In an interview just before his death, Issan Dorsey, an American Zen priest and abbot of the Hartford Street Zen Center, stated, “AIDS is not fatal. Life is fatal. If you have AIDS, you are alive.” Although infected with AIDS, Issan worked to establish the Maitri Hospice for those dying from complications related to AIDS in the San Francisco Castro District, the heart of the gay and lesbian community. His efforts reflect the statement–although the body may be diseased, one can continue to give abundantly and tirelessly, articulated by Vimalakirti in the Vimalakirtinirdesa Sutra (Sutra on the Teaching of Vimalakirti).

The healthcare system in the new Russia is in an agonizing flux of political, economic, and ideological turmoil. The individual in this system, comfortable with the long-established policies of the former Soviet system, is now confronted with instability, rapid change, and an uncertain future.

Healthcare Providers advising patient surrogates on the appropriateness of continued care for comatose patients have often been sharply criticized for coercive behavior toward patient surrogates; with failing to provide them with adequate information; and for a general failure to adequately cinsider the cimplex needs and hopes of patients, their surrogates, and caregivers. Because decisions on the continuation or withdrawal of care (for example where tube feeding or respiratory assistance are required for nonresponsive patients) often need the legal approval of surrogates the failure of both medical personnel and patient families to understand each other's priorities may lead to ethical and interpersonal conflict.

Reports about possible genetic bases of homoerotic sexual orientation in adults have received a kind of schizophrenic social reception. On the one hand, these reports have been welcomed by some gay men and lesbians as biological confirmation of the commonly held view that sexual orientation is an involuntary trait, that sexual orientation is not in any meaningful sense chosen. Simon LeVay has received mail from thankful correspondents who welcomed his 1991 report about the possible neuroanatomical basis for male homoerotic sexual orientation, and some legal analysts see important implications of biological studies for the ways in which civil rights are recognized, especially those that depend on an immutable characteristic like race or gender.

The prevention of disability has been the driving force behind much research. In epidemiology three levels of prevention are defined: primary, secondary, and tertiary prevention. Primary prevention is the prevention of the initiation or occurrence of a disease; secondary prevention is the prevention or amelioration of the consequences of a disease, and tertiary prevention refers to rehabilitation or the limitation of disability associated with the disease. We have examples of all three levels of prevention in the area of childhood disability. Primary prevention is the protection of infants against congenital rubella syndrome by ensuring that women of childbearing age have adequate immunity before they become pregnant. The prevention of choreoathetosis, mental retardation, and deafness, by treating hyperbilirubinemia and preventing kernicterus in newborns, is a great success story in prevention. Similarly, at the level of secondary prevention, is the reduction in mental retardation caused by phenylketonuria, or PKU, by eliminating phenylalanine in the diets of newborns who lack the enzyme to metabolize this amino acid. Tertiary prevention is the area of rehabilitation medicine, and is regarded as the least desirable level of prevention. Indeed, tertiary prevention can be seen as “doing the best we can” in terms of rehabilitation, often while seeking a means of really preventing the disease.

Few ethics committees were in place when the New Jersey Supreme Court announced its ruling on the Quinlan case in 1976. Today, the vast majority of hospitals have formed ethics committees and their use in nursing homes and other healthcare facilities is growing. Given the increasing commitment to the use of ethics committees and their increasing influence on healthcare decision making, the careful evaluation of committee performance should be a high priority. Yet to date ethics committees appear to have undergone relatively little scrutiny. While professional articles on ethics committees do appear and at least one journal (CQ) sets aside a regular section for the discussion of “Ethics Committees at Work” articles to date have primarily been limited to essays, philosophical inquiries, reports, case studies, and, occasionally, surveys. The use of more structured research methodologies has been lacking. As a result, it is not yet clear, for example, what characteristics describe the best functioning ethics committee. Indeed, what constitutes best functioning lacks careful definition as well. Committee impact on medical decision making and patient outcomes, while discussed, has not been systematically measured and analyzed.

