Since the development of the first neural prosthesis, that is, the cochlear implant in 1957, neural prosthetics have been one of the highly promising, yet most challenging areas of medicine, while having become a clinically accepted form of invasiveness into the human body. Neural prosthetic devices, of which at least one part is inserted into the body, interact directly with the nervous system to restore or replace lost or damaged sensory, motor, or cognitive functions. This field is not homogenous and encompasses a variety of technologies, which are in various stages of development. Some devices are well established in clinical practice and have become routine, such as cochlear implants. By comparison, other technologies are in experimental phases and still need to be further developed to achieve the desired results.

The goal of this article is to explore how a social justice framework can help illuminate the role that consent should play in health and science policy. In the first section, we set the stage for our inquiry with the important case of Henrietta Lacks. Without her knowledge or consent, or that of her family, Mrs. Lacks’s cells gave rise to an enormous advance in biomedical science—the first immortal human cell line, or HeLa cells.

Reviews of philosophical books run the risk of being either excessively and unconstructively critical or superficially praiseworthy. To avoid both these risks, we test the approach outlined by Häyry in his book Rationality and the Genetic Challenge: Making People Better? by applying it to an eighth genetic challenge, namely, a variation of the genetic enhancement challenge discussed by Häyry as it applies to sports. We assess whether genetic enhancement in sports should be conceived as an eighth wonder or an eighth cardinal sin that stems from the interaction between genetics and society, question whether Häyry’s nonconfrontational approach is really useful for dealing with these issues, and discuss how his method can be improved.

In speculating on the motives for government, English philosopher Thomas Hobbes identified the pervasive role of fear and the danger of violent death, holding famously that where no government prevails to secure physical safety and property, there can also be no enduring knowledge, art, or civilization—leaving human lives “solitary, poore [sic], nasty, brutish and short.”

The claim that the answers we give to many of the central questions in genethics will depend crucially upon the particular rationality we adopt in addressing them is central to Matti Häyry’s thorough and admirably fair-minded book, Rationality and the Genetic Challenge. That claim implies, of course, that there exists a plurality of rationalities, or discrete styles of reasoning, that can be deployed when considering concrete moral problems. This, indeed, is Häyry’s position. Although he believes that there are certain features definitive of any type of thinking that can accurately be labeled rational, he maintains that nothing about that set of features compels us to conclude that there is a single rationality. What is more, and significantly for the way in which Häyry’s book develops, there is no Archimedean point from which we are licensed to pronounce one flavor of rational deliberation to be intrinsically superior to any other or to be justified to the exclusion of all others. To this belief that “there are many divergent rationalities, all of which can be simultaneously valid,” we can perhaps give the name “the Doctrine of the Plurality of Rationalities” or, for short, “DPR.”

Applying bioethical principles can be difficult in resource-poor environments, particularly for Western doctors unfamiliar with these limitations. The challenges become even greater when clinicians must make rapid critical decisions. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances.

With the development of large-scale health registries and human biobanks to be used as research infrastructures, bioethicists, lawyers, philosophers, and social scientists have worked intensely to cast light on current challenges to the principle of informed consent.

This paper is structured in three sections. The first discusses the institutional framework pertaining to bioethics in Serbia. The functioning of this framework is critically assessed and a number of recommendations for its improvement presented. It is also emphasized that philosophers are underrepresented in public debate on bioethics in Serbia. Second, this underrepresentation will be related to two issues that figure prominently in Serbian society but are not accompanied by corresponding bioethical discourses: the first is abortion and the second is the largely unrestricted use of neuropharmacology since the 1990s, both for therapeutic and for cosmetic/recreational purposes. Finally, the perspective of bioethics in Serbia is addressed. It is asserted that this perspective can be based on the enhancement of public philosophical debate on bioethical issues, especially those with notable features in Serbian society (such as abortion and neuropharmacology). Such enhancement would also strengthen the corresponding institutional and legal frameworks.

