The influx of new groups into society, such as recently established religious groups whose practices differ from societal norms, may disturb relatively stable communities. This instability is exacerbated if these practices contravene long-held fundamental societal tenets, such as the protection of children. This situation now exists in Mexico, where the country's traditional Catholic and secular values clash with those of a religion introduced from the United States, Jehovah's Witnesses. The focal point for these clashes, as it has been elsewhere, is in the bioethics arena.

Physician-patient communication is not optimal. It suffers from an imbalance of information and power, misunderstandings and incomplete information transferred between the parties, and time constraints. Time constraints are due to patient volume, physician responsibilities, and explicit or implicit time restrictions imposed by patient insurers or physician employers. Communication is also complicated by a hesitancy to ask questions or give specific information, delays in accessing parties to transfer important information (usually, it is difficult to contact or recontact the physician), and poor communication skills. These difficulties do not universally exist among patients and clinicians—but are common enough to be discussed regularly in medical journals and in the popular media. Some of these problems are more frequently encountered in certain patient or physician subsets (e.g., certain medical specialties, practice locations, patient age groups, and cultural groups).

The crisis in donor organ and tissue supply is one of the most difficult challenges for transplant today. New policy initiatives, such as the driver's license option and required request, have been implemented in many states, with other initiatives, such as mandated choice and presumed consent, proposed in the hopes of ameliorating this crisis. At the same time, traditional acquisition of organs from human cadavers has been augmented by living human donors, and nonheartbeating human donors, as well as experimental animal and artificial sources. Despite these efforts, the crisis persists and is perhaps most tragic when it threatens the lives of children, driving parents to sometimes desperate measures. Herein, we address one very controversial step some parents have taken to obtain matching tissue or organs for their needy children—that is, having a child, in part, for the purpose of organ or tissue procurement.

Human rights law is a powerful, but often neglected, tool in advancing the rights and freedoms of persons with mental disabilities. International law may seem marginal or unimportant in developed countries with democratic and constitutional systems of their own. Yet, even democracies often resist reform of mental health law and policy, and domestic courts do not always compel changes necessary for the rights and welfare of persons with mental disabilities. Additionally, human rights are obviously important for countries without democratic and constitutional systems because they may provide the only genuine safeguard against abuse of persons with mental disabilities ostensibly based on political, social, or cultural justifications.

The advent of the Internet has had a significant impact on the formation of an information-driven, rapid-paced society. The number of Internet users reached 50 million in only five years compared to 13 years for television and 38 years for radio. Consumer expectation for access, convenience, and speed has made the cyberspace superhighway a medium for knowledge exchange and for e-commerce. The Internet offers a wide variety of health services and products to healthcare professionals as well as to the public. Online pharmaceutical sales are predicted to reach $20–25 billion over the next four years. This is a dramatic increase when compared to the $1.9 billion in 1999. At the click of the mouse, medications can be ordered and delivered conveniently to your door. Yet, consumer discomfort with the security of information provided via the Internet is growing, and recent incidents involving disclosure of healthcare information serve to heighten this concern.

Organ donation and transplantation touch on profound, and at times elusive, values and beliefs. These involve personal identity, embodiment, the relationship between the individual and the community, and death. Different cultural and religious perspectives, reflecting deeply ingrained but often unspoken assumptions about human identity and responsibilities, subtly but profoundly affect attitudes to donation and transplantation.

A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors' human “experiments” and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians' human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists' role in repressing dissent, Latin American and Turkish military doctors' complicity in torture, and even the South African medical profession's systematic involvement in apartheid may seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse compel an inquiry into medicine's vulnerability to becoming an adjunct to illicit state purposes.

Bioethics as it stands today is a typically American product, but whether it can be spread across the globe as easily as Coca-Cola remains to be seen. Historically, we can observe that the internationalization of bioethics has taken place in a form of concentric waves beginning in the United States and encompassing increasingly new territories having older roots. Born in the 1960s, bioethics as the study of ethical issues in life sciences began to permeate the Anglo-Saxon world. Ten years later it penetrated countries with developed liberal democratic traditions and remnants of the different Protestant attitudes to life where issues such as patients' rights, abortion, euthanasia, eugenics quickly started to appear frequently in newspapers, magazines, and on television. Then in the '80s the bioethics wave swept into the European community, and by the end of the '80s and early '90s bioethics advanced timidly into Eastern Europe. Because the difficult birth of bioethics in Eastern Europe is not widely known, the purpose here is to provide a perspective of that development, including its struggle with a totalitarian legacy, as well as to offer some comments as to how current cultural gaps between East and West, and especially between the Western and Orthodox worlds, might be bridged.

These CQ Sources were compiled by Bette Anton.

