In the summer of 1995, Thomas W. Parham went to his physician, Peter Arcan, for an ordinary check up. During his visit, Dr. Arcan suggested that Mr. Parham join a clinical trial studying a new drug to shrink enlarged prostates. Mr. Parham was confused because he never had prostate problems, but Dr. Arcan stated that the drug might prevent future difficulties. When asked why he joined the study, Mr. Parham stated, “I just followed his advice, just like if he said to take two aspirin instead of one. He’s a doctor and I’m not.”

Mr. Parham should not have been entered into the study because he had been hospitalized a year earlier due to a chronic slow heart rate, a clear study-exclusion criterion that would disqualify him from being a subject in the protocol. However, Dr. Arcan sought an exemption from the drug company stating that Mr. Parham’s heart rate was only “mildly slow,” failing to report the prior hospitalization. After Mr. Parham began taking the study medication, he complained of fatigue, a symptom of a slow heart rate. Within weeks, after requesting to be taken off the study, he was hospitalized and a pacemaker was implanted for his slow heart rate. The drug’s manufacturer, SmithKline Beecham P.L.C., was paying Dr. Arcan $1,610 for each patient enrolled in the study. The fee covered study expenses, but was sufficient to give the recruiting physician a profit for each subject enrolled.

In July 1997, the voting representatives at the National Consensus Conference (NCC) on Bioethics in Health Research voted unanimously to adopt the proposed Guidelines for the Conduct of Health Research Involving Human Subjects in Uganda (Guidelines). This vote represented the culmination of a three-year journey towards the development of a coherent and cohesive framework for the ethical review of health research involving human subjects in Uganda.

Attendees at the NCC included both voting representatives and non-voting participants. Voting representatives had been designated by the institutional entity with which they were affiliated to represent that entity at the NCC and to voice the concerns and opinions of the entity and its constituents.

According to Giles Scofield, ethicists can provide expert testimony in descriptive ethics and metaethics, but not normative ethics. Lawrence Schneiderman appears to disagree with this view, and presumably believes that it is appropriate for an expert witness in ethics to provide ethics testimony in all three areas. I draw this conclusion from several claims made in his commentary which aim to show that we would be contending experts if both invited to testify on a case involving claims about futile medical treatment. This disagreement aside, taken together both commentaries suggest that my testimony in the case of Andrew Sawatzky is wanting.

In the response that follows I do not engage in a debate about the content of my testimony.

In the late twentieth century the United States experienced a wave of cases concerning compelled obstetric interventions, cases which attracted much legal and philosophical interest. Behind and alongside them, however, lies a little known strand of authorities which concerns a parent wishing to refuse life-sustaining treatment and a hospital seeking to prevent this on the basis of the State's interest in protecting innocent third parties, usually the patient's dependent minor children. This issue appears to be unique to the United States. Although the leading case in point was influential in cases concerning compelled obstetric intervention, it has received little examination in its own right. This is a shame, since it spawned an intriguing line of cases worthy of reflection today.

The first meeting of the Global Forum for Bioethics in Research was initiated by the Fogarty International Centre of the National Institutes of Health (NIH) and sponsored by the World Health Organisation (WHO), the Pan American Health Organisation (PAHO) and the NIH. Held in Bethesda on November 7-10,1999, the intent was to bring together individuals involved in medical research in low- and middle-income nations to share views with each other and with organisations that support clinical research. Approximately 120 persons from 34 countries participated, including individuals from developing countries, pharmaceutical organisations, and communities where medical research is under way.

The participants addressed the partnerships required between research sponsors and investigators involved in clinical trials in developing countries and the long-term needs for international multicentred training programs.

Although the notion of physician value neutrality (PVN) in medicine may be traced back to the writings of Sir William Osler, it is relatively new to medicine and medical ethics. We argue in this paper that how physician value neutrality (PVN) has been cashed out is often obscure and its defense not persuasive. In addition, we argue that the social/political implementation of neutrality, Political Liberalism (PL), fails, and thus, PVN's case is weakened, for PVN's justification relies largely on the reasoning undergirding PL. For these reasons, we conclude that PVN has no philosophical or ethical warrant and thus should be abandoned. We suggest that the physician present to her patients some type of statement or creed that would give them an idea of where she stands on important axiological issues and how these stands are cashed out clinically.

