translated into information, combined with more information, and distributed are taking research repositories into the virtual realm.

The term “virtual” has a number of meanings, and so a research repository can qualify as virtual in a variety of ways. The term would seem to apply, for example, to (1) constructing a repository by forming a network among institutions; (2) using the Internet or the World Wide Web to solicit specimens and information; (3) integrating web-based technology into the operation of the bank; (4) using the Internet or web-based technology to manage relationships with donors or collection sites and recipients; and (5) digitizing specimens. The all-digital repository would seem the most virtual of all possible repositories, a true cyberbank.
Accountability in Population Biobanking: Comparative Approaches
Authors: Deschênes Mylène , Sallée Clémentine
Published: January 2007

Biobanking activities for genetic research purposes have recently undergone nothing short of a small revolution. Many biobanks have left their traditional home of a small refrigerator in a laboratory to reach the unprecedented proportion of large, sophisticated storage centers containing DNA samples from whole populations. As we turn our attention to research on complex diseases and show great interest in human genetic variation and genetic epidemiology, we need to base our research not only on the DNA of small family cohorts, but on larger sample collections, coupled with geographic location, genealogical information, and environmental and medical data. Population genetic research projects are underway around the world. Setting up such large-scale population biobanks is a challenge for any researcher. Population genetic research projects raise legal, ethical, and social issues that need to be addressed properly in order to maintain the trust of the population, an absolute requirement for the success of such research endeavour.