Faculty Bibliography

It is easy to demonize [PETER SINGER], 58, since his theory points toward conclusions that some find morally repugnant-for example, that euthanasia might be the appropriate response to the intractable suffering of an infant born with a terrible genetic malady. Those who scorn his views can rarely produce an argument about why he is wrong-they simply don't like his conclusions. But ethics is all about arguments, not moral pronouncements. I don't always agree with Peter

OBJECTIVE: To explore assisted reproductive technology (ART) programs' beliefs about and practices for screening program candidates for the use of ART services. DESIGN: An anonymous, self-administered, mailed questionnaire. SETTING: U.S. ART programs. PARTICIPANT(S): Directors of U.S. ART programs. MAIN OUTCOME MEASURE(S): Screening practices and beliefs, agreement with statements about screening rights and responsibility, information collected about candidates, and likelihood of turning away hypothetical candidates. RESULT(S): The majority of programs do not have a formal policy for screening candidates. The majority of program directors agree that they have a right and responsibility to screen candidates. On average, programs turn away 4% of candidates each year. The majority of programs report being very to extremely likely to deny treatment to the couples described in various scenarios, such as physical abuse, positive HIV status, and single parenthood. Significant variation was seen across programs in their likelihood of turning away various hypothetical candidates. CONCLUSION(S): There is substantial variation in ART programs' screening practices. These results highlight the need for increased debate over what constitutes inappropriate denial of access to services, and what are prudent, social, ethical, and medical judgments.

Kidney transplantation is a superior treatment strategy than chronic dialysis for end-stage renal disease patients. However, there is a severe shortage of cadaveric kidneys that are available for transplantation. Therefore many patients are turning to living donors. We describe four models of incentives to improve rates of living kidney donation: the market compensation model, the fixed compensation model, no-compensation model and the expense reimbursement model. We discuss the advantages and disadvantages of each of these models. Any incentive to improve rates of living kidney donation must be accompanied by safeguards. These safeguards will prevent living donors from being viewed primarily as a resource for transplants. These safeguards will also prevent vulnerable individuals from being coerced into donation and will monitor long-term outcomes of donors using a donor registry. We recommend the use of the expense reimbursement model along with these safeguards, in order to increase rates of living kidney donation.

Caplan reviews The Truth about the Drug Companies: How They Deceive Us and What To Do about It by Marcia Angell; On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health by Jerome P. Kassirer; and Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs by Jerry Avorn

While the Holocaust is often placed at the genesis of bioethics, this relatively young field has not yet seriously explored the conduct of German scientists and physicians involved in the human subjects experiments of the Holocaust. We comfort ourselves with the beliefs that the individuals involved in the events of the Holocaust were mad or evil and unlike other scientists and physicians. Yet the evidence is that these professionals were educated and capable members of a technologically sophisticated society who believed they were somehow behaving morally within the context of their social-political situation. The first defendants at Nuremberg were physicians and public health officials. An examination of the trial transcripts provides data about what motivated these medical scientists to engage in human experimentation and mass murder and the extent to which ethics rationales were given for unparalleled moral wrong-doing in biomedicine. Bioethics must still address these beliefs and subject them to close scrutiny.

Both adult women and prepubertal girls facing cancer treatment may have the option to harvest and cryopreserve ovarian tissue. If they have successful therapy for their disease, the tissue may be autotransplanted back into the woman's body or follicles may be harvested and matured in vitro. These techniques all remain experimental, however, and should be performed only by specialized centers that can provide a multidisciplinary team. The procedures should be done under approval from an Institutional Review Board with proper assurance of informed consent. Although the costs for research could be assessed to patients if no research funds are available, clinical fees should not be charged at this stage in the development of these technologies. Consideration should be given to the protection of minors by ensuring parental informed consent and child assent whenever possible. Disposition of cryopreserved gonadal tissue in the event of the participant's death should be formally designated. A registry should be established to follow the health of participants and their eventual offspring.