Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

As a bioethical and social issue, euthanasia has become in the 1990s what abor- tion was in the 1960s. Around the world, a de facto taboo on open discussion of the practice is seemingly falling by the wayside, as recognition increases that “active” euthanasia is taking place in spite of social and legal prohibitions. Euthanasia, or more specifically physician-assisted suicide, has become the most visible bioethical issue of the present era; and in the United States the debate has taken on (...) a prominence and urgency unprecedented in our nation's history. (shrink)

Medical training is intense by design. Starting with medical school, for 4 years most of the time in the formal curriculum is filled with numerous essential topics, and, as scientific and medical knowledge increases, it is increasingly difficult to “triage” what must be learned. Efforts to insert new topics are often fraught with obstacles and resistance. Thus, it is problematic to suggest that even more be taught in those finite years of formal medical education. However, that is exactly what we (...) propose to do here. (shrink)

Busy physicians and scientists tend to be willfully naive about politics. Physics, chemistry, and biology are clean—that is, subject to relatively consistent and identifiable laws or at least trends and, certainly in the case of medicine, beneficial when properly applied. Politics, on the other hand, tend to be unpredictable, murky, and dirty—that is, too often all about self-serving power and, ultimately, money.

Elizabeth H. Blackburn, Ph.D., is a leader in the area of telomere and telomerase research—in fact, in 1984 she codiscovered the ribonucleoprotein enzyme telomerase, opening up new potentials in cancer research and therapy. This and subsequent work has earned her numerous honors, not the least of which are the National Academy of Science Award in Molecular Biology, an Honorary Doctorate of Science from Yale University, the American Cancer Society Medal of Honor, and many more awards. Dr. Blackburn is a Fellow (...) of the American Academy of Arts and Sciences, the Royal Society of London, the American Academy of Microbiology, and the American Association for the Advancement of Science. She was elected to the National Academy of Sciences, and is a Member of the Institute of Medicine. (shrink)

Garrett Hardin, Ph.D.—biologist, environmental ethicist, and lightning rod for controversy for over four decades—died in a double suicide with his wife in September 2003 at his longtime home in Santa Barbara, where he was a Professor Emeritus of Human Biology at the University of California. Both Hardins had been ill for some time and in fact were leaders in the local chapter of the Hemlock Society, the “right-to-die” advocacy organization.

The profession of medicine has developed codes of ethical conduct for thousands of years. From the Hippocratic Oath of ancient Greece onward to modern times, a universal and central element of such codes has expressed the imperative that a physician shall “Do no harm.”.

I work at a large urban medical center. Our hospital has over 1,200 beds and was built in 1805 to take care of the poor. Our patients are still poor, but now so are the hospital and the doctors. Russian doctors are paid about one-third of what truck drivers are paid. The government historically allocates no more than 3% of the budget to medicine because this is not a means of production, like manufacturing.

Tom Koch's review of Jack Kevorkian's is a valuable look at this one (in)famous crusader's practices. The immediate question raised, and to which Koch provides his own perspectives, is what practical conclusions might be drawn from the final experiences and actions of this cohort of suffering individuals. My briefest and perhaps flippant answer is —including, unfortunately, those derived or hinted at by Koch himself.

is a new campaign devoted to reducing the environmental harmsgenerated by the healthcare industry. One of the leading local proponents of this effort is Michael Lerner, founder of Commonweal, a Bolinas, Californiagenius grant”).

Although housed in an anonymous Victorian house in San Francisco, California, the Zen Hospice Project is world renowned for its pioneering model of training hospice volunteers, providing direct services to patients, and offering educational programs to the broader public.

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, Based on the old principle of the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care (...) of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question. (shrink)

Ram Dass is one of America's most renowned spiritual teachers. Born Richard Alpert, he received his Ph.D. in psychology from Stanford University and taught there and at Harvard University before going to India and receiving the name Ram Dass () from his guru. He has long been involved in many charitable service organizations, particularly those devoted to providing healthcare for underserved populations. Among his many books are BeHereNow, HowCanIHelp, and CompassioninAction; his newest book is StillHere:EmbracingAging,Changing,andDying.

It's a chilly winter night outside, but very warm inside the hospice guest house. All of the people gathered here have wished one another “Happy New Year” and settled on cushions in the big meeting hall. Both fireplaces are lit, and the many little white cards with the names of each person who died last year are arranged on the mantels over the fireplaces and on a table in the center of the room. Paul, our teacher for the evening, says (...) a few simple and wise words about impermanence and about being of service and then explains tonight's process: we, the volunteers in attendance, will pick up the cards, either by choosing a specific patient's name or at random, and take them one by one to the fires, dropping them in and saying something about each deceased person. The idea is to hear a litany of names being remembered and honored and sent onward as volunteers flow steadily to and from the fireplaces. (shrink)

A woman presents to her physician with a newly diagnosed condition that in her considered and informed judgment requires an elective surgical procedure. The physician, after speaking with her, agrees that this is an acceptable option. The procedure in question is in fact one of the commonest surgeries performed on American women. The physician is also aware that although the procedure is deemed elective in this and in most cases, research has shown that the consequences of not providing the procedure (...) when it is requested can be severe in terms of both physical and emotional sequelaewhich itself can add to the complexity and risk of the procedure. Presented with this option, the patient expresses dismay but also her resigned commitment to follow through with this referral, and leaves the office in tears. (shrink)