It is a funny thing with the Dutch. On one hand, they seem preoccupied with death and adamant that patients be allowed to decide for themselves in what way they want to die. On the other, contrary to popular belief, the Dutch physician is allotted a very influential role in treatment decisions, far more prominent than in many other Western countries. From an American perspective Dutch professional ethics may seem quite paternalistic: a patient’s freedom to decide to have a particular medical treatment is limited by the physician’s professional assessment of the medical need of this treatment. The question arises: What is the relationship between the professional responsibility of Dutch physicians and the right of Dutch patients to decide for themselves? This question is illustrated by the ongoing national debate in The Netherlands on euthanasia and the growing demand for a further reaching right to self-determination concerning ending one’s life. However, contrary to popular belief, not all Dutch ethical debate concerns end-of-life questions.

In Rationality and the Genetic Challenge: Making People Better? Matti Häyry provides a clear and informed discussion and analysis of a number of competing answers to the above questions. Häyry describes three main perspectives on the morality of prenatal genetic diagnosis (PGD), the “restrictive,” “moderate,” and “permissive” views, and his analysis illuminates that these views can be distinguished in terms of their different “rationalities”—their respective understanding of what counts as a reasonable choice for parents to make in light of PGD.

The process of research is often lengthy and can be extremely arduous. It may take many years to proceed from the initial development of an idea through to the comparison of the new modalities against a current gold-standard practice. Each step along the way involves rigorous scientific review, where protocols are scrutinized by multiple scientists not only in the specific field at hand but related fields as well. In addition to scientific review, most countries require a further review by a panel that will specifically address the ethics of the proposed research. In Canada, those panels are referred to as Research Ethics Boards (REB), with the United States counterparts known as Institutional Review Boards (IRB).

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.

In China, state investment into public hospitals has radically decreased since the early 1980s and has brought on the dismantling of the healthcare system in most parts of the country, especially in rural areas. As a result of this overhaul, the majority of public hospitals have needed to compete in the so-called socialist market economy. The market economy stimulated public hospitals to modernize, take on highly qualified medical professionals, and dispense new therapies and drugs. At same time, liberalization has clearly affected the attitude and behavior of both medical professionals and the general public. The public has many concerns about the healthcare system for various reasons: there are long hospital waiting lists, patients experience difficulties in obtaining an appointment to see a qualified doctor, and, over the past decades, there has been an increase in out-of-pocket healthcare expenditure. These and other changes in post-reform China have radically reshaped the doctor–patient interaction, which is increasingly eroded by tension and violence.

As the authors of the Millennium Development Goals (MDG) Gap Task Force have noted, access to medicines is a vital component of realizing the human right to health. Without reliable access to drugs, the highest attainable standard of health cannot be achieved.

At the Cambridge Consortium for Bioethics Education held in New York in April 2010 (refer to CQ Vol. 19, No. 4, p. 430), participants were asked to submit three to five of their favorite bioethics readings, ones they recommend for curriculum lists as well as those they find personally useful. Their responses are compiled below. Some entries received several mentions, others a single one. Some picks are traditional favorites, others are less well known. As a point of interest, the reading most often recommended was Rachels J. Active and passive euthanasia. New England Journal of Medicine 1975;292(2):78–80.

Dying before one’s time has been a prominent theme in classic literature and poetry. Catherine Linton’s youthful death in Wuthering Heights leaves behind a bereft Heathcliff and generations of mourning readers. The author herself, Emily Brontë, died young from tuberculosis. John Keats’ Ode on Melancholy captures the transitory beauty of 19th century human lives too often ravished by early death. Keats also died of tuberculosis, aged 25. “The bloom, whose petals nipped before they blew, died on the promise of the fruit” is how Percy Bysshe Shelley expressed his grief over Keats’ death. Emily Dickinson wrote So Has a Daisy Vanished, being driven into depression by the early loss of loved ones from typhoid and tuberculosis.

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.

These CQ Sources were compiled by Bette Anton.