Kennedy Institute of Ethics Journal

Kennedy Institute of Ethics Journal 12.2, June 2002


Feature Articles

    Kaveny, M. Cathleen.
  • Conjoined Twins and Catholic Moral Analysis: Extraordinary Means and Casuistical Consistency
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    Subject Headings:
    • Conjoined twins -- Surgery -- England -- Manchester.
    • Bioethics -- Religious aspects -- Catholic Church.
      This article draws upon the Roman Catholic distinction between "ordinary" and "extraordinary" means of medical treatment to analyze the case of "Jodie" and "Mary," the Maltese conjoined twins whose surgical separation was ordered by the English courts over the objection of their Roman Catholic parents and Cormac Murphy-O'Connor, the Roman Catholic Cardinal Archbishop of Westminster. It attempts to shed light on the use of that distinction by surrogate decision makers with respect to incompetent patients. In addition, it critically analyzes various components of the distinction by comparing the reasoning used by Catholic moralists in this case with the reasoning used in other cases that raise similar issues, including women facing crisis pregnancies who prefer abortion to adoption and the Indiana "Baby Doe" case.
    Pinkus, Rosa Lynn B.
  • From Lydia Pinkham to Bob Dole: What the Changing Face of Direct-to-Consumer Drug Advertising Reveals about the Professionalism of Medicine
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    Subject Headings:
    • Advertising -- Drugs -- Law and legislation -- United States -- History.
    • Consumer education -- United States -- History.
    • Medical ethics -- United States -- History.
      From its founding in 1847, the AMA divided drugs into "ethical" and "unethical" preparations. Those that were ethical had a known composition and were advertised only to the profession. Others, patent medicines (technically proprietary drugs, whose trademarks were protected by copyright), were sold directly to the public. In spite of the AMA's efforts to ban the advertising and sale of these nostrums, proprietary drugs flourished during the nineteenth century. Starting in 1900, however, three major societal trends combined to bolster the AMA's campaign, and by 1920 almost all advertising was directed to physicians, who would then prescribe medications to their patients. This ban on advertising pharmaceuticals directly to the public remained virtually unchanged until approximately 1980. Since then, it has slowly eroded and, as recently as 1997, the FDA created guidelines for pharmaceutical companies to advertise on television. What does this change say about the profession of medicine, the role of the physician in society, and the doctor-patient relationship? Using a comparative historical approach, this paper examines these issues.
    Barnard, David.
  • In the High Court of South Africa, Case No. 4138/98: The Global Politics of Access to Low-Cost AIDS Drugs in Poor Countries
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    Subject Headings:
    • Pharmaceutical Manufacturers' Association of South Africa -- Trials, litigation, etc.
    • South Africa -- Trials, litigation, etc.
    • Drugs -- Prices -- Law and legislation -- South Africa.
    • AIDS (Disease) -- Treatment -- South Africa.
    • Public health -- Economic aspects -- South Africa.
      In 1998, 39 pharmaceutical manufacturers sued the government of South Africa to prevent the implementation of a law designed to facilitate access to AIDS drugs at low cost. The companies accused South Africa, the country with the largest population of individuals living with HIV/AIDS in the world, of circumventing patent protections guaranteed by intellectual property rules that were included in the latest round of world trade agreements. The pharmaceutical companies dropped their lawsuit in the spring of 2001 after an avalanche of negative publicity. Yet, despite the government's victory, AIDS drugs remain very expensive in South Africa, and the government still refuses to provide antiretroviral therapy to adults. These events have shone a spotlight, not only on the possibilities for coordinated political activism in the era of instant global communications, but also on the tangled social, economic, and political dimensions of AIDS treatment in poor countries.
    Outka, Gene H.
  • The Ethics of Human Stem Cell Research
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    Subject Headings:
    • Embryonic stem cells -- Research -- United States.
    • Bioethics -- United States.
      The medical and clinical promise of stem cell research is widely heralded, but moral judgments about it collide. This article takes general stock of such judgments and offers one specific resolution. It canvasses a spectrum of value judgments on sources, complicity, adult stem cells, and public and private contexts. It then examines how debates about abortion and stem cell research converge and diverge. Finally, it proposes to extend the principle of "nothing is lost" to current debates. This extension links historic discussions of the ethics of direct killing with unprecedented possibilities that in vitro fertilization procedures yield. A definite normative region to inhabit is located, within a larger range of rival value judgments. The creation of embryos for research purposes only should be resisted, yet research on "excess" embryos is permissible by virtue of an appeal to the "nothing is lost" principle.

Bioethics Inside the Beltway

    Holt, Ellen.
  • Expanding Human Research Oversight
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    Subject Headings:
    • United States. Dept. of Health and Human Services. Office of Human Research Protections.
    • Human experimentation in medicine -- Moral and ethical aspects -- United States.
    • Human experimentation in medicine -- Government policy -- United States.

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