Even more so than in other areas of medicine, issues at the end of life elucidate the importance of religion and culture, as well as the role of the family and other social structures, in how these issues are framed. This article presents an overview of the variation in end-of-life treatment issues across 12 highly disparate countries. It finds that many assumptions held in the western bioethics literature are not easily transferred to other cultural settings.

As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and an expanding (...) array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions. (shrink)

The paper outlines the policy context and summarizes the numerous policy issues that AD raises from the more generic to the unique. It posits that strong public fears of AD and its future prevalence projections and costs, raise increasingly difficult policy dilemmas. After reviewing the costs in human lives and money and discussing the latest U.S. policy initiatives, the paper presents two policy areas as examples the demanding policy decisions we face. The first focuses on the basic regulatory function of (...) protecting the public from those who would exploit these fears. The second centers on the well-debated issues of advance directives and euthanasia that surround AD. Although more dialogue, education and research funding are needed to best serve the interests of AD patients and families as well as society at large, this will be challenging because of the strong feelings and divisions AD engenders. (shrink)

Rapid advances in cognitive neuroscience and converging technologies have led to a vigorous debate over cognitive enhancement. This book outlines the ethical and social issues, but goes on to focus on the policy dimensions, which until now have received much less attention. As the economic, social and personal stakes involved with cognitive enhancement are so high, and the advances in knowledge so swift, we are likely to see increasing demands for government involvement in cognitive enhancement techniques. The book therefore places (...) these techniques in a political context and brings the subsequent considerations and divisions to the forefront of the debate, situating their resolution within the milieu of interest group politics. The book will provide a starting point from which readers can develop a balanced policy framework for addressing such concerns. (shrink)

The centerpiece of Aldous Huxley's Brave New World is state control of the human reproduction process as a means of ensuring social stability. Although written as fiction, recent advances in human genetic and reproductive technology promise to give us more control over our biological destiny, including procreation. Concurrently, they create new social policy dilemmas, challenge prevailing "givens" of the human condition, and, technologically, increase the possibility of centralized control over reproduction. After reviewing the current status of human genetic technology and (...) discussing its use in the United States, this article analyzes the implications of these innovations for the future. (shrink)

As rapid advances in human genetic research are transferred into new areas of genetic technology, questions relatingto the use of these techniques will escalate. This paper examines some of the policy concerns surrounding recent developments in genetic screening. It discusses the impetus and implications of genetic screening in general, examines various applications, and analyzes the costs and benefits of screening programs currently in existence. Special emphasis is placed on whether or not screening should be considered a matter of public health (...) and mandated on those grounds. This paper argues against any compulsory screening programs except where the disease is easily identified, applicable across social groups, and treatable. While screening services for carriers of genetic disease and prenatal diagnosis should be made available and education programs should be expanded substantially, the burden of proof for involuntary programs is placed on the proponents. There is little public health justification at thb time for mandatory screening though this does not preclude future public health demands. It is argued that the goals and justification of various human genetic technologies must be examined at this time due to the rapid advancement of the research as well as the ultimate benefits promised for humankind. CiteULike Connotea Del.icio.us What's this? (shrink)

This brief review of the efficacy, safety, and costs of IVF demonstrates that this procedure has become accepted medical practice without adequate scientific assessment. Its rapid proliferation especially in the market-oriented USA system, has preceded the type of outcomes research that is essential in order to protect both individual patients and the health care system. In addition, concern over the psychological costs borne by the vast majority of women who unsuccessfully pursue pregnancy through these techniques should warrant a level of (...) caution which to date has not been forthcoming. The demand for pregnancy, the organisation of medical specialties surrounding these procedures, the open-ended reimbursement and incentive structure, and powerful market forces make it unlikely that IVF and a whole range of medical technologies can be regulated without some semblance of a national health system. These findings clearly reinforce the themes raised by the Radical Statistics Health Group and illustrate some of the weaknesses of a market approach to medical care. (shrink)

The 1990s “Decade of the Brain” stimulated research on many fronts and resulted in considerable advancement in neuroscience. Unfortunately, we have been slow to develop a policy dialogue to anticipate and deal with vast implications. Simply put, our political and social institutions have not kept pace with these advances. At the base, policy issues center on how we interpret the implications of these developments, especially given the complexity of the subject and the speculative nature of much of the evidence to (...) date. The issues discussed here go to the heart of the major problems facing the world today and challenge basic assumptions on both the right and the left of the political/ideological spectrum as well as the standard social science model of behavior. As a result, the findings of neuroscience are open to ideological maneuvering designed to put the most expedient spin on their meaning. (shrink)

Book reviewed in this article: Artificial Reproduction: A Social Investigation. By R. Snowden, G.D. Mitchell, and E. M. Snowden. Redefining Human Life: Reproductive Technologies and Social Policy. By Robert H. Blank. Reproductive Ethics. By Michael D. Bayles.

Rapid advances in biomedicine, accompanied by changing social values, are thrusting bioethical decision making into the political spectrum. This article examines the forces which are politicizing bioethical decisions and demonstrates the challenges they raise. It also presents an overview of the current political context and concludes that American political institutions and processes are not well-suited for dealing with these intense, sensitive bioethical issues. Although the article reflects skepticism concerning the ability of the political system to fulfill the expansive demands confronting (...) it, it ends by suggesting several potential adaptations which should make the process more responsive and the institution's actions more effectual. (shrink)