For a variety of reasons, the AIDS epidemic is forcing a thorough reassessment of many of the standards by which the terminally ill and other medical patients are treated by health-care systems throughout the world. This has generally been a good thing. It has provided needed motivation for public policy-makers to take seriously a range of health-care issues that have often been downplayed, ignored, or debated with vigour only within the relatively mute pages of the academic journals of health-care professionals, philosophers, law professors and others. Issues such as euthanasia, testing for dangerous communicable diseases, palliative care, and even important general questions about the distribution and availability of health-care resources have been pushed toward the front of the public health-care agenda largely because of the impact of AIDS. And it is fair to say that these matters are often being addressed with an urgency and sensitivity that would be absent without the political impetus that was unleashed along with this disease. One of the most controversial issues that has arisen concerns access to experimental therapies by the terminally ill. As is the case in other areas, the political forces generated by the AIDS tragedy have created an opportunity for productive review of policies and practices that undoubtedly deserve scrutiny and reform. However, my aim in this paper is to urge caution on some of the advocates of reform. I will argue that many recent proposals to enhance access to experimental therapies by the terminally ill rest on philosophically unsupportable grounds and pose an unjustifiable threat to the public interest in finding safe and effective therapies for terminal illnesses.

Le droit, il est inutile d'insister sur ce point, est essentiellement normatif. Il règle, dirige, impose, sanctionne les conduites, ou du moins certains types de conduites, dans la société. À cet égard, le milieu clinique est un milieu qui, comme tous les autres, n'échappe évidemment pas aux interactions entre individus (par exemple, les rapports entre patient et médecin) ou entre individus et collectivité (par exemple, entre les médecins et l'hôpital ou l'hôpital et l'État). Il est done naturel que les milieux médicaux et hospitaliers soient générateurs de normes d'une part et, d'autre part, utilisent celles-ci de façon courante dans les relations humaines.

In selecting for discussion the general theme of the donation and sharing of cells, tissues and organs (typically accomplished by transfusion and other forms of surgical transplantation) the program committee of the Second Congress of the Canadian Bioethics Society appears to have been astonishingly prescient in anticipating that two North American physicians —clinical researchers rather than “basic” scientists, by the way —would receive, as they did just over a month ago, Nobel Prizes in Physiology or Medicine for their medical achievements.1 Dr. Joseph Murray was cited in part for successfully performing, in 1954, the first human kidney transplant (the recipient lived eight years), as well as for discovering how to minimize the body's rejection of this organ; Dr. Donnall Thomas was cited for work he accomplished in 1956 —the first bone-marrow cell transfusion to a 16-year-old patient (who is still alive) such that the human immune reaction of a graft to this recipient's body could be medically managed to avoid rejection of the transplanted material (Economist 1990). Having mentioned these awards, I should note that Dr. George Hitchings had already received the Nobel Prize in Medicine in 1988, being credited with the discovery of a powerful immunosuppressant, azathioprine, which greatly improved the survival of the recipients of unmatched graft transplants.