I work at a research institute where the staff spends its time thinking about ethical issues that arise with progress in medicine, the life sciences, and technology. After such thinking, we make public policy recommendations. We pride ourselves in the diversity of our staff: there is a doctor, a lawyer, a linguistic anthropologist, a political scientist, a theologian, some philosophers, and so on. Both men and women do research and we are religiously diverse: Catholics, Jews, Protestants, and atheists

In March 1988 the People's Republic of China announced the birth of the first test-tube baby born to a 39-year-old infertile peasant woman. This surprise announcement appeared in strong contradiction to China's population reduction goals amidst a population crisis. Yet, the media attention given to this medical achievement would seem to be consistent with the political, social, and economic changes taking place in the last decade, including technological innovation as the key to a modern socialist nation. In short, this announcement highlights tensions facing China as it simultaneously attempts to modernize within a trans-national economy, control population, and maintain traditional Confucian family values within a rapidly changing context.

On the morning of December 2, 1994, after a preceding afternoon of discussion, the Advisory Committee to the Director of the National Institutes of Health (NIH) unanimously voted to approve the recommendations of the Report of the Human Embryo Research Panel. Panel members like myself who were present were elated. The vote marked the culmination of nearly a year of work. Approval of the report also represented a decisive step forward in bringing an end to a 15-year long moratorium on federally funded research on the preimplantation human embryo and techniques of in vitro fertilization.

In September 1994, the New York Times carried a front page article declaring healthcare reform dead in Congress. The obituary on healthcare followed a Congressional decision not to pursue the issue further in 1994. Although Congress and the President will likely revisit healthcare reform during 1995, the choices may be between various incremental steps, rather than substantive changes to bring about universal coverage.

The problem of physician-assisted death (PAD), assisted suicide and active euthanasia, has been debated predominantly in the ethically familiar vocabulary of rights, duties, and consequences. Patient autonomy and the right to die with dignity vie with the duty of physicians to heal, but not to kill, and the specter of “the slippery slope” from voluntary euthanasia as a last resort for patients suffering from terminal illness to PAD on demand and mercy killing of “hopeless” incompetent patients. Another dimension of the debate over PAD concerns the evaluative question of what constitutes a good death. At stake are Issues of character and virtue in the face of death and dying and their Implications for legitimizing the practice of PAD. Critics of PAD argue that “natural” death in the context of comfort care, as provided by hospice programs, is the good death. In contrast, PAD amounts to an easy way out, an evasion of the ultimate human challenge and task of dying. Because hospice care is clearly preferable to PAD, the former should be encouraged and the latter remain prohibited.

Hong Kong is a territory of only 400 square miles in size, but with a large population of six million people. We have excellent medical facilities in both the public and private sector and the general health indices of the population are good, with low infant mortality rates (5 per 1000) and long life expectancies (75 years for men and 80 for women).

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.

It is now 110 years since the first reported medical use of donor insemination (DI). Despite its somewhat doubtful beginnings and its chequered history, especially up until the 1970s, DI has become a well accepted and utilised part of most infertility treatment services. An American survey in 1988 reported that approximately 80,000 women a year undergo the procedure, and that over 30,000 children are born each year. The only figures from the United Kingdom cover a 5-month period between August 1 and December 31, 1991, and show that 4,260 patients were treated with DI during this period. The treatment was carried out in 85 different centres.

Before sailing past the sirens' “flowery meadow,” Ulysses instructed his sailors to lash him to the mast so that he would not succumb to the siren's singing. His advance directive demonstrated that he valued his dispositional or long-term autonomy over his unquestioned right to make decisions. He also indicated to his oarsmen that he understood the nature of temptation and his inability to resist it. Ideas of autonomy and sexual choice are central to this discussion of new AIDS treatments, especially the trials of preventative vaccines. Questions arise over the rights of individuals and the extent that these should be limited by concerns of the gay community. Should the gay community intervene in the risky decisions of individuals if no explicit advance directive exists? If so, how do they justify their paternalism? Could their aims not be better served through strengthening the individual dispositional autonomy of trial participants rather than making specific claims about the common good?