Do We Still Need Doctors? is a personal account from the front lines of the moral and political battles that are reshaping America's health care system. Using compelling firsthand experiences, clinical vignettes, and moral arguments, John D. Lantos, a pediatrician, asks whether, as we proceed with the redesign of our health care system, doctors will - or should - continue to fulfill the roles and responsibilities that they have in the past. Interspersing moving personal stories of his young patients suffering from AIDS, cancer, and other chronic or terminal illnesses with his own stirring dilemmas of truth telling, creative navigation of HMO bureaucracy, and reflections on the identity crisis of medical education, Dr. Lantos reveals how changes in our health care system and new technologies are fostering new ways of understanding and responding to illness. He taps into the public's sense of wanting doctors and hospitals to do something other than what they do now and the frustrating disagreement about what they should do in the future. Do We Still Need Doctors? neither demonizes nor idealizes managed care or for-profit medicine. Instead, Dr. Lantos argues that managed care continues a trend toward rationalizing disease and streamlining treatment that doctors themselves have initiated and sustained over the last fifty years. Illness and death will always resist rationalizing, and in order to respond to them, doctors and patients alike need to re-imagine what healing is or ought to be.

Over the past decade much significant new work has appeared in the field of Jewish ethics. While much of this work has been devoted to issues in applied ethics, a number of important essays have explored central themes within the tradition and clarified the theoretical foundations of Jewish ethics. This important text grew out of the need for a single work which accurately and conveniently reflects these developments within the field. The first text of its kind in almost two decades, Contemporary Jewish Ethics and Morality presents wide-ranging and carefully organized recent essays on Jewish ethical theory and practice. Serving as an introduction to Jewish ethics, it acquaints the student with the distinctive methodological issues involved and offers a sampling of Jewish positions on contemporary moral problems. The book features work from both traditionalist and liberal contributors, making this the only volume which encompasses the full range of contemporary Jewish ethical perspectives. Writers such as Harold Schulweis, Judith Plaskow, David Novak, David Hartman, and Blu Greenberg discuss law and ethics, natural law, humility, justice, sex and the family, euthanasia, and other vital issues relating to modern Judaism. Many of the readings appear here for the first time, making this important text the most timely sourcebook in its field. Uniquely qualified to reflect the high level and depth of contemporary work in this area of study, Contemporary Jewish Ethics and Morality is an essential contribution to any course dealing with Jewish ethics.

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested.

The two companies had agreed that the CEPH would supply Millennium with a store of genetic material collected from a large number of French families, and Millennium would supply funding and expertise in new technologies to accelerate the identification of the genes, terms that the French government had approved. But in early 1994, just as the collaboration was to begin, the French government abruptly called a halt.

Are there parallels between the "moment of insight" in science and the emergence of the "unknowable" in religious faith? Where does scientific insight come from? Award-winning biologist Robert Pollack argues that an alliance between religious faith and science is not necessarily an argument in favor of irrationality: the two can inform each other's visions of the world. Pollack begins by reflecting on the large questions of meaning and purpose--and the difficulty of finding either in the orderly world described by the data of science. He considers the obligation to find meaning and purpose despite natural selection's claim to be a complete explanation of our presence as a species--a claim that calls upon neither natural intention, nor design, nor Designer. Next, the book focuses on matters of free will, from the choice of a scientist to accept evidence, to the choice of a religious person to accept a revelation, to a patient's loss of free will in medical treatment. Here Pollack addresses questions of ethics and offers a provocative comparison of two difficult texts whose contents remain incompletely understood: the DNA "text" of the human genome and the Hebrew record of Jewish written and oral law. In closing, Pollack considers the promise of genetic medicine in enabling us to glimpse our own future and offers a reconsideration of the possible utility of the so-called placebo effect in curing illness. Whether refuting a DNA-based biological model of Judaism or discussing the Darwinian concept of the species, Pollack, under the banner of free inquiry, presents a genuine, vital, and well-argued assay of the intersection of science and religion.

Divided Staffs, Divided Selves offers a case-centered approach to the teaching of health care ethics to a wide range of students and clinicians. The book provides both clinical case material and a method for engaging in a dialogue regarding difficult decisions in the mental health care field that have potentially tragic choices. The essays that introduce the volume place the ethical problems of treating mentally ill people in the context of the health care ethics movement and traditions of ethical decision making. The individual cases are real, derived from actual clinical and consultative experiences.

This book analyzes the major issues of research ethics through a careful review of the treatment in official policies on research ethics developed throughout the world (especially North America, Western Europe, and the Pacific Rim). Among the issues covered are animal research, research on human subjects, epidemiological research, genetic research, reproductive research, research on vulnerable subjects, clinical trials, drug approval and the research process, and research on women and minorities. Brody also evaluates the content and the methods of developing these policies in light of his philosophical position of pluralistic casuistry. This is the only book that analyzes all the major issues in research ethics. It is the only book which deals with these issues from an international perspective rather than just a US perspective. Major official policies from important research-intensive countries are reprinted in the appendix (close to 200 plates of otherwise difficult material).