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and Accountability Act (HIPAA) prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms.

The German Nazi regime has become a standard model for unspeakable things that one should reject. Contemporary people will characterize political opponents, benighted policies, and other undesirable things as “fascist” or “Nazi.” In ethics, and medical ethics in particular, this analogy arises regularly. Therefore, it is not surprising that German people are particularly sensitive about their history. For example, the German high court regularly refers to the Nazi era in its reluctance to accept lethal social activities. This sensitivity surfaced again in 1988, when influential applied ethicist Peter Singer accepted a German invitation to speak to a Symposium on “Bioengineering, Ethics, and Mental Disability.” Singer had also agreed to deliver a separate lecture on the topic “Do severely disabled newborn infants have a right to life?”

The Office of Inspector General (OIG), Department of Health and Human Services, has issued a proposed rule under section 5201 of the Omnibus Consolidated and Emergency Supplemental Appropriations Act for Fiscal Year 1999 (OCESAA) that would provide a safe harbor from civil sanctions under section 1128A(a)(5) of the Social Security Act for independent dialysis facilities that pay premiums for Supplementary Medical Insurance (Medicare Part B) or Medicare Supplemental Health Insurance Policies (Medigap) for financially needy Medicare beneficiaries with end-stage renal disease (ESRD).

End-stage renal disease is a chronic disease that requires regular dialysis treatments and monitoring of laboratory values, diet and medication. ESRD patients suffer from irreversible renal failure, often accompanied by diabetes, anemia, hypertension and congestive heart failure.

Malpractice lawsuits serve as a great source of pain, consternation and loss for physicians and patients alike, usually leaving all parties involved in the process with a sense of betrayal. A significant number of physicians will be sued at least once in their career, especially if they practice in some of the more vulnerable specialties. In addition, there is some evidence that the threat of malpractice lawsuits changes the practice style of many physicians, leading to the practice of “defensive medicine” and raises the total cost of health care. Clearly, the prevention of medical malpractice is an issue that deserves considerable attention from physicians and from those who train them.

Empirical evidence suggests that medical negligence may play a relatively minor role in malpractice lawsuits. As demonstrated by Localio, et al., one in thirty-five cases of negligence or incompetence actually results in a lawsuit.

To find adequate answers to a changing reality heavily influenced by advances in technology, medical professionals have developed and adopted an array of terms that have brought new concepts into the profession. “Dignity,” “vegetative state,” “futility,” “double effect,” and “brain death” have become indispensable words in the medical setting. In the following discussion, the attention is on terminology. If we believe in phenomenology, the assumption is that we should closely reflect on the words we use in all spheres of life, especially in those that concern life and death. This article calls for a sincere discussion about these terms and concepts. The thesis put forward is that the language in the medical setting serves primarily the physicians, at times at the expense of the patients’ best interests. This language and the concepts it describes have generated an unhealthy atmosphere for patients, which might lead to undesirable actions at the end of patients’ lives.

On April 6, 2000, Dr. J. Craig Venter of Celera Genomics told a Congressional committee that his company finished its analysis of the human DNA and would have a completed map of the human genome by early summer, 2000. Scientists expect the completed human genome to revolutionize drug therapies through the creation of treatments tailored to specific genetic makeups. In order to create a map of the human genome, three billion letters of DNA that encode eighty thousand genes must be identified and ordered. In March, 2000, Celera released a successful sequence of the fruit fly genome, and it employed the same methods in creating the human genome.

In December 1998, two groups of scientists announced that they had successfully isolated and cultured human pluripotent stem cells. This news was greeted with both tremendous enthusiasm and concern. Because these cells can develop into most types of cells or tissues in the human body, they hold great promise for scientific research and medical advances. For example, stem cells can potentially be used to:

• Generate cells and tissues for transplantation and therapy for conditions such as Parkinson’s disease, spinal cord injury, stroke, burns, heart disease, diabetes, and arthritis;

• Improve scientists’ understanding of the complex events that occur during normal human development, as well as the abnormal events which cause conditions such as birth defects and cancer; and

• Substantially change the development and testing of drugs. New medications could be tested initially on stem cells, and only drugs which were safe and effective on the cells would be tested further on laboratory animals and humans.