The rural health context in the United States presents unique ethical challenges to its approximately 60 million residents, who represent about one quarter of the overall population and are distributed over three-quarters of the country’s land mass. The rural context is not only identified by the small population density and distance to an urban setting but also by a combination of social, religious, geographical, and cultural factors. Living in a rural setting fosters a sense of shared values and beliefs, a strong work ethic, self-reliance, and a tendency for close-knit extended social structures where overlapping relationships are commonplace.

Contemporary bioethics has evolved over the past 40 years predominantly as a “Western” construct drawing fundamental inspiration for its conceptual and methodological frameworks from secular, Anglo-American philosophical traditions. American bioethicists can be credited with playing a defining role in the globalization of this new discipline to the developing countries of the world, but in this process, in the words of LaFleur, “Bioethics has become international without becoming internationalized.” Among the criticisms leveled against the dominant American model of bioethics is that in its focus on universalism it ignores local cultural and religious influences that are vital to the comprehension of the moral life in many societies. Medical sociologist Renée C. Fox and historian Judith P. Swazey have termed this as a form of “cultural myopia.”

For millennia physicians were admonished to obscure the details of patients’ illnesses and poor prognoses. The Hippocratic ethic precludes physicians from including patients in medical decisionmaking. That ethic demanded of doctors that they “[p]erform [their duties] calmly and adroitly, concealing most things from the patient … revealing nothing of the patient's future or present condition.”

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at tuija.takala@helsinki.fi.

Let’s face it, the humanities are in trouble. Last year, in The Chronicle of Higher Education, Thomas H. Benton warned prospective graduate students to avoid doctoral studies in the humanities. His rationale: a job market down 40%, the improbability of tenure, the more certain prospect of life as an adjunct, and eventual outright exile from one’s chosen field. Benton, the pen name of William Pannapacker, an associate professor of English at Hope College in Holland, Michigan, pulled no punches. His piece was entitled, “Graduate School in the Humanities: Just Don’t Go.”

Deciding to undergo a predictive genetic test is difficult. The patient has no symptoms that might tip the balance in favor of the test, and knowledge of the information might have significant implications for her physical and mental health, her family, and her financial position. Furthermore, although the decision to undergo many medical tests might reasonably be said to be the patient's own business, it could be argued that predictive genetic tests are different. Dean Bell and Belinda Bennett argue that genetic information has a “shared” or “familial” character due to the likelihood of it affecting others. If others might be affected by the results of your test, then it is certainly plausible to suggest that they have an interest in knowing the information. If that is the case, then it could also be argued that they are entitled to be considered when you are deciding whether to undergo a test.

As of June 2009, Israel’s population was 7,424,400 people, 5,604,900 of which were Jewish, 1,502,400 were Arabs, and approximately 317,200 had no religion or are non-Arab Christians. Established in 1948, Israel is a highly urban and industrialized country. Its gross domestic product (GDP) per capita (based on exchange rate) is US$23,257, positioning it among the European developed countries. Life expectancy is 79 years for males and 82 years for females, with infant mortality rate of 4 cases per 1,000 live births. Of Israel’s GDP, 7.7% is spent on health.

A significant portion of the practice of medicine is dependent on individual acts of medical altruism. Many of these acts, such as the donation of blood, gametes, stem cells, and organs, entail varying degrees of bodily intrusion and, for the altruist, various combinations of discomfort, risk, and expense. Discussion of the ethics of altruism has typically been fragmented under various rubrics such as blood donation, organ and tissue transplantation, health information, and the assisted reproductive technologies. The ethics of these specific examples of altruism are best explored in conjunction with a broader discussion of their relatively neglected mother discipline, altruism in medicine.

Informed consent began as a way of protecting physicians against legal liability. It did so by requiring physicians to provide their patients with sufficient information so that the patients could assent to or withhold consent from a proffered medical treatment. It was also intended to be an accurate expression of the patient's wishes. As such, it established the conditions by which a patient could be held responsible for his decisions concerning medical treatment.

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.

The international media recently reported the case of Eluana Englaro, a 38-year-old woman in a permanent vegetative state (PVS) who died in February 2009 following withdrawal of her feeding tube. At the time of her death, she had been unconscious for 17 years. For many years, her father had been seeking permission to allow her to die. His request was rejected by the courts several times on different grounds, until the Italian Supreme Court finally granted it. The case caused considerable political turmoil. The government, the president, the Constitutional Court, and the European Court of Human Rights got involved. This paper gives an account of the history of the case, enriched by personal communications with the people directly involved and a memoir by the father of Eluana.

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at tuija.takala@helsinki.fi.

This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact “The Great Debates” department editor, D. Micah Hester (hesterdm@uams.ed), UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

End-of-life (EoL) decisions concerning euthanasia, stopping life-support machines, or handling advance directives are very complex and highly disputed in industrialized, democratic countries. A main controversy is how to balance the patient’s autonomy and right to self-determination with the doctor’s duty to save life and the value of life as such. These EoL dilemmas are closely linked to legal, medical, religious, and bioethical discourses. In this paper, we examine and deconstruct these linkages in Germany and Israel, moving beyond one-dimensional constructions of ethical statements as “social facts” to their conflicting and multifaceted embedding within professional, religious, and cultural perspectives.

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 (gloebe@midwestern.edu) regarding books they would like to see reviewed or books they are interested in reviewing.

Mrs. J was a 66-year-old Muslima who was brought to the hospital from the subacute unit where she had been living for the past 2 years because of intense pain caused by keratitis, an inflamed cornea of a nonfunctioning eye. In addition to her severe eye pain, Mrs. J suffered with a number of other difficult medical conditions, including amyotrophic lateral sclerosis. She was both gastric tube and ventilator dependent and had a history of multiple myleoma, chronic obstructive pulmonary disease, and congestive heart failure. Mrs. J came from a large and traditional Muslim family with 6 children and 17 grandchildren. Although she had full decisionmaking capacity, she designated one of her sons to make her medical decisions for her.

Croatia is a transitional society in that it is a country emerging from a socialist command economy toward a market-based economy with ensuing structural changes of a social and political nature—some extending into the healthcare system. A legacy from our past is that, until now, Croatian healthcare institutions have had no real experience with clinical ethics support services. When clinical cases arise presenting complex ethical dilemmas in treatment options, the challenges presented to the medical team are substantial. The case described below recently occurred on a ward in a university hospital in Croatia. An unexpected request from the patient’s parents created a number of issues that needed to be addressed by the medical team, which was made more difficult by the lack of clinical ethics support services. Such cases press the question currently being debated as to what type of ethics support services would be suitable for Croatia and why.

The call has been made for global bioethics. In an age of pandemics, international drug trials, and genetic technology, health has gone global, and bioethics must follow suit. George Annas is one among a number of thinkers to recommend that bioethics expand beyond its traditional domain of patient–physician interactions to encompass a broader range of health-related matters. Medicine, Annas argues, must “develop a global language and a global strategy that can help to improve the health of all of the world's citizens.” Individual countries cannot address global health issues, and culturally specific principles are inadequate for addressing global bioethics concerns. We will need a language and moral framework grounded in a foundation of universally shared, transcultural judgments about humankind that will also recognize moral pluralism. The claim has been made that such a foundation already exists in human rights, and that human rights should, therefore, be the new lingua franca of bioethics.