The Pittsburgh protocol is ethically and legally acceptable as written, but more research is needed to determine if it can be implemented in ways that will observe the procedures that make it ethically acceptable. If so, its desirability as public policy will depend on the number of organs it is likely to generate and its effects on public attitudes toward organ donation generally. In the final analysis, the controversial aspects of this protocol concern symbolic issues about respect for the (...) dead and near dead, rather than substantive concerns that real patient interests will be harmed. (shrink)

A great deal has been learned in the past fifteen years from the study of pain mechanisms. More recently, the relief of pain has begun to receive much needed attention as well. Although most, if not all, acute and cancer pain can be relieved, recent evidence shows that inadequate treatment of pain is still common among the general population—even for pain due to cancer. Inadequate treatment of cancer pain is even more likely if the patient is a member of an (...) ethnic minority, female, elderly, or a child. Evidence also suggests that substance abusers are at risk for poor pain treatment.A number of barriers which involve problems of knowledge, attitudes, and laws and regulations affect health care professionals, patients, and the health care system; collectively, they contribute to the inadequate treatment of pain. (shrink)

A great deal has been learned in the past fifteen years from the study of pain mechanisms. More recently, the relief of pain has begun to receive much needed attention as well. Although most, if not all, acute and cancer pain can be relieved, recent evidence shows that inadequate treatment of pain is still common among the general population—even for pain due to cancer. Inadequate treatment of cancer pain is even more likely if the patient is a member of an (...) ethnic minority, female, elderly, or a child. Evidence also suggests that substance abusers are at risk for poor pain treatment.A number of barriers which involve problems of knowledge, attitudes, and laws and regulations affect health care professionals, patients, and the health care system; collectively, they contribute to the inadequate treatment of pain. (shrink)

Perhaps the most significant law affecting the provision of health services to the American Indian and Alaska Native population is the Indian Self-Determination and Education Assistance Act of 1975. This Act allows tribes to assume the management and control of health care programs from Indian Health Service and to increase flexibility in health care program development. Under ISDEAA, tribes have the option to contract or compact with IHS to deliver health services using pre-existing IHS resources, third party reimbursements, grants, and (...) other sources. Typically, tribes develop their own non-profit health care corporations to provide services to their community, and as a result are eligible for grants and other types of funding not available to federal agencies like IHS. (shrink)

Perhaps the most significant law affecting the provision of health services to the American Indian and Alaska Native population is the Indian Self-Determination and Education Assistance Act of 1975. This Act allows tribes to assume the management and control of health care programs from Indian Health Service and to increase flexibility in health care program development. Under ISDEAA, tribes have the option to contract or compact with IHS to deliver health services using pre-existing IHS resources, third party reimbursements, grants, and (...) other sources. Typically, tribes develop their own non-profit health care corporations to provide services to their community, and as a result are eligible for grants and other types of funding not available to federal agencies like IHS. (shrink)

Childhood obesity has become a central concern in many countries and a range of policies have been implemented or proposed to address it. This co-authored book is the first to focus on the ethical and policy questions raised by childhood obesity and its prevention. -/- Throughout the book, the authors emphasize that childhood obesity is a multi-faceted phenomenon, and just one of many issues that parents, schools and societies face. They argue that it is important to acknowledge the resulting (...) complexities and not to think in terms "single-issue" policies. -/- After first reviewing some of the factual uncertainties about childhood obesity, the authors explore central ethical questions. What priority should be given to preventing obesity? To what extent are parents responsible? How should we think about questions of stigma and inequality? In the second part of the book, the authors consider key policy issues, including the concept of the 'obesogenic environment,' debates about taxation and marketing, and the role that schools can play in obesity prevention. -/- The authors argue that political debate is needed to decide the importance given to childhood obesity and how to divide responsibilities for action. These debates have no simple answers. Nonetheless, the authors argue that there are reasons for hope. There are a wide range of opportunities for action. Many of these options also promise wider social benefits. (shrink)

During 1980–90, Japan's annual real GDP growth rate was 4.6%, but which declined to 1.2% in the 1990s. While the drop in itself is a problem, at the same time it exacerbated many other problems, namely inequality, budget deficits, and the increasing burden of an aging society.

