The possibility of creating human embryonic stem cell lines from the inner cell mass of blastocysts has led to considerable debate about how these scientific developments should be regulated. Part of this debate has focused on the ethical analysis and part on how this analysis should influence policymaking.

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

Finland is a country in Northern Europe with a population of approximately 5.1 million people. It lies between Sweden and Russia and has a border with Norway too. It is part of the European Union and also belongs to the European Monetary Union. It is a welfare state in the sense that healthcare services, schools, universities, and social services are for the most part paid for by tax-based funding. In terms of basic healthcare, the state, through local municipalities, provides comprehensive coverage to all residents, and this is utilized by both the wealthy and the poor.

Professionalism, like common sense, remains a timeless ingredient in the ethically successful practice of medicine in the twenty-first century. Professional ideals are particularly relevant in times of economic and social upheaval, medicolegal crises, provider shortages, and global threats to the public health. The American Board of Internal Medicine specifies professionalism as “constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.” Because of its transcendent nature, professionalism, like ethics, is also considered “a structurally stabilizing, morally protective force in society.” Professions enjoy tremendous deference and autonomy in exchange for three unwritten but prerequisite promises: expert knowledge, self-regulation, and a fiduciary responsibility to place the needs of the client ahead of self-interest. Many educators suggest that professionalism includes additional characteristics such as honesty, altruism, temperance, commitment, integrity, and suspension of self-interest. However, there are large gaps in providing more user-friendly and operational models of professionalism to learners and evaluators at all levels of the academic hierarchy.

In two articles about the controversy surrounding stem cell research, Søren Holm claims that no argument has so far been advanced in the debate to justify the necessity of destructive research on human embryos for the therapeutic potential of stem cell research to be achieved, and that it is up to the scientists themselves to produce “convincing arguments” for their case. This seemingly defeatist statement on behalf of bioethics originates from the viewpoint that neither a reiteration of old arguments about the moral status of the human embryo nor the generation of new arguments of the same kind are likely to have any positive bearing on the controversy; on the other hand, the impact of science on the current debate is unquestionable, due to three “partially independent” developments:

Given the money, prestige and power at stake in high-level sports, ethical lapses are hardly surprising. Nor are the rules, people, and organizations we entrust to punish infractions and ensure fair play. Similarly, the high stakes involved in medical education invite ethical slips. Yet, there are not only few referees in this all-important “game,” but also the subject itself has been almost entirely off-limits in the academic literature.

In Japan, modern biomedical ethics emerged in the early 1980s. One of the main triggers was the nationwide debate on organ transplantation and brain death. A lengthy process of academic, religious, and political discussion concerning organ transplantation, lasting well over a few decades, resulted in the enactment of the Organ Transplantation Law in 1997.1 The defining of death and other bioethical issues, including death with dignity and euthanasia, were also stimulating topics throughout the latter end of the twentieth century. For instance, the death-with-dignity movement, which started around the late 1960s, developed into a hospice/palliative-care movement by the end of the 1980s.

What do the terms “profession, professional, professionalism” mean in 2002? One dictionary defines profession as “a calling requiring specialized knowledge and often long and intensive academic preparation,” and it defines professionalism as “the conduct, aims, or qualities that characterize or make a profession or professional person.” These definitions are appealingly simple. Complexity arises when we add the term “medical” as in the medical profession, a medical professional, or medical professionalism; and, here a specific understanding of “the conduct, aims, and qualities that characterize” the field of medicine is required. To complicate matters, professionalism applies to both the profession as a whole as well as the individual professional persons, such as the physicians.

These CQ Sources were compiled by Bette Anton.

In the early 1990s, the primary problem in Russian bioethics was to gain the attention and recognition of the public and the medical establishment. Very few people were even familiar with the word “bioethics.” Within medical education, only a paternalistic and scholastic “medical deontology” was viewed as the professionally acceptable way to deal with the existing moral problems. The public was ignorant of the rights of patients and consumers of medical services. The usual way of resolving conflicts between patients and physicians was to complain to medical authorities. Very few cases of disputes were brought to the courts. Representatives of religious groups did not participate in discussions involving dilemmas generated by progress in biomedical technologies, and they did not seek to influence legislation in this area.

Medical residency—specialty training after the completion of medical school—is an essential component of medical education and is required in order to be a licensed, independent medical practitioner in most jurisdictions. As things currently stand in the United States, the match between medical school graduates and residency programs is governed by a match between rank-order lists prepared by candidates and residencies alike. An applicant picks a number of residency programs and ranks them according to order of interest. The residency program prepares a similar list, ranking the candidates it most wants in its program. A computer program compares the rankings and makes assignments according to a certain algorithm. Using these lists, the match system assigns approximately 24,000 applicants to approximately 21,000 training positions in pediatrics, obstetrics and gynecology, internal medicine, and the rest. These assignments are then announced to all parties on specific days. The system has been in place since 1952 and is overseen by the National Residency Match Program (NRMP), a nonprofit organization. This system has several advantages. First of all, it standardizes the timetable for decisions, and applicants are in no position to tie up offers while waiting to hear from other institutions. Institutions are not held captive, either, in making assignments while waiting to hear from particular parties.

