Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

This paper introduces the medical factual matrix as a new and potentially valuable tool in medical ethical analysis. Using this tool it demonstrates the idea that a defined medical intervention can only be meaningfully declared futile in relation to a defined goal of treatment. It argues that a declaration of futility made solely in relation to a defined medical intervention is inchoate. It recasts the definition of goal futility as an intervention that cannot alter the probability of the existence of (...) the important outcome states that might flow from a defined intervention. The idea of value futility and the extent of physician obligations in futile situations are also addressed. It also examines the source of substantive conflicts which commonly arise within the doctor-patient relationship and the ensuing power relations that operate between doctor and patient when questions of futility arise. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law to establish (...) a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)