Written not by a journalist or politician but rather by a theology professor with a Ph.D. in New Testament studies, Voting by the Bible: The Economic and Foreign Policy Issues begins with the assumption that God intended the Bible to give guidance to every area of life£including how governments should function. Derived from author Wayne Grudemþs magisterial Politics£According to the Bible, this book highlights those economic and foreign-policy issues that have dominated political debate recently. Throughout, author Wayne Grudem (...) supports political positions that would be called more 'conservative' than 'liberal.' However, 'it is important to understand that I see these positions as flowing out of the Bible's teachings rather than positions I hold prior to, or independently of, those biblical teachings,' he writes. 'My primary purpose in the book is not to be liberally or conservative, or Democrat or Republican, but to explain a biblical worldview and a biblical perspective on issues of politics, law, and government.' Concise yet carefully argued, this book is a must-read for any Christian concerned about current debates over the economy, the size and role of government, and the best way forward out of the current recession. Not every reader will agree with the book's conclusions. But by grounding his analysis deeply on Scripture, Grudem has equipped Christians to better understand and respond to some of today's key political debates wisely and in a manner consistent with their primary citizenship as members and ambassadors of the kingdom of God" -- Publisher description. (shrink)

This paper provides an evaluation of the spinoff of a for-profit company from the American Institute of Certified Public Accountants (AICPA), a nonprofit professional association. The evaluation is based on a review of the literature on public policy issues surrounding organizational conversions from nonprofit to for-profit legal status. Many criticisms of this for-profit spinoff were voiced by professional leaders and accounting regulators, and we demonstrate that these criticisms are grounded in widely recognized policy principles relating to nonprofit conversions. (...) The public policy issues raised by this study have implications for the governance of professional associations in all disciplines. (shrink)

The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive issues of (...) rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia... (shrink)

The status of marijuana as an illegal drug has greatly evolved in recent years. Many countries have decriminalized possession of marijuana for personal use. Others have not decriminalized it but simply “tolerate” it for private personal use. Four countries have passed laws legalizing medical marijuana and one other tolerates the use of marijuana for medical purposes without having legislated a specific right for such possession and use. To date, 17 of the United States and the District of Columbia have also (...) passed laws regarding medical marijuana. However, state medical marijuana laws are at odds with the federal Controlled Substances Act, which prohibits possession of marijuana. This fact, in tandem with employer requirements under the Drug-Free Workplace Act, has created a dilemma for employers who have employees with medical conditions for which medical marijuana has been recommended. Given that 18 additional states currently have medical marijuana legislation pending, medical marijuana in the workplace is an issue which is not going to go away. As a result, it is time to examine the interface between federal and state laws as well as the public policy issues surrounding the lack of rights which medical marijuana patients have in their workplaces. (shrink)

In 1993, investigators from George Washington University Medical Center separated the cells of 17 human embryos and produced 48 embryos, an average of three embryos for each original. The method, variously called twinning, cloning, embryo splitting, and blastomere separation, demonstrated that human embryos could be split to create genetically identical entities during conception. When publicized, however, the experiment brought to mind a different view of cloning repeated since the beginning of the new reproductive technologies. In the early 1970s, when research (...) on in vitro fertilization was in its infancy, commentators worried that cloning–defined as the duplication of persons–would be next, leading to a scenario of “boys genetically exactly like the father, girls like the mother, or individuals like some true or false hero of art, science, or sports, or like some demagogue or some saint.”. (shrink)

Experiments have suggested that umbilical cord blood stem cells can be used to prevent diseases such as atherosclerosis. This paper discusses ethical issues surrounding such usage such as the uncertainty that individuals at risk of a disease will actually get the disease; issues related to research with children; safety issues; from where these stem cells would be obtained; and whether these usages should be considered as therapies or as physical enhancements.