Recently, the U.S. House of Representatives voted, for the second time in two years, to ban all human-cloning research, whether the research involves reproduction or creating cells that might be used to understand and treat disease. As I explain in this article, the proposed legislation has important implications not only for human cloning research but also for research in general.

On May 18, 2001, the Korean Bioethics Advisory Commission (KBAC), sponsored by the Ministry of Science and Technology, published a set of recommendations for biotechnological research and application, including scientific experiments with human embryos. Four days later, the KBAC held a public hearing to finalize its recommendations. Since then, public reaction and debate over the ethical aspects of human embryo research have actively surfaced. Most leaders of religious organizations, especially Catholic churches, objected to any type of embryo research. On the other hand, some leaders of the scientific community supported freer scientific research on human embryos.

Although space limitations do not permit including all the responses received after the passing of David Thomasma, some representative expressions are included below. As these remembrances attest, Edmund Pellegrino spoke for all of us when he said at David's memorial service, “It has been said that we die only when forgotten; if so, David will live a long time. He remains a presence for his family, friends, collaborators, and all who met him.”

This paper explores the implications of human reproductive cloning for our notions of parenthood. Cloning comes in numerous varieties, depending on (among other things) the kind of cell to be cloned, the age of the source at the time the clone is created, the intended social relationship, if any, between source and clone, and whether the clone is to be one of one, or one of many, genetically identical individuals alive at a time. The moral and legal character of an act of cloning may, moreover, differ in light of these distinctions. Surprisingly, however, reproductive cloning in all its variety seems to undermine the view of parenthood that is most popular among proponents of reproductive technology in the bioethics literature. This view, geneticism, has much to recommend it. I will show, however, that as commonly understood, geneticism is incompatible with the reproductive view of cloning. I then canvass alternative accounts of parenthood—namely, conventionalism, gestationalism, and intentionalism—but none succeeds in explaining reproductive cloning. I thus return to a reconstructed version of geneticism. I argue that the problem for geneticism rests not with the notion of genetic parenthood as such but with a particular, flawed, understanding of it, which I call informational geneticism. Informational geneticism should be rejected in favor of a “physicalistic” version of geneticism, which treats genes as particular objects, not abstract types, and takes seriously the essentially embodied character of reproduction. For these reasons, physicalistic geneticism survives the challenge represented by reproductive cloning. Additionally, physicalistic geneticism accommodates attractive aspects of competing views of parenthood, meeting some powerful objections in the process.

In April of 2001 I published a brief commentary in the journal Academic Medicine questioning the current character and functioning of the National Residency Matching Program (or “the match,” as it is known in medical schools and teaching centers). The purpose of the article was to stimulate a rethinking of process. At 50 years old, the environment through which the match operates (and has helped to create) has changed, and as such I thought it time to ask ourselves whether or not the match, its algorithm, and, more important, the values it manifests might well need an overhaul.

Residents in long-term care facilities and rehab hospitals sometimes ask healthcare professionals (HCPs) to help them do things that HCPs judge to be on balance harmful. A person with respiratory problems may ask for a cigarette, a diabetic for alcohol, a dysphagiac for food or fluids by mouth, a person at risk for falling for her walker, and so on. These requests raise two kinds of problems. The first pits residents against HCPs. Should HCPs ever help residents do what they consider harmful? The second pits HCPs against HCPs. If HCPs disagree among themselves—some thinking that the resident should receive the assistance, others thinking not—what should be done?

“What is a poet? An unhappy person who conceals profound anguish in his heart but whose lips are so formed that as sighs and cries pass over them they sound like beautiful music.” These opening lines from Kierkegaard's Either/Or signify a tragic state of affairs because the poet brings joy to others and yet experiences no joy himself. In a similar vein, consider the child prodigy—Bobby Fischer, Shirley Temple, Mozart. Although there is no question that these children were gifted, there is some debate about how happy their childhoods were. There are benefits to just “being a kid,” and it is not clear that these individuals had that opportunity.

Most physicians confront the moral and technical challenges of treating persons who are coming to the natural end of their lives. At the level of the health system, this issue becomes a more pressing area for reform as premature death decreases and more people live a full life span. Well-developed countries and international organizations such as the World Health Organization (WHO) and the Organisation of Economic Cooperation and Development (OECD) have made recommendations for improving healthcare problems in aging societies. Turkey belongs to the WHO and the OECD. This article describes end-of-life healthcare in Turkey, the design of the healthcare system to meet this need, challenges that should be addressed, and solutions that would be appropriate to Turkish culture and resources.

On September 4, 2001, press reports indicated that the Defense Intelligence Agency of the U.S. Department of Defense (DOD) planned to reproduce a strain of anthrax virus suspected of being held in Russian laboratories. According to the same reports, the Central Intelligence Agency (CIA), under the auspices of Project Clear Vision, is engaged in building replicas of bomblets believed to have been developed by the former Soviet Union. These small bombs were designed to disperse biological agents, including anthrax. Government attorneys were said to be confident that, because these projects were designed to develop defensive measures, they were not in violation of the 1972 Biological and Toxin Weapons Convention.