Introduction

Preface to the Fourth Edition I am honored by the decision of the editors of Paulist Press to produce the fourth edition of this Reader. I am pleased that faculty and students continue to find this Reader a helpful addition to their classes. As one would expect, the problems in the field of bioethics have become even more complicated and new ones are added on an almost daily basis. Consequently the selection process for articles continues to present major challenges. To reflect changing times and needs, this fourth edition will be different in four major ways. First, it will contain fewer articles. My hope is that the brevity will make the Reader more useful in the classroom. Additionally too large a text can be intimidating. One of my colleagues refers - fondly, I trust - to the third edition as the "telephone book." The desire to be too inclusive in content and articles can be dysfunctional conceptually as well as pedagogically. Second, none of the articles in this edition is carried over from previous editions. The third edition retained seven articles from the original 1976 edition. These articles I still regard as classic essays, but times and needs change. Third, I have developed a new method of organizing the traditional topics. I have grouped articles around four general themes - abortion and reproduction; death and dying; consent, therapy, and research; and public issues. I hope this will be a format that is easily adapted to the general way courses are organized. Fourth, not all of the standard commentators are represented. The reason for this is simply that newer scholars are making significant contributions and these need to be recognized. My hope is that these articles, organized in this fashion and with these general criteria, will provide a context for the continuing discussion and debate of these most critical problems. I am particularly thankful to Russ Conners,Pat McCormick, Steve Lammers, and Jim Walter who took the time to consider my proposal and to suggest other authors and articles. I appreciate their help as well as the continuing conversations I have with them. I would also like to express my continuing gratitude to Jon Strauss, the President of WPI, and JoAnn Manfra, Department Chair, and my colleagues in the Humanities Department for their continuing support and encouragement of my work. Such collegiality is a rare, but deeply appreciated, gift.

A thoroughly up to date anthology of biomedical ethics that draws on the major scholars in the field to present an overview of the key issues facing health care professionals and consumers of the '90s.

Issues in bioethics, medicine, and healthcare continue to plague us - as patients, as consumers, as citizens. Here, under one cover, are thirty of the most current and perceptive articles, culled from key medical, ethical, philosophical, legal and theological journals. Dr. Shannon once again offers - to healthcare professions and students alike - access to this decade's core bioethics questions, a spectrum of viewpoints, and a wealth of insight. The Issues Abortion. Fetal Tissue Research. Reproductive Technology. Gene Therapy. Death with Dignity. Advance Directives. Physician Assisted Suicide. Clinical Research and Consent. HIV/AIDS. Privacy and Disclosure. Organ Transplants. Healthcare Rationing. The Authors Daniel Callahan. Scott Aaron. Brenda Almond. Carole Ulanowsky. Maura Ryan. Richard McCormick. Mark Lappé. W. French Anderson. Hans Jonas. Timothy Quill. Robert Capone. Ezekiel & Linda Emanual. Albert Jansen. Andrew McThenia. Steven Miles. Terrence Ackerman. Carol & Robert Levine. Giles Scofield. Dorothy Wertz. John Fletcher. Susan Wendell. John LaPuma. Edward Lawlor. David Hadorn. James Childress. Robert Veatch. Leon Kass. Alexander Morgan Capron. Ronald Bayer. Nancy Jecker.

Introduction-Thematic Ethical Issues, Thomas A. Shannon

PART ONE ABORTION AND REPRODUCTION

1. An Ethical Challenge to Prochoice Advocates, Daniel Callahan
2. Reflections On the Moral Status of the Pre-Embryo, Thomas A. Shannon and Allan B. Wolter, O.F.M.
3. The Choice in "Choose Life", Scott Aaron
4. Hiv and Pregnancy, Brenda Almond and Carole Ulanowsky
5. The Argument for Unlimited Procreative Liberty: A Feminist Critique, Maura A. Ryan, Ph.D.
6. Therapy of Tampering: the Ethics of Reproductive Technology and the Development of Doctrine, Richard A. Mccormick, S.J.
7. Ethical Issues in Manipulating the Human Germ Line, Marc Lappe', Ph.D.
8. Human Gene Therapy: Why Draw a Line?, W. French Anderson

PART TWO DEATH AND DYING

9. The Burden and Blessing of Morality, Hans Jonas
10. Death and Diginity: Acase of Individualized Decision Making, Timothy E. Quill, M.D.
11. The Pvs Patientand Theforgoing/Withdrawing of Medical Nutrition and Hydration, Thomas A. Shannon and James J. Walter
12. Unsuccessful Emergency Medical Resuscitation: Are Continued Efforts in the Emergency Department Justified?, William A. Gray, M.D., Robert J. Capone, M.D.M and Albert S. Most, M.D.
13. Friend-of-the-Court Brief for Larry James Mcafee, the Atlanta Archdiocese
14. Living Wills: Past, Present, and Future, Ezekiel J. Emanuel, M.D. and Linda L. Emmanuel, M.D.
15. Initative 119: What Is At Stake?, Albert R. Jonsen

PART THREE CONDENT, THERAPY, AND RESEARCH

16. Deciding for Others: Issues of Consent, Andrew W. Mcthenia
17. Informed Demand for "Non-Beneficial" Medical Treatment, Steven H. Miles. M.D.
18. Balancing Moral Principles in Federal Regulations of Human Research, Terrence F. Ackerman
19. Building a New Consenus: Ethical Principles and Policies for Clinical Research On Hiv/Aids, Carol Levine, M. A., Nancy Neveloff Dubler, Ll.B., and Robert J. Levine, M.D.
20. Is Consent Useful When Resuscitation Isn't?, Giles R. Scofield
21. Privacy and Disclosure in Medical Genetics Examined in An Ethics of Care, Dorothy C. Wertz, Ph.D. and John C. Fletcher, Ph.D

PART FOUR PUBLIC POLICY ISSUES

22. Toward a Feminist Theory of Disability, Susan Wendell
23. Quality-Adjusted Life-Years: Ethical Implications for Physicians and Policymakers, John La Puma, M.D. and Edward F. Lawlor, Ph.D.
24. The Oregon Priority-Setting Exercise: Quality of Life and Public Policy, David C. Hadorn
25. Ethics, Public Policy, and Human Fetal Tissue Transplantation Research, James F. Childress, Ph.D.
26. Routine Inquiry About Organ Donation: An Alternative to Presumed Consent, Robert M. Veatch, Ph.D.
27. Organs for Sale? Propriety, Property, and the Price of Progress, Leon R. Kass, M.D.
28. Which Ills to Bear? Reevaluating the "Threat"...488 Alexander Morgan Capron
29. Ublic Health Policy and the Aids Epidemic: An End to Hiv Exceptionalism?, Ronald Bayer, Ph. D.
30. An Ethical Framework for Rationing Health Care, Nancy S. Jecker, Ph. D., and Robert A. Pearlman, M.D., M.P.H.