The Cambridge Quarterly has a history of presenting multidisciplinary perspectives in bioethics, welcoming a lively dialogue between clinicians, philosophers, theologians, social scientists, lawyers, and others on a range of bioethics concerns. This special issue of the journal focuses explicitly on contributions from anthropologists to the field.

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

There was a remarkable outpouring of publications related to the concept of medical futility between 1988 and 1995, and there has been a substantial drop-off since then (Figure 1). A wide variety of definitions of the concept were offered from many corners of the medical profession, from medical social sciences, as well as from judges in several state and federal courts. Attention was drawn to the conflicts over when it is appropriate to declare further treatment futile, who has the authority to make such determinations, and what evidence is required.

Despite a growing awareness within American biomedicine and bioethics that the social category “race” is of limited use in describing patients, some fields of medicine continue to use it interchangeably with, or instead of, the term “ethnicity.” Doing so reflects the assumption that social categories have a basis in physiology.

In the United States, organ transfer has generated a highly selective and overly specialized approach to bioethics. A dominant assumption is the myth of medical democracy: whereas professionals involved in this highly technocratic arena publicly embrace notions of medical equality, particularized practices expose another reality. The more specific ideological tenets of medical democracy read as follows: First, all potential transplant patients are equally deserving of replacement organs. Further, all citizens are entitled to equal access to these unusual commodities, which are regularly described as precious and scarce “national resources.” Whether the premises of medical democracy are in fact played out in daily practice, however, is another matter entirely. Organ donation is driven by a universalized sense of humanity, whereby all bodies are assumed equal beneath the surgeon's knife. Yet the social worth of individuals varies radically: children, pregnant women, the unemployed, and prisoners, for example, expose a wide spectrum of responses to certain categories of bodies. So, too, do the cultural origins of organ donors. By drawing on anthropological knowledge of sociomedical practices relevant to organ transfer, this essay explores this theme of medical democracy specifically in reference to the needs of Latinos in New York City.

These CQ Sources were compiled by Bette Anton.

In 1999, a case was described on national television in which a woman had enlisted onto an international bone marrow registry with the altruistic desire to offer her bone marrow to some unidentified individual in need of a transplant. The potential donor then was notified that she was a compatible match with someone dying from leukemia and gladly donated her marrow, which cured the recipient of the disease. Years later, though, the recipient developed end-stage renal disease (ESRD), a consequence of the high-dose chemotherapy she received earlier to destroy her stem cells and prepare her for the bone marrow transplant. Finding a suitable donor for a kidney transplant proved extremely difficult. Desperate, she requested that the donor registry personnel help her locate the individual who earlier was determined to be a compatible donor and asked this now-identifiable individual to consider donating one of her two normally functioning kidneys for a kidney transplant.

Few early debates in bioethics invigorated the field to the same extent as the one concerning whether or not young children could be used in nontherapeutic research. Though some of the issues in the debate were never fully settled, a consensus emerged, reflected in the Common Rule—that surrogates could consent to use children in such research, although once the level of risk rises above minimal, additional stipulations are required. Nontherapeutic research on cognitively impaired elderly people raises equally complex ethical issues, but there has been a dearth of debate in the literature about whether such research is ethically permissible. Instead, there have been many published recommendations regarding the circumstances under which such research can occur.

Carson Strong's article “Cloning and Infertility” has initiated a conversation in this journal about the ethical and policy issues surrounding the question of who, if anyone, should be allowed access to human reproductive cloning technology, should somatic cell nuclear transfer ever become technically feasible and safe. Strong's position in that article is that infertile opposite sex couples for whom cloning is the last resort for having a genetically related child are the only people who should be granted access to such technology, primarily because this need to have a genetically related child would give such couples respectable reasons for cloning themselves. Also, every child has a basic right to a “decent minimum opportunity for development.” Thus it would be morally wrong, other things being equal, to clone a person with cystic fibrosis or spina bifida but morally permissible to clone a nearsighted person, because nearsightedness is not sufficiently disabling to violate the child's birthright. With this caveat, he concludes that protecting reproductive freedom requires that physicians be allowed to provide cloning services only to that small subset of infertile opposite sex couples who would need it as a last resort, should human reproductive cloning ever become safe and feasible.

Charles Dickens began one of his many great works of literature with this seemingly paradoxical, self-contradictory statement. Reflecting on a jury verdict in Northern California in June of 2001, in the context of what has transpired during the decade of the 1990s with regard to the care of dying patients, observations in the genre of Dickens come readily to mind. In 1991, two of the most compelling books on the subject of pain, medicine, and society were published: Eric Cassell's The Nature of Suffering and the Goals of Medicine and David Morris's The Culture of Pain. Both works unflinchingly recognized and explored the implications of the vast clinical literature documenting the failure of modern medicine to respond compassionately and effectively to what had by then become an epidemic of undertreated pain.

Unlike the compassionate conservatism of George Bush, Compassionate Utilitarianism is not a confusing concept. Nor is it a newly minted version of Utilitarianism given that it is embedded in the writings of Jeremy Bentham, writings that have come to light only with the Oxford University Press publication of his Deontology in 1983 as edited by me. Bentham's An Introduction to the Principles of Morals and Legislation (IPML) expresses the standard interpretation of Hedonistic Utilitarianism. What he said in Deontology serves as the basis of Compassionate Utilitarianism.

If you buy and read only one book this year, make it this one. Then, after you read and reread this book, buy and read, if you have not done so already, it's prequel, Cosmopolis. When you've done that you may find yourself wondering one thing and worrying about another (at least, where medical ethics is concerned). Why do we hear so little about Montaigne and Wittgenstein? And why do we bother so much with Descartes and his followers? Did philosophy take a wrong turn somewhere? Has ethics gone in one direction, philosophy in another? Did we moderns zig, when we could, and should, have zagged?

Fair warning to the reader: Culture of Death: The Assault on Medical Ethics in America, by Wesley J. Smith, is hard for me to review. I work at Rush–Presbyterian–St. Luke's Medical Center, where in April 1989, Rudy Linares removed his son, Sammy, from a ventilator at gunpoint. I took the criticism hard and was critical of others who were in the outcry. In fact, some of the people Smith criticizes are people with whom I had differences. Yet, Smith's views are so harsh and alien to my understanding of the culture and practice of healthcare that I find them off-putting. Further, he and I participate in the same listserv, where I often disagree with his postings.

(Note: This consensus statement appeared in somewhat differing format as an editorial in the Western Journal of Medicine 2001;175 [October 2001]. The full text and list of cosigners is published here for the first time.)

Bioethics is the formal discipline concerned with ethical and broader issues arising in the practice of medicine and the other healthcare professions and science as a whole. Bioethicists are concerned not only with the impacts and quandaries faced by individual patients and their caregivers, but the impacts of healthcare on society and the broader natural world. Although bioethicists approach such issues from many different theoretical perspectives, most if not all agree that the healthcare professions and industry should seek to minimize any real or potential health risks associated with providing healthcare.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will igve you an opportunity to respond in the letters section. Your input is desired and anticipated.