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Back Issues and Articles
Back Issues and Articles

Table of Contents
Table of Contents
ASLME - [PDF] (Free Download)
Table of Contents
Letter From the Editor
Letter From The Editor
ASLME - [PDF]

Reflections on Emerging Technologies at the Centennial of Organ Transplantation
Symposium Articles
Introduction Reflections on Emerging Technologies at the Centennial of Organ Transplantation
Robert M. Sade - [PDF]

Reflections on Emerging Technologies at the Centennial of Organ Transplantation
The God Squad and the Origins of Transplantation Ethics and Policy
Albert R. Jonsen - [PDF]

The era of replacing human organs and their functions began with chronic dialysis and renal transplantation in the 1960s. These significant medical advances brought unprecedented problems. Among these, the selection of patients for a scarce resource was most troubling. In Seattle, where dialysis originated, a "God Committee" selected which patients would live and die. The debates over such a committee stimulated the origins of bioethics.
The Use of Nonhuman Animals in Biomedical Research: Necessity and Justification
Gary L. Francione - [PDF]

Discourse about the use of animals in biomedical research usually focuses on two issues: its empirical and moral use. The empirical issue asks whether the use of nonhumans in experiments is required in order to get data. The moral issue asks whether the use of nonhumans can be defended as matter of ethical theory. Although the use of animals in research may involve a plausible necessity claim, no moral justification exists for using nonhumans in situations in which we would not use humans.
Markets in Health Care: The Case of Renal Transplantation
Troyen Brennan - [PDF]

This article explores the ethics and economics of a mar-ket in donated kidneys in the United States. With the impending changes in the health care system, the author argues that a full turn to the market for distribution of kidneys is not appropriate. However, he would sanction a regulated market, as outlined in the article.
The Injustice of Enforced Equal Access to Transplant Operations: Rethinking Reckless Claims of Fairness
H. Tristram Engelhardt, Jr. - [PDF]

The globalizing or totalizing imposition of a particular understanding of justice, fairness, or equality, as seen, for example, in Canada's single health care system, which forbids the sale of private insurance and the purchase of better basic health care, cannot be justified in general secular terms because of the following limitations: (1) the plurality of understandings of justice, fairness, and equality, and (2) the inability to establish one understand-ing as canonical. The secular state lacks plausible moral authority for the coercive imposition of one such account on peaceable, consenting adults. This state of affairs, with regard to the weakness of human moral epistemologi-cal powers, means that the secular state fails to have the moral authority to forbid coercively the sale and purchase of organs. It further lacks the secular, moral authority to impose equal access to organ transplantations. Assertions of such authority amount to reckless claims of fairness, and for this reason, health care policy must be set within the constraints of limited, constitutional regimes.
Clinical Trials of Xenotransplantation: Waiver of the Right to Withdraw from a Clinical Trial Should Be Required
Monique A. Spillman, Robert M. Sade - [PDF]

Xenotransplantation pits clinical research ethics against public health needs because recipients must undergo long-term, perhaps life-long, surveillance for infectious diseases. This surveillance requirement is effectively an abrogation of the right to withdraw from a clinical trial. Ulysses contracts, which are advance directives for future care, may be an ethical mechanism by which to balance public health needs against limitation of individual rights.
Brain Death : Too Flawed to Endure, Too Ingrained to Abandon
Robert D. Truog - [PDF]

The concept of brain death has become deeply ingrained in our health care system. It serves as the justification for the removal of vital organs like the heart and liver from patients who still have circulation and respiration while these organs maintain viability. On close examination, however, the concept is seen as incoherent and counter-intuitive to our understandings of death. In order to abandon the concept of brain death and yet retain our practices in organ transplantation, we need to either change the definition of death or no longer maintain a commitment to the dead donor rule, which is an implicit prohibition against removing vital organs from individuals before they are declared dead. After exploring these two options, the author argues that while new definitions of death are problematic, alternatives to the dead donor rule are both ethically justifiable and potentially palatable to the public. Even so, the author concludes that neither of these approaches is likely to be adopted and that resolu-tion will most probably come when technological advances in immunology simply make the concept of brain death obsolete.
Independent Articles
Genetic Determinism and Discrimination: A Call to Re-Orient Prevailing Human Rights Discourse to Better Comport with the Public Implications of Individual Genetic Testing
Karen Eltis - [PDF]

Genetic testing can not only provide information about diseases but also their prevalence in ethnic, gender, or other vulnerable populations. While offering the promise of significant therapeutic benefits and serving to highlight our commonality, genetic information also raises a num-ber of sensitive human rights issues touching on identity and the perception thereof, as well as the possibility of discrimination and social stigma. It stands to reason that the results of individual screenings could haplessly be used to make general assumptions about entire ethnic or gender groups. In this manner, genetic information can directly influence identity by impacting and perhaps even reframing conceptions of group rights and dimensions of self-identification, thus importing constitutional scrutiny on questions of dignity and discrimination in particular. Is there a risk of collective stigmatization deriving from discrete testing of self-identified individuals? Would such stigmatization impinge on individual dignity by the exog-enous imposition of ethnic or gender/sexual identity? If so, what norms can most adequately respond if and when individual and group interests diverge? These questions are examined from a comparative perspective.
Ethics of Population-Based Research
Holly A. Taylor, Summer Johnson - [PDF]

This paper considers the morally relevant ways in which population-based research is a distinct type of human subjects research that have unique moral considerations relevant for public health practitioners and researchers. By defining population-based research, the authors distin-guish it from public health practice and then consider, in more detail, the ways in which population-based research differs from clinical human subjects research. Based upon the distinctions between these types of research and prac-tice, they identify five important issues that arise in the design and conduct of certain kinds of population-based research. The authors hope that public health practitio-ners find these distinctions useful in determining when their work may actually be population-based research and that public health researchers use them to identify the areas where ethical issues in their research may arise.
Ethics, Law, and Commercial Surrogacy: A Call for Uniformity
Katherine Drabiak, Carole Wegner, Valita Fredland, Paul R. Helft - [PDF]

In the United States at this time, no uniform federal law exists regarding commercial surrogacy, and state statu-tory schemes vary vastly, ranging from criminalization to legal recognition with contract enforcement. The authors examine how commercial surrogacy agencies utilize the Internet as a means for attracting parents and surrogates by employing emotional cultural rhetoric. By inducing both parents and surrogates to their jurisdiction, agencies circumvent vast discrepancies in state statutory regula-tive schemes and create a distinct interstate business, absent an efficient regulatory framework or legal recourse in some circumstances. The authors propose a uniform federal regulatory scheme premised upon regulating inter-state business transactions to create accountability and legal remedies for both the parents and the surrogate.
Use of Forensic DNA Evidence in Prosecutors' Offices
Jeffrey M. Prottas, Alice A. Noble - [PDF]

This article reports on a survey of DNA-related prac-tices and procedures within District Attorneys' offices to obtain preliminary information about actual prosecutorial practices. The data obtained is preliminary but supportive of further study of areas targeted by the survey.
Columns
Currents in Contemporary Ethics
Meghan K. Talbott - [PDF]

Currents in Contemporary Ethics
The Ethical Health Lawyer
Elizabeth A. Weeks - [PDF]

The Ethical Health Lawyer
Reviews in Medical Ethics
John Keown - [PDF]

Reviews in Medical Ethics
Recent Developments in Health Law
Eric Benson, Brendan Hickey, and Katherine Wong - [PDF]

Recent Developments in Health Law