4. Services and facilities for intellectually disadvantaged people

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).

Although organ transplantation is the preeminent medical miracle of the last quarter of a century, Many Sleepless Nights is the first book to go beyond the headlines and describe the patients who have embraced this last chance to hold on to life, the intricate medical procedures that can save them, the surgeons and nurses who work in this emotionally charged world, and the ethics which complicate this miracle high-tech therapy. Lee Gutkind was granted unconditional access to the world's largest transplant center - the University of Pittsburgh's Presbyterian-University and Children's hospitals, where there is an organ transplant every eight hours, 365 days per year. For four years he immersed himself in the frantic night-and-day world of transplantation, living side by side with transplant candidates and recipients, jetting though the night with organ procurement teams, monitoring patients with surgeons and nurses, observing in the operating room, participating in the ethical and psychosocial evaluations of prospective patients which help to determine who will receive scarce organs. During his four years at Presbyterian and Children's Hospitals, Gutkind established close relationships with many patients, and his portrayal of them, living and sometimes dying under unbelievable stress, is a moving and dramatic statement about the capacity of human beings to endure. Many Sleepless Nights also outlines the history of organ transplantation and tells the story of the large and complex medical teams behind the operation. It captures the tension of the search for viable organs; the pressure decisions about which patients, among many, will receive them; and the surgery itself.Its vivid portrayal of the transplant pioneer Thomas Starzl - a man obsessed with saving lives - shows how a major innovator in American medicine functions during days and nights of extreme pressure.

We all age differently, but we can learn from shared experiences and insights. The conversations, or paired essays, in Aging Thoughtfully combine a philosopher's approach with a lawyer-economist's. Here are ideas about when to retire, how to refashion social security to help the elderly poor, how to learn from King Lear -- who did not retire successfully -- and whether to enjoy or criticize anti-aging cosmetic procedures. Some of the concerns are practical: philanthropic decisions, relations with one's children and grandchildren, the purchase of annuities, and how to provide for care in old age. Other topics are cultural, ranging from the treatment of aging women in a Strauss opera and various popular films, to a consideration of Donald Trump's (and other men's) marriages to much younger women. These engaging, thoughtful, and often humorous exchanges show how stimulating discussions about our inevitable aging can be, and offer valuable insight into how we all might age more thoughtfully, and with zest and friendship.

Biotechnology (BT) offers exciting and promising prospects for healing the sick and relieving the suffering. But because of their impressive powers to alter the workings of body and mind, the "dual uses" of the same technologies make them attractive also to people who are not sick but who would use them to look younger, perform better, feel happier, or become more "perfect." These applications of BT present us with difficult challenges. This report considers such possible "beyond therapy" uses and explores both their scientific basis and the ethical and social issues they will raise. In enjoying the benefits of BT, we will need to hold fast to an account of the human being, seen not in material or mechanistic or med. terms, but in psychic and moral and spiritual ones.

Coronaspection is a groundbreaking series of forty video interviews concerning COVID-19 and its spiritual challenges, featuring major faith leaders worldwide. Coronaspection was created as a means of providing hope and inspiration to faithful of all religions, as humanity struggled, and as it continues to struggle, with the challenges posed by COVID-19. This volume seeks to answer questions that have emerged following the release of the video interviews: How is religion functioning during COVID-19? Do different religions respond to the crisis differently? These and similar questions require a synthetic view of the project, which in turn is based on an analysis of its themes and messages.

"I have been a Jew during Fascism, a bourgeois under Communism, a rebel defeated in an uprising, a refugee among the free, and a have-not amid plenty. This book contains over 60 stories that range from my youth in Hungary, the ordeal of a death march and concentration camps, the oppression of the Communist dictatorship, the promise and defeat of the Hungarian Revolution and, finally, my American years"--Preminary pages

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.

My 'discovery' of the Polish School of philosophy of medicine stemmed from my studies in the genesis of Ludwik Fleck's epistemology. These studies, and my interest in the scientific roots of Fleck's epistemology were a nearly 'natural' result of my own biography: like Fleck I had been trained, an had worked as an immunologist, and had later switched to studies in the social history of medicine and biology. Moreover, it so happened that Fleck's book, Genesis and Development of a Scientific Fact -the description of a science as it is, not as it should be -was the first epistemological study in which I found echos of my experience in the laboratory. My interest in Fleck was also highlightened by the fact that in his works, and, as I discovered later, in the works of his predecessors of the Polish School of philosophy of medicine, was formulated the problem that had stimulated my interest in the history of medicine and biology, and is still central to my present investigations: the relationships between biological knowledge and clinical practice. The writing of the book was made possible through to the help of many colleagues and friends. The unfailing support for my research, whatever its subject might be, from my colleagues from Unit 158 of INSERM and in particular from its head Patrice Pinell, has made my study of the Polish School possible.