As new information and communication technologies (ICTs) are being applied in healthcare, the most obvious and seemingly the only questions to ask would be if they are clinically effective and if they deliver positive outcomes for patients. In the medical tradition, outcomes are usually assessed in randomized controlled trials (RCTs) through clear and well-understood criteria of safety and clinical effectiveness. These seem to be suitable and fully adequate for evaluating drugs. (Although, of course, drug prescribing is more complex and includes, among others, economic considerations.) But are these criteria useful or sufficient when applied to the evaluation of ICTs in healthcare? In this paper we argue that they are not. ICT-related applications are complex and diverse and require a different and more encompassing approach to evaluation.

The current concern with reforming and regulating managed care under the general rubric of “patients' rights” has eclipsed the more fundamental need to legislate the human rights of those without adequate access to any healthcare. To characterize the regulatory activity as a “rights” movement inflates its moral dimension. The concept of “rights” carries a serious and powerful moral force that is currently inappropriately applied to the parochial concerns of a segment of the population privileged to have health insurance coverage. By contrast, the language of “rights” refers to a high level of universality for the most rudimentary of human concerns. If there was a universal right to become a patient equal to other patients, a concept of patients' rights would have legitimacy. As it is, however, the central determinant of this “right” is how much the insurance policy costs and what is covered. To so diminish the meaning of “right” within the miasma of managed care is to lose sight of the real possibilities of applying a positive “right” to healthcare and, in the long run, is to diminish the ethics of healthcare.

Ethical questions about end-of-life treatment present themselves at two levels. In clinical situations, patients, families, and healthcare workers sift through ambivalent feelings and conflicting values as they try to resolve questions in particular circumstances. In a very different way, at the societal level, policy makers, lawyers, and bioethicists attempt to determine the best policies and laws to regulate practices about which there are a variety of deeply held beliefs. In the United States we have tried a number of ways to resolve the societal-level issues. We have ignored them, argued to try to convince others of our beliefs, voted to let the majority determine what is right or wrong, and turned to the courts to decide, as in the cases of Karen Ann Quinlan, Nancy Cruzan, and Jack Kervorkian. Yet none of these approaches has yet left us with comfortable, unambiguous cultural norms about issues such as euthanasia and physician-assisted suicide, which are readily assumed by “ordinary people” as they face individual and interpersonal dilemmas.

Within the latter half of the 30-year history of bioethics there has been an increasing pressure to address bioethical issues globally. Bioethics is not traditionally a theory-based enterprise, rather the focus has been problem related. With the introduction of the global perspective, theory has, however, become more important. One of the best known, probably the best known, theory of bioethics is the one presented by Tom L. Beauchamp and James F. Childress in their Principles of Biomedical Ethics in 1979. This theory is known as the “four principles” or the “Georgetown mantra” approach or “mid-level principlism.” It is the attempt to create a global framework for bioethics on the four principles—autonomy, justice, beneficence, and nonmaleficence—that I will scrutinize in this paper.

Our global knowledge of different cultures and the diversity of values increases almost daily. New challenges arise for ethics. This is especially true in the field of bioethics because the technological progress of medicine throughout the world is causing dramatic interactions with traditionally held values. Science and technology are rapidly advancing beyond discussions and corresponding political struggles over human rights, leaving those debates behind. This rapid development of science is at odds with the principle of sustained development that calls for measured and thoughtful planning, such that no new idea should rupture the delicate fabric of communities, environment, and cultural evolution.

It is now a widely shared opinion in the Western countries that a child's disability would probably place an unexpected burden on her parents, a burden that the parents have not committed themselves to dealing with. A child with a physical or mental disability is not, so to speak, a part of the package the parents ordered. This line of reasoning has recently been supported by Rosamond Rhodes in her article “Abortion and Assent.”

These CQ Sources were compiled by Judith Schaeffer Young.

These CQ Sources were compiled by Bette Anton.

Recent figures show that 151.7 million nonelderly Americans who had private insurance received that insurance from their employers (out of 167.5 million with private insurance). Employers who contract with health plans on behalf of their employees influence the health of their employees and, in turn, the nature and quality of the healthcare system in the United States. Despite the magnitude of their influence, they have been relatively free from both government and ethical guidance with respect to the specific substantive benefits they offer their employees. Employers have enormous discretion with respect to what substantive benefits they include in employer health plans because they are governed by the Employment Retirement Security Act (ERISA). But the decisions that employers make when they choose benefits for their employees are just as much rationing decisions in need of bioethical analysis as are the rationing decisions that are made at the bedside by patients, physicians, and their families. Moreover, even strong discretion, of the kind employers have, is subject to ethical standards.

These CQ Sources were compiled by Bette Anton.

When surgeons transplant animal organs into humans, people who did not receive the organs incur risks. These third parties may stand near or far in time or space. No one knows the likelihood, breadth, or nature of the risks in question. The common wisdom among infectious-disease specialists is that in the best of xenotransplant conditions, such third-party risk may be minimized but not eliminated.