Multiple gestations, or multifetal pregnancies,raise a number of significant policy questionsconcerning the well being of women and the wellbeing of the children fetuses might become.Important questions for feminists pertain notonly to multifetal pregnancy itself, but alsoto the medical interventions associated withthese pregnancies. In this paper, we addressthe questions of how many embryos should betransferred in assisted reproduction, how manyfetuses should remain in a multiple gestation,who should make these decisions, and the needto protect women from overexposure to exogenoushormones. Although we (...) focus on assistedreproduction in the United States, we believethat our suggestions are applicable to othercountries where the technology is comparable. (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)

Methodology is often a point of contention in gender-based salary studies. Although this debate seems at first to be merely about technical issues, it also has an important conceptual dimension. We argue that there are two competing implicit conceptions of discrimination, one institutional and the other individual, that underlie many such debates. We first contrast the preferred methodologies advanced by each side, the policy capturing approach and the flagging approach, and explore the theoretical meaning of their statistical models. We (...) then describe a practical application of both methodological approaches in one specific salary inequity study. In conclusion, we reflect on the implications of such practical statistical choices, discuss how such models can be combined, and make suggestions for sociologists who act as statistical experts or work with them in gender-based salary inequity studies on their own campuses. (shrink)

This article seeks to contribute to the discussion of how the gender gap in foreign and security policy issues can be explained by examining how early the gender differences manifest themselves. All told, 251 Swedish children between the ages of six and nine were interviewed about their views on foreign aid, refugee policy, weapons exports, armed resistance, self-defense, and concern or fear about the outbreak of war. Opinion differences between boys and girls were then compared to the differences (...) between adult men and women. The results showed that the differences between boys and girls were very small or nonexistent. Only in the question of fear about the outbreak of war did girls differ significantly from boys, displaying a much higher degree of worry. In the conclusion, these results are discussed in relation to different theories about the causes of the gender gap in foreign policy issues. (shrink)

If we agree that the adoption of Human Rights Instruments during the second half of the last century has led to a system of globally accepted values, are these also applicable to children? There are some indications that the Convention on the Rights of the Child is beginning to have an impact, in particular where a culture of rights is already in existence. This paper examines policy issues concerned with three interconnected rights: to education, rest and leisure, and freedom (...) from exploitation. Does the fact that a society subscribes to a culture of rights make any difference in this respect?The paper begins by considering different approaches to the right of freedom from economic exploitation in International Instruments and discusses a number of aspects relevant to the work of children. It then compares recent amendments to child labour legislation in two societies, one of which is a state party to several children's rights conventions, while the other has not ratified any International Treaties of relevance to its own child citizens. (shrink)

Over the last decade, several European countries and the Council of Europe itself have strongly supported the use of advance directives as a means of protecting patients’ autonomy, and adopted specific norms to regulate this matter. However, it remains unclear under which conditions those regulations should apply to people who are placed in correctional settings. The issue is becoming more significant due to the increasing numbers of inmates of old age or at risk of suffering from mental disorders, all (...) of whom might benefit from using advance directives. At the same time, the closed nature of prisons and the disparate power relationships that characterise them mean that great caution must be exercised to prevent care being withdrawn or withheld from inmates who actually want to receive it. This paper explores the issue of prisoners’ advance directives in the European context, starting with the position enshrined in international and European law that prisoners retain all their human rights, except the right to liberty, and are therefore entitled to self-determination regarding health care decisions. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health (...) care. Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