"The book is readable and challenging; readers will never see psychiatry in the same way again." -- Choice Reviews Originally called mad-doctoring, psychiatry began in the seventeenth century with the establishing of madhouses and the legal empowering of doctors to incarcerate persons denominated as insane. Until the end of the nineteenth century, every relationship between psychiatrist and patient was based on domination and coercion, as between master and slave. Psychiatry, its emblem the state mental hospital, was a part of the public sphere, the sphere of coercion. The advent of private psychotherapy, at the end of the nineteenth century, split psychiatry in two: some patients continued to be the involuntary inmates of state hospitals; others became the voluntary patients of privately practicing psychotherapists. Psychotherapy was officially defined as a type of medical treatment, but actually was a secular-medical version of the cure of souls. Relationships between therapist and patient, Thomas Szasz argues, was based on cooperation and contract, as is relationships between employer and employee, or, between clergyman and parishioner. Psychotherapy, its emblem the therapist's office, was a part of the private sphere, the contract. Through most of the twentieth century, psychiatry was a house divided-half-slave, and half-free. During the past few decades, psychiatry became united again: all relations between psychiatrists and patients, regardless of the nature of the interaction between them, are now based on actual or potential coercion. This situation is the result of two major "reforms" that deprive therapist and patient alike of the freedom to contract with one another: Therapists now have a double duty: they must protect all mental patients-involuntary and voluntary, hospitalized or outpatient, incompetent or competent-from themselves. They must also protect the public from all patients. Persons designated as mental patients may be exempted from responsibility for the deleterious consequences of their own behavior if it is attributed to mental illness. The radical differences between the coercive character of mental hospital practices in the public sphere, and the consensual character of psychotherapeutic practices in the private sphere, are thus destroyed. At the same time, as the scope of psychiatric coercion expands from the mental hospital to the psychiatrist's office, its reach extends into every part of society, from early childhood to old age. Thomas Szasz is professor of psychiatry emeritus at the State University of New York Health Science Center in Syracuse, New York and Adjunct Scholar at the Cato Institute, Washington, DC. He is the author of over two dozen books in fifteen languages, including The Myth of Mental Illness and most recently, Pharmacracy: Medicine and Politics in America . "The book is readable and challenging; readers will never see psychiatry in the same way again."-- Choice "Szasz now appears to have been transformed into an ally rather than an enemy of the National Health Service general adult psychiatrist. Szasz's project has always been to argue passionately for a boundry of demarcation around the responsibility and power of psychiatry....But what saves this book from being just another mugging of psychiatry is that Szasz does raise a fundamental question at the core of our discipline. If we restricted our attention only to those clients who wanted to see a psychiatrist, and disengaged from all those who really didn't, how different might our professional practice and experience be?"-- The British Journal of Psychiatry

A gripping exploration of the legal and ethical dilemmas in neonatal intensive care—a truly original work. Chosen as an Outstanding Academic Titles in 2003 by Choice Magazine In this new, startlingly original book, John D. Lantos weaves a compelling story that captures the dilemmas of modern medical practice. The Lazarus Case: Life-and-Death Issues in Neonatal Intensive Care begins with a fictional malpractice case—an amalgam of typical cases in which Lantos appeared as an expert witness—and uses it as the framework for addressing the ethical issues surrounding neonatal intensive care. Lantos draws on his experience in neonatal medicine, pediatrics, and medical ethics to explore multiple ethical dilemmas through one poignant representative situation. In Lantos's model case, a doctor decides to stop resuscitation of a premature infant, a tiny "preemie" who seems past reasonable care. The baby survives with severe neurological defects and the parents sue the doctor, alleging that stopping treatment was negligent. From this case, Lantos considers our moral obligations to critically ill babies, the meaning of negligence, and the sorts of social structures that shape the moral consciences of doctors. Each chapter begins with Lantos deposing in the conference room of the plaintiffs' lawyers. The questions put to Lantos throughout the deposition spark an engrossing retelling of his personal experiences with premature babies, as well as his thoughtful discussions of ethics, morality, history, and medical statistics. Sprinkled throughout the book are references to fictional works by Camus, Dostoevsky, Shakespeare, Twain, and others. Lantos uses these literary examples to further illustrate the ambiguities, misunderstandings, responsibilities, and evasions that plague our decisions regarding life and death, medical care and medical education, and ultimately the cost and value of preserving the lives of the most vulnerable among us.

III Look Before You Leap: Technological Risks of Xenotransplantation -- Introduction -- Blood Sucking Host Hoppers: Zoonotic and Xenogeneic Bugs -- Theoretical Likelihood of Xenogeneic Diseases -- Practical Experience with Xenogeneic Infections -- Scientist as Lawyer: Absence of Evidence is Not Evidence of Absence -- Mi Casa Es Su Casa? Issues of Public Health Acceptability -- The U.K. Approach -- The U.S. Approach -- Stasi Medicine? - How Surveillance Can Coexist with Human Rights -- Consent, Informed or Presumed? -- Community Consent -- Life Trumps Autonomy? -- Conclusion -- IV Of Pigs and Men: Issues of Speciesism and Chimerism -- Introduction -- Are All Animals Created Equal? -- We Feel Your Pain -- Agreeing to Disagree -- Singer: Weigh Animals Like Humans -- Regan: Don't Play the Weighing Game with Life -- Frey: Humans Outweigh Animals by a Longshot -- Leahy: Weigh it in Words -- How Much Does Private Language Count? -- Physiological Signs of Pain -- Only Language Separates Us From Them -- Giving Darwin Some Respect -- Chimerism and Its Discontents -- Piled High and Deep: The Realities of Pork -- Transgressing the Pig Genome -- Transgressing Humanity -- Transgressive Psychology -- Conclusion: No Revolution Likely on the Animal Phann -- V The Right to Life: Society's Obligation to Provide Health Care and Xenotransplantation -- Introduction -- Ought Implies Kant -- Berlin's Polarization and the Power of Negative Thinking -- Dealing in John Rawls: Primary Goods in a Just Society -- Don't Forget About the Health Benefits! -- Doyal and Gough's Theory of Human Needs -- Why Must My Rights Be Everyone's Rights? -- Giving an Inch and Taking a Mile: Can Health Care Include Xenotransplantation? -- No Religious Preference -- Conclusion -- VI Is Xenotransplantation Worth the Risk? -- Introduction -- Truth or Consequences: Incommensurability of Negativities