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This book discusses some of the most critical ethical issues in mental health care today, including the moral dimensions of addiction, patient autonomy and compulsory treatment, privacy and confidentiality, and the definition of mental illness itself. Although debates over these issues are ongoing, there are few comprehensive resources for addressing such dilemmas in the practice of psychology, psychiatry, social work, and other behavioral and mental health care professions. This book meets that need, providing foundational background for undergraduate, graduate, and professional courses. Topics include central questions such as evolving views of the morality and pathology of deviant behavior; patient competence and the decision to refuse treatment; recognizing and treating people who have suffered trauma; addiction as illness; the therapist’s responsibility to report dangerousness despite patient confidentiality; and boundaries for the therapist’s interaction with patients.

Medical and social progress depend on research with human subjects. When that research is done in institutions getting federal money, it is regulated by federally required and supervised bureaucracies called “institutional review boards” (IRBs) expected to apply bioethical principles in making decisions. Do — can — these administrative agencies do more harm than good? The Censor’s Hand addresses this fundamental but long-unasked question. The book answers the question by consulting a critical experience — the law’s learning about regulation — and by amassing the empirical evidence scattered around many literatures. The book concludes that IRBs are fundamentally misconceived. Their usefulness to human subjects is doubtful, but they delay, distort, and deter research that can save lives, soothe suffering, and enhance welfare. IRBs make decisions poorly. They cannot be expected to make decisions well, for they lack the expertise, ethical principles, legal rules, effective procedures, and accountability essential to good regulation. And IRBs are censors in the place censorship is most damaging — universities in which academic freedom is essential. In sum, IRBs are bad regulation that cannot survive cost-benefit analysis. They were an irreparable mistake that should be abandoned so that research can be conducted properly and regulated sensibly.

Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by “conscience clauses.” These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access to care, argue that professional refusals should be tolerated only when they are based on valid medical grounds. This book finds a way around the polarizing rhetoric associated with this issue by proposing a compromise that protects both a patient’s access to care and a physician’s ability to refuse. This focus on compromise is crucial, as new uses of medical technology expand the controversy beyond abortion and contraception to reach an increasing number of doctors and patients. The author argues that doctor–patient matching on the basis of personal moral values would eliminate, or at least minimize, many conflicts of conscience, and suggests that state licensing boards facilitate this goal. Licensing boards would be responsible for balancing the interests of doctors and patients by ensuring a sufficient number of willing physicians such that no physician’s refusal left a patient entirely without access to desired medical services.

We are approaching the day when advances in biotechnology will allow parents to “design” a baby with the traits they want. The continuing debate over the possibilities of genetic engineering has been spirited, but so far largely confined to the realms of bioethics and public policy. This book approaches the question in religious terms, discussing human germline modification (the genetic modification of the embryonic cells that become the eggs or sperm of a developing organism), from the viewpoints of traditional Christian and Jewish teaching. The contributors, religious scholars and writers, call our attention not to technology but to humanity, reflecting upon the meaning and destiny of human life in a technological age. Many of these scholars argue that religious teaching can support human germline modification implemented for therapeutic reasons, although they offer certain moral conditions which must be met. The contributions offer a variety of opinions, including a discussion of Judaism’s traditional presumption in favor of medicine, an argument that Catholic doctrine could accept germline modification if it is therapeutic for the embryo, an argument implying that “traditional” Christian teaching permits germline modification whether for therapy or enhancement, and a “classical” Protestant view that germline modification should be categorically opposed.

Most of us are generally ill-equipped for dying. Today, we neither see death nor prepare for it. But this has not always been the case. In the early fifteenth century, the Catholic Church published the Ars moriendi texts, which established prayers and practices for an art of dying. In the twenty-first century, physicians rely on procedures and protocols for the efficient management of hospitalized patients. How might we recapture an art of dying that facilitates our dying well? In this book, physicians, philosophers, and theologians attempt to articulate a bioethical framework for dying well in a secularized, diverse society. Contributors discuss such topics as the acceptance of human finitude; the role of hospice and palliative medicine; spiritual preparation for death; and the relationship between community and individual autonomy. They also consider special cases, including children, elderly patients with dementia, and those suffering from AIDS in the early years of the epidemic, when doctors could do little more than accompany their patients in humble solidarity. These chapters make the case that only a robust bioethics—one that could foster both the contemplation of finitude and the cultivation of community–could bring about a modern art of dying well.

