Anyone with so much as a passing familiarity with bioethics knows how significantly and persistently (at least since mid-century) the law has insinuated itself into healthcare and the process of bioethical decisionmaking. Viewed from the insular perspective of traditional medical practice and medical ethics, it is not surprising that the “legalization” of the patient–physician relationship and clinical judgment has been characterized by some as pernicious. What is much more surprising, however, is when a book by a professor of law evinces the same jaundiced view of the role of law in this area. Nonetheless, the “limits” that Professor Dworkin considers to be inherent in the capacity of the law to resolve bioethical issues are significant, and hence in his opinion the role of the law should be severely circumscribed. This gloomy portrait of the “havoc” wreaked by law upon the landscape of medical practice, painted by a lawyer, stands in stark contrast to an earlier and much more sympathetic account offered by Columbia University historian and medical humanities professor David J. Rothman in his 1991 book Strangers at the Bedside, the informative subtitle of which is A History of How Law and Bioethics Transformed Medical Decision Making.

Like many other locals, I was unprepared for the global media's invasion of Roslin. The former mining village just outside the southern city limits is best known to most Edinburgh citizens for its tiny, ornately carved medieval chapel. Constructed for Crusading Knights and long associated with Freemasons, Rosslyn Chapel was made famous by Sir Walter Scott's Lay of the Last Minstrel. Nowadays it is visited, in coachloads, by devotees of less literary and historically more dubious esoterica, many of whom believe that the Holy Grail and/or a ‘true’ version of the gospels are buried beneath it. In the local media, demands for the chapel's foundations to be excavated in search of secret clues to the meaning of life, death, and everything, have figured just as prominently as articles agonizing over scientific developments at the Roslin Institute, half a country mile away.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will igve you an opportunity to respond in the letters section. Your input is desired and anticipated.

Dr. McGee presents a cogent argument for the patentability of the diagnosis of gene forms that are found to be associated with disease or other phenotypic manifestations. We're convinced he's wrong. An analogy will help explain why.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

The decade-long debate over ownership of living human materials has recently intensified with the ability of biomedical research to isolate, purify, and use human genes and gene products as therapeutics, factories for the production of therapeutics, and targets for the identification of therapeutic pharmaceuticals. Indeed, advances in genomic research have resulted in the identification of hundreds of thousands of DNA fragments and hundreds of genes. Many within the scientific and business communities believe genes and gene fragments have commercial value and have filed patent applications on the nucleic acid sequences. This commercialization has amplified the discussion surrounding the ethics of patenting genes and the ownership of the human genome.

One strategy for defenders of gene patenting is to adopt a constructivist interpretation of genetic testing to avoid the “product of nature doctrine.” I argue that accepting this view (which seems to be the approach of the U.S. Office of Patents and Trademarks) results in an intolerable dilemma for physicians. They must either infringe patents or fail to act on all the medically relevant information they possess (malpractice).

The critical look at hospice care by Felicia Ackerman in Vol. 6 of the Cambridge Quarterly requires a response, since the author presents her view as having major implications for health policy. As a healthcare executive with over 25 years experience, and as a spokesperson for both my own program and others in the National Hospice Work Group, twelve of the nation's largest nonprofit hospices, I submit that her analysis of hospice care is naive. Ackerman's lack of practical understanding concerning the care of the terminally ill results in a discussion that misses the key policy issues.

To those defining euthanasia as a battle for the principle of self-determination, persons seeking physician assisted death (PAD) are soldiers in the fight for patient autonomy. The reasons they seek it, or the potential of other, non-life-threatening interventions is less important than this principle: individuals have the right not only to choose death (suicide), but to be assisted in dying. They should not be second guessed or denied on the basis of another's distaste for that decision. This paper offers a general review of deaths attributed to Dr. Jack Kevorkian's PAD practice in an attempt to answer two questions: Why do persons seek physician assisted death, and, to what extent does induced death seem, in retrospect, a reasonable and perhaps necessary medical response to specific patient complaints?

What motivates a polemic like Felicia Ackerman's “Goldilocks and Mrs. Ilyich: A Critical Look at the ‘Philosophy of Hospice’”? Ackerman announces that in addition to analyzing and criticizing hospice principles as embodied in the National Hospice Organization's “Philosophy of Hospice,” her article will also present “some discussion of hospices in actual practice …” She presents, in fact, two examples of hospice practice: one is a dubious anecdote, the meaning of which she apparently misunderstands, and the second is a description of a twenty-year-old policy of St. Christopher's Hospice in England, which, I believe, is no longer strictly adhered to.

Tom Koch's review of Jack Kevorkian's “subjects” is a valuable look at this one (in)famous crusader's practices. The immediate question raised, and to which Koch provides his own perspectives, is what practical conclusions might be drawn from the final experiences and actions of this cohort of suffering individuals. My briefest and perhaps flippant answer is “few, if any”—including, unfortunately, those derived or hinted at by Koch himself.

The patient was a 19-year-old man who was the victim of an accidental head injury. The attending neurosurgeon felt that, due to uncontrollable and repeated elevated intracranial pressures, the patient would die within 48 hours. The patient's mother requested that the neurosurgeon contact a urologist to collect the patient's sperm for implantation into the patient's girlfriend. The neurosurgeon felt that the situation raised a number of ethical issues and requested that the hospital's bioethics committee consider the case.

This is an interesting case in that posthumous reproduction involves complex legal and moral problems. But I do not think it is a hard case, because there is no indication that the patient wished to parent a child with his woman friend, posthumously or otherwise.

Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

Don't you just know it. It's a relatively peaceful day and you are getting some quality work done when the phone rings. The caller requests help in the form of an ethics consult. When you first hear about it you think someone is pulling your leg, but no, this is the real world. A case like this exemplifies many of the twists and turns of fact, and belief, that accompany many clinical ethics consultations. Several of the facts of the case generate an immediate emotional response that tempts the mind to run with them down enticing and confusing paths of thought. The “child,” age 19, is a minor in some states, but not in many. This introduces the whole notion of decisionmaking by parents or designated surrogates. Additional information suggests the comatose victim's mother is the prime motivator behind the request. The various motivations for the mother are revealed, primarily her desire to have a grandchild. The patient's own feelings are portrayed as ambivalent and the potential recipient, after the patient's sisters had been excluded because of consanguinity, is a 16-year-old girl who didn't even show up at the care conference. You are also told that the technical feasibility of the medical procedure under consideration is questionable and, of course, your legal department can't give you a straight answer—just hazard a guess.

In this case, the patient's mother repeatedly asked (1) about the health of any prospective child and (2) whether she would be assured some custodial role. She also questioned the role of the prospective recipient. The committee facilitated obtaining the necessary information, sharing this information with the surrogate, and assisted the surrogate and two of her daughters to share both their feelings and additional information they possessed.

The journal Nature Genetics recently reported a statement made by Dr. Brigitte Boisselier declaring the rights of parents to clone themselves. Dr. Boisselier is the scientific director of Clonaid—a Bahamas based company that plans to offer human cloning for $200,000. Does this offer have the same scientific credibility as Captain Kirk requesting “Beam me up, Scotty!”? How do we begin to respond to this offer and Dr. Boisselier's claim for its ethical justification?

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, “What might we do of practical use in preparation for the Supreme Court's ruling?” Based on the old principle of “think globally, act locally,” the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question.