Death as an event: a commentary on Robert Morison.

1) We have no need to abandon either the concept of death as an event or the efforts to set forth reasonable criteria for determining that a man has indeed died. 2) We need to recover both an attitude that is more accepting of death and a greater concern for the human needs of the dying patient. But we should not contaminate these concerns with the interests of relatives, potential transplant recipients, or "society." To do so would be both wrong and dangerous. 3) We should pause to note some of the heavy costs of technological progress in medicine: the dehumanization of the end of life, both for those who die and for those who live on; and the befogging of the minds of intelligent and moral men with respect to the most important human matters.

Thinking about the body.

KIE: The relation between a human being and his body is a complicated question made more problematic by new technologies. Kass ponders the "mind-body problem" in its many aspects. He discusses the body in speech and experience, examines its unitary and bipolar properties, and comments on the results of upright posture and on the body as a source of both pride and humility. He considers the nature of human dignity and the development of sociability and culture. In comparing cultures based on their treatment of the dead, he finds that "hyperrational" societies demonstrate the least respect for both living and dead bodies. He concludes that modern scientific man is losing his respect for the meaning of life by his insistence on achieving autonomy through biomedical technologies.^ieng

Is there a right to die?

To speak of rights in the very troubling matter of medically managed death is ill suited both to sound personal decisionmaking and to sensible public policy. There is no firm philosophical or legal argument for a "right to die."

Practicing ethics: where's the action?

KIE: Kass uses the occasion of the Hastings Center's 20th anniversary to critique contemporary bioethics. He describes what he terms seven "dominant fashions" in the modern practice of ethics that he believes have resulted in a theoretical and rationalistic approach with grave weaknesses. He raises questions about the relationship between moral theory and moral action, and about the nature and formation of a moral life. In discussing the future work of the Hastings Center, Kass calls for less thinking about doctrine and principles and more thinking about education and institutions, particularly those involved with medical practice.^ieng

"I will give no deadly drug." Why doctors must not kill.

Is the profession of medicine ethically neutral? If so, whence shall we derive the moral norms or principles to govern its practices? If not, how are the norms of professional conduct related to the rest of what makes medicine a profession?

Professing ethically. On the place of ethics in defining medicine.

Medicine, despite technological advances and societal changes, remains essentially what it has always been, a profession rather than a trade, with its own ends, means, and intrinsic norms of conduct. Being a professional is an ethical matter, entailing devotion to a way of life, in the service of others and of some higher good. The medical profession is devoted to the naturally given end of health and assists the immanent powers of self-healing. It serves the needs as it treats the infirmities of the sick, sensitive to their vulnerability, shame, and exposure and mindful of the meaning of the delicate tension between bodily wholeness and necessary decay. These special characteristics imply specific and inherently medical obligations, both of omission and commission, as well as an appropriately reverential stance of the physician before his chosen profession.

KIE: A thesis is developed concerning the basic nature of medicine as a profession, rather than a trade, and the ethical implications of being a medical professional. Unique moral duties and norms of conduct are ascribed to the physician; they flow from the precariousness of health, the human consciousness of illness, and the explicitly defined relationship of the patient's illness and health to the physician's professed devotion to healing and comforting.

Change and permanence: reflections on the ethical-social contract of science in the public interest.

Modern science, dedicated since its 17th century origins to the mastery and possession of nature for the relief of man's estate, is a source of great social change, affecting our opinions, practices, and ways of life. It thus exists necessarily in tension with law and morality, our institutions of stability and order. This tension between change and permanence, between science and law or morals, was institutionalized by the American Founders who sought to encourage, under law, the progress in science and the useful arts, by means of the copyright and patent laws. American science and technology have flourished under the patent law, an ingenious ethical and social contract between scientists and the polity, through which private right and interest and public good generally coincide. Nevertheless, this contract has its limitations. Some of these limitations are vividly seen through the recent Supreme Court decision (in the Chakrabarty case) to permit the patenting of living microorganisms. Analysis of this case shows why the contract between science and the polity embodied in the Patent Laws may not always serve the public good and may also be harmful to science itself. Also, permitting ownership of living species shows how close we have come in our thinking to overstepping the sensible limits of the project for the mastery and possession of nature.

Ethical dilemmas in the care of the ill. I. What is the physician's service?

Physicians must continue to rely on their own powers of discernment and prudent judgment and not look to external "expert" guidance or expect simple solutions in facing the myriad ethical dilemmas in caring for the ill. Their ability to exercise the requisite virtues in particular cases requires, however, greater self-consciousness and thoughtfulness about the nature and purpose of medicine, including such questions as the following: Who and what is the physician? Whom and what does he serve? What is his relation to his patient and society? In exploring these questions, this article discusses how and why the medical profession's perception of its ethical dilemmas may differ from that of the broader American society and how physicians must respond to protect and preserve the integrity of their profession.

Segregation of functional sex factor into minicells.

The segregation of a bacterial plasmid, the sex factor F', has been investigated in a cell-division mutant of Escherichia coli which produces small anucleate cells (minicells). Significant amounts of isotopically labeled DNA segregate into minicells dependent upon the presence of F'. Minicells containing F'Gal or F'(lambda) are shown to donate the plasmid in conjugation. These results demonstrate that the sex factor may be dissociated from the bacterial chromosome and that this separation does not prevent its subsequent transfer.

'Doctors must not kill'.

KIE: Four physicians respond to "It's over, Debbie," an anonymous resident physician's account of an incident when he or she injected a terminally ill cancer patient with a lethal dose of morphine (JAMA 1988 Jan 8; 259(2): 272). Gaylin and his colleagues condemn both the physician's violation of legal and ethical norms, and the conduct of JAMA's editor in publishing the article without editorial rebuke or comment. They warn that the issue of active euthanasia "touches medicine at its very moral center," and that, as pressure to legalize euthanasia in response to patient demand increases, the medical profession must repudiate direct and intentional killing of patients and discipline doctors who kill.^ieng