An estimated 100 million nonhuman vertebrates worldwide—including primates, dogs, cats, rabbits, hamsters, birds, rats, and mice—are bred, captured, or otherwise acquired every year for research purposes. Much of this research is seriously detrimental to the welfare of these animals, causing pain, distress, injury, or death. This book explores the ethical controversies that have arisen over animal research, examining closely the complex scientific, philosophical, moral, and legal issues involved. Defenders of animal research face a twofold challenge: they must make a compelling case for the unique benefits offered by animal research; and they must provide a rationale for why these benefits justify treating animal subjects in ways that would be unacceptable for human subjects. This challenge is at the heart of the book. Some chapters argue that it can be met fairly easily; others argue that it can never be met; still others argue that it can sometimes be met, although not necessarily easily. The book considers how moral theory can be brought to bear on the practical ethical questions raised by animal research, examines the new challenges raised by the emerging possibilities of biotechnology, and considers how to achieve a more productive dialogue on this polarizing subject.

Teams of scientists around the world are racing to create protocells—microscopic, self-organizing entities that spontaneously assemble from simple organic and inorganic materials. The creation of fully autonomous protocells—a technology that can, for all intents and purposes, be considered literally alive—is only a matter of time. This book examines the pressing social and ethical issues raised by the creation of life in the laboratory. Protocells might offer great medical and social benefits and vast new economic opportunities, but they also pose potential risks and threaten cultural and moral norms against tampering with nature and “playing God.” This book offers a variety of perspectives on these concerns. After a brief survey of current protocell research (including the much-publicized “top-down” strategy of J. Craig Venter and Hamilton Smith, for which they have received multimillion dollar financing from the U.S. Department of Energy), the chapters treat risk, uncertainty, and precaution; lessons from recent history and related technologies; and ethics in a future society with protocells. The discussions range from new considerations of the precautionary principle and the role of professional ethicists to explorations of what can be learned from society’s experience with other biotechnologies and the open-source software movement.

The intrauterine device (IUD) is used by 150 million women around the world. It is the second most prevalent method of female fertility control in the global South and the third most prevalent in the global North. Over its five decades of use, the IUD has been viewed both as a means for women’s reproductive autonomy and as coercive tool of state-imposed population control, as a convenient form of birth control on a par with the pill and as a threat to women’s health. This book investigates the development, marketing, and use of the IUD since the 1960s. The book offers a biography of a multifaceted technological object through a feminist science studies lens, tracing the transformations of the scientific discourse around it over time and across different geographies. It describes how developers of the IUD adapted to different social interests in their research and how changing assumptions about race, class, and female sexuality often guided scientific inquiries. The IUD, the book argues, became a “politically versatile technology,” adaptable to both feminist and nonfeminist reproductive politics because of researchers’ attempts to maintain the device’s suitability for women in both the developing and the developed world. The book traces the evolution of scientists’ concerns—from contraceptive efficacy and product safety to the politics of abortion—and describes the most recent, hormone-releasing, menstruation-suppressing iteration of the IUD.

The current framework for the regulation of human subjects research emerged largely in reaction to the horrors of Nazi human experimentation, revealed at the Nuremburg trials, and the Tuskegee syphilis study, conducted by U.S. government researchers from 1932 to 1972. This framework, combining elements of paternalism with efforts to preserve individual autonomy, has remained fundamentally unchanged for decades. Yet, as this book documents, it has significant flaws—including its potential to burden important research, overprotect some subjects and inadequately protect others, generate inconsistent results, and lag behind developments in how research is conducted. Invigorated by the U.S. government’s first steps toward change in over twenty years, Human Subjects Research Regulation brings together the leading thinkers in this field from ethics, law, medicine, and public policy to discuss how to make the system better. The result is a collection of novel ideas—some incremental, some radical—for the future of research oversight and human subject protection. After reviewing the history of U.S. research regulations, the contributors consider such topics as risk-based regulation; research involving vulnerable populations (including military personnel, children, and prisoners); the relationships among subjects, investigators, sponsors, and institutional review boards; privacy, especially regarding biospecimens and tissue banking; and the possibility of fundamental paradigm shifts.

