NOW FEATURING A NEW AFTERWORD, "PANDEMIC ETHICS" From two eminent scholars comes a provocative examination of bioethics and our culture’s obsession with having it all without paying the price. Shockingly, the United States has among the lowest life expectancies and highest infant mortality rates of any high-income nation, yet, as Amy Gutmann and Jonathan D. Moreno show, we spend twice as much per capita on medical care without insuring everyone. A “remarkable, highly readable journey” (Judy Woodruff ) sure to become a classic on bioethics, Everybody Wants to Go to Heaven but Nobody Wants to Die explores the troubling contradictions between expanding medical research and neglecting human rights, from testing anthrax vaccines on children to using brain science for marketing campaigns. Providing “a clear and compassionate presentation” ( Library Journal ) of such complex topics as radical changes in doctor-patient relations, legal controversies over in vitro babies, experiments on humans, unaffordable new drugs, and limited access to hospice care, this urgent and incisive history is “required reading for anyone with a heartbeat” (Andrea Mitchell).

Neonatal intensive care has been one of the most morally controversial areas of medicine during the past thirty years. This study examines the interconnected development of four key aspects of neonatal intensive care: medical advances, ethical analysis, legal scrutiny, and econometric evaluation. The authors assert that a dramatic shift in societal attitudes toward newborns and their medical care was a stimulus for and then a result of developments in the medical care of newborns. They divide their analysis into three eras of neonatal intensive care. The first, characterized by the rapid advance of medical technology from the late 1960s to the Baby Doe case of 1982, established neonatal care as a legitimate specialty of medical care, separate from the rest of pediatrics and medicine. During this era, legal scholars and moral philosophers debated the relative importance of parental autonomy, clinical prognosis, and children's rights. The second era, beginning with the Baby Doe case (a legal battle that spurred legislation mandating that infants with debilitating birth defects be treated unless the attending physician deems efforts to prolong life "futile"), stimulated efforts to establish a consistent federal standard on neonatal care decisions and raised important moral questions concerning the meaning of "futility" and of "inhumane" treatment. In the third era, a consistent set of decision-making criteria and policies was established. These policies were the result of the synergy and harmonization of newly agreed upon ethical principles and newly discovered epidemiological characteristics of neonatal care. Tracing the field's recent history, notable advances, and considerable challenges yet to be faced, the authors present neonatal bioethics as a paradigm of complex conversation among physicians, philosophers, policy makers, judges, and legislators which has led to responsible societal oversight of a controversial medical innovation.