The rapid advances made in genetic research and technology over the last few decades have led to a host of important discoveries that have allowed for the detection (and hopefully soon the treatment) of a number of genetic conditions and diseases. Not surprisingly, these advances have also raised numerous ethical concerns about how result­ ing technologies will be implemented, and the impact they will have on different com­ munities. One particular concern is the enormous costs involved in conducting genetic research (...) and the fact that the private sector has become heavily involved; the desire to commercialize the results and technology derived from genetic research is considered problematic. In September 1998, the Second International Conference on DNA Sampling, titled "The Commercialization of Genetic Research: Ethical, Legal and Policy Issues," was held of the conference, and of this book, was to in Edmonton, Alberta, Canada. The goal facilitate an interdisciplinary discussion of the legal, ethical, and policy implications arising from the commercialization of genetic research. We solicited contributions for the book from authors in fields as diverse as ethics, law, medicine, health policy, and the social sciences. The papers included, while based on presentations given at the conference, have been substantially expanded and enhanced by the commentary received and discussions held at the conference. (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)

Thirty-four states, the District of Columbia, and Puerto Rico have legalized medical cannabis. While no two state medical cannabis programs are alike, public health concerns related to advertising, packaging and labeling, pesticide use, scientific research, and the role of medical cannabis in the opioid crisis are emerging across the country. This article examines these issues, the policy approaches states are adopting to protect patients and the public, and an assessment of the underlying federal legal landscape.

The first stage of the human embryonic stem(ES) cell research debate revolved aroundfundamental questions, such as whether theresearch should be done at all, what types ofresearch may be done, who should do theresearch, and how the research should befunded. Now that some of these questions arebeing answered, we are beginning to see thenext stage of the debate: the battle forproperty rights relating to human ES cells. The reason why property rights will be a keyissue in this debate is simple and (...) easy tounderstand: it costs a great deal of money todo this research, to develop new products, andto implement therapies; and private companies,researchers, and health professionals requirereturns on investments and reimbursements forgoods and services. This paper considersarguments for and against property rightsrelating to ES cells defends the followingpoints: (1) It should be legal to buy and sellES cells and products. (2) It should be legalto patent ES cells, products, and relatedtechnologies. (3) It should not be legal tobuy, sell, or patent human embryos. (4) Patentson ES cells, products, and related technologiesshould not be excessively broad. (5) Patents onES cells, products, and related technologiesshould be granted only when applicants statedefinite, plausible uses for their inventions. (6) There should be a research exemption in EScell patenting to allow academic scientists toconduct research in regenerative medicine. (7)It may be appropriate to take steps to preventcompanies from using patents in ES cells,products, and related technologies only toblock competitors. (8) As the field ofregenerative medicine continues to develop,societies should revisit issues relating toproperty rights on a continuing basis in orderto develop policies and develop regulations tomaximize the social, medical, economic, andscientific benefits of ES cell research andproduct development. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy with respect (...) to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

Discussions of human biology and its consequences for ethics and public policy are often misguided. Both proponents and critics of behavioral genetics, reproductive cloning, and genetic testing have mistaken beliefs about the role of genes in human life. Taking Biology Seriously calls attention to the social context in which both the science and our ethical precepts and public policies play a role.

The international gender equality agenda evolved into one of mainstreaming a gender perspective into all policies and programmes. Within this process, the role of men gained increasing attention in the debates on gender equality. This resulted in the inclusion of ‘men's role’ as one of the themes of the agenda of the Commission on the Status of Women for the year 2004. While this is another step forward in the global efforts for achieving equality between women and men, its potential (...) risks should not be overlooked. Therefore, it is necessary to revisit the concept of gender and carefully assess and monitor how the role of men is included in the agenda. This article starts with the premise that gender inequalities are the product of historically determined gender order in which the differentially assigned male female attributes are unequally structured in layers of privileged and subordinate positions of masculinities and femininities. The concept of patriarchy is brought back into the analysis to capture the interlinkages between the various status hierarchies that lead to shifts in hegemonic forms of masculinity that reproduces itself under diverse and changing conditions. Thus, while the article attempts to account for the generic and universal characteristics of gender inequality, at the same time, it draws attention to its specific socio-cultural manifestations. Finally, policy guidelines are offered for the consideration of the role of men in gender agenda setting. Accordingly, it is suggested that men's initiatives for alternative masculinities are acknowledged and that the questions regarding which men, in what kinds of alliances and for which end are reflected upon in formulating policies. (shrink)