The healthcare system in the United States is the most expensive in the industrialized world, yet delivers very mediocre outcomes in such measures as equity, infant mortality, and longevity. In addition, a major portion of the American public either lacks health insurance or is underinsured. It is highly unlikely that the Affordable Care Act will do much to reverse the situation, despite decreasing the numbers of uninsured. Costs continue to rise and occupy an increasingly large percentage of GDP. Limiting the amount and kinds of healthcare interventions – rationing - available is both necessary and inevitable to avoid fiscal disaster. This book argues that we already accept draconian and open rationing throughout the health system, such as in organ transplantation. The features that make this and other rationing schemes acceptable are fairness, openness and equality of treatment. Rosoff suggests that combining fair and sensible rationing of interventions that arguably do not offer significant or meaningful benefit, such as intensive care for the dying or expensive chemotherapy for the terminally ill, with institution of a nationalized insurance program offering comprehensive care to all, would not only control costs but fulfil an ethical imperative to the nation’s residents. The book considers the political and structural obstacles to instituting such massive alterations, but ultimately argues that both economic and moral reasons would necessitate these radical changes.

Legal texts have been with us since the dawn of human history. Beginning in 1953, life too became textual. The discovery of the structure of DNA made it possible to represent the basic matter of life with permutations and combinations of four letters of the alphabet, A, T, C, and G. Since then, the biological and legal conceptions of life have been in constant, mutually constitutive interplay—the former focusing on life’s definition, the latter on life’s entitlements. This book argues that this period of transformative change in law and the life sciences should be considered “bioconstitutional.” It explores the evolving relationship of biology, biotechnology, and law through a series of national and cross-national case studies. The book starts by mapping out the conceptual territory in an introduction, after which the chapters offer “snapshots” of developments at the frontiers of biotechnology and the law. They examine such topics as national cloning and xenotransplant policies; the politics of stem cell research in Britain, Germany, and Italy; DNA profiling and DNA databases in criminal law; clinical trials in India and the United States; the GM crop controversy in Britain; and precautionary policymaking in the European Union. These cases demonstrate changes of constitutional significance in the relations among human bodies, selves, science, and the state.

Federal regulations that govern research misconduct in biomedicine have not prevented ongoing high-profile cases of fabrication, falsification or plagiarizing (FFP) in scientific research. Current policy holds individual scientists or team members responsible for FFP. But a fair and effective policy must take into account the context in which this behavior is embedded -- in the pressure to publish positive findings in order to obtain tenure or grant money, or in institutions that may not be supportive of ethical practice but themselves carry no risk. This book analyzes a series of clinical research cases in which reported misconduct went undetected for a decade or more and finds laxity of oversight, little attention to harm done and inadequate correction of the scientific record. Goals of research misconduct policy must be to: protect scientific capital (knowledge, scientists, institutions, norms of science), support fair competition, contain harms to end users and the public trust, and enable science to meet its societal obligations. Reaching these goals will require a system-wide evolution of responsibility to promote and ensure scientific integrity.

Synthetic biology, which aims to design and build organisms that serve human needs, has potential applications that range from producing biofuels to programming human behavior. The emergence of this new form of biotechnology, however, raises a variety of ethical questions—first and foremost, whether synthetic biology is intrinsically troubling in moral terms. Is it an egregious example of scientists “playing God”? This book takes on this key ethical question, as well as others that follow, offering a range of philosophical and political perspectives on the power of synthetic biology. The chapters consider the basic question of the ethics of making new organisms, laying out the conceptual terrain and offering opposing views of the intrinsic moral concerns. The chapters discuss the possibility that synthetic organisms are inherently valuable and address whether, and how, moral objections to synthetic biology could be relevant to policy making and political discourse. Variations of these questions have been raised before, in debates over other biotechnologies, but, as this book shows, they take on novel and illuminating form when considered in the context of synthetic biology.

The transformative potential of genetic and cybernetic technologies to enhance human capabilities is most often either rejected on moral and prudential grounds or hailed as the future salvation of humanity. In this book, Nicholas Agar offers a more nuanced view, making a case for moderate human enhancement—improvements to attributes and abilities that do not significantly exceed what is currently possible for human beings. He argues against radical human enhancement, or improvements that greatly exceeds current human capabilities. Agar explores notions of transformative change and motives for human enhancement; distinguishes between the instrumental and intrinsic value of enhancements; argues that too much enhancement undermines human identity; considers the possibility of cognitively enhanced scientists; and argues against radical life extension. Making the case for moderate enhancement, Agar argues that many objections to enhancement are better understood as directed at the degree of enhancement rather than enhancement itself. Moderate human enhancement meets the requirement of truly human enhancement. By radically enhancing human cognitive capabilities, by contrast, we may inadvertently create beings (“post-persons") with moral status higher than that of persons. If we create beings more entitled to benefits and protections against harms than persons, Agar writes, this will be bad news for the unenhanced. Moderate human enhancement offers a more appealing vision of the future and of our relationship to technology.