Table of contents for Bioethics / by W. Noel Keyes.

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Acknowledgments	iii
Introduction	xv
Part I
Sources of Bioethics for Members of Hospitals, Ethics Committees, and Regulators of Healthcare	1
Chapter 1
Drawing Lines in Bioethics: Medicine and the Law 	3
	1.	What Are the Subjects of Bioethics and the Law?	3
	2.	Environmental Parts of Ethics	6
	3.	The European Union Convention on Human Rights (ECHR) and Bioethics Normal Medical Practice 	9
	4.	The Partial Transition from Bioethics to the Law-Charles Snow	11
	a)	Differences between Bioethics (Referred to the Hospital's Ethics Committee) and Medical Malpractice (Referred to the Hospital's Peer Review Committee); Physician Expert Witnesses	14
	b)	The Better Way to Face These Problems	23
Chapter 2
The Creation and Evolution of the Universe and Humankind	27
	1.	Cosmic Evolution from the Beginning of Time	28
	a. 	The Big Bang and the Meaning of the Creator of the Universe, Its Age, and Evolution	32
	b. 	Potential of Progress in Astrobiology, Astrology	41
	2.	The Importance of the Continuance of Evolution into Bioethics, Medicine, and the Law	46
	a)	What Constitutes Life Itself?	46
	b)	The Importance of Considering the Meaning of Evolution	54
	c)	Evolutionary Advances by the Third Millennium	63
	d)	A Key to the Basis of Significant Contingencies (Not Design) in Evolution	66
	e)	Law and Biology	68
Chapter 3
Religious Sources, Their Restrictions, and Their Possible Bioethical Standards	73
	1.	Certain Differences between Religious and Bioethical Standards	74
	a)	Monotheism and Its Maintenance in Modern Times	76
	b)	Consideration of Religious and Ethical Standards under the U.S. Constitution	80
	2.	A Brief Look at Several of America's Diverse Religions Together with Their Restrictions on Possible Medical and Ethical Sources	86
	3.	The "Wall of Separation" and Legal Bans on Teaching Religion in Public Schools	127
Chapter 4
Some Differences and Difficulties with Science and Philosophy in the Search for Bioethical Standards	145
	1.	Better Reasoning and Performance of Science; Law and Ethics Partially Distinguished	146
	2.	Some Scientists Are Religious, Fewer Are Atheists, and More Are Agnostics	151
	a)	Prayer and Certain Conflicts; Reincarnation	152
	b)	Limitations of Science; Risk/Benefit Review by IRBs in Research Clinics; Complementary and Alternative Medicine (CAM)	165
	3.	A Problem With the Use of Either Reason or Philosophy Alone	176
	4.	The Allegation of Neutral Principles; Science and the Humanities	180
	5.	The Change in Modern Philosophy and Secular Humanism	185
Chapter 5
Autonomy, Responsibility, and Informed Consent	189
	1.	Autonomy and Responsibility	190
	a)	Animal Anatomy of Autonomy in Nature and the Need for Ecology	190
	b)	From Animal Autonomy to Human Autonomy	193
	c)	Paternalistic Opposition to Individual Autonomy	200
	d)	The Balance Between Autonomy and Responsibility, Majority vs. Minority	207
	2.	 Eugenics Examples in Bioethical Issues	211
	a) 	The Ethical Need for Increased Individual Responsibility	214
	b)	Bioethical Considerations of Religious Diversity and Educational Autonomy	218
	3.	The Informed Consent: Results from Advances in Autonomy	222
	a)	The Golden Rule for Use by Physicians	226
	b)	Alleged Reliance on Patients to Ask Questions	228
	c)	Informed Consent Concerned with Alternative Treatments in Law and Medicine and the Rise of Consumerism	230
	d)	Guidelines for Informed Consent in Medicine and the Law; Mandating Reporting of Violence	233
	e)	Informed Consent on Clinical Research under IRBs and Experimental Treatments during Life-Threatening Situations through Randomized Placebo-Controlled Investigations	237
	f)	Informed Consent by Emergency Department Physicians, EMTALA, the Triad Terrorist Attacks; Radiation Treatment	242
	gi)	Nuclear Terrorism	250
	h) 	Informed Consent v. Ethnic Groups and Prisoners	258
	i)	Informed Consent v. Laws Authorizing Patient Access to Obtain Physician Profiles; Medical Students Characterized as "Doctors"	261
	j) 	Mental Competence to Give Informed Consent	269
	k) 	Informed Consent by Minors	275
Chapter 6
Ethics, Bioethics, and Ethics Committees	279
	1. 	Lack of Fundamental Constitutional Rights to Healthcare and Education, Costs	280
	2.	Bioethicists: With and Without Religion	285
	3. 	Ethics as Viewed by Some Physicians; Errors and Interests; Lack of Effective Discipline; and Use of Placebos	293
	a)	Ethics Viewed by a Survey of Physicians vs. Other Readers (of JAMA)	293
	b)	Evaluations of Physicians (or Bioethicists) Who Work for Manufacturers of Drugs or Medical Devices	294
	c)	Peer Review Distinguished from Most Bioethical Committee Matters	308
	d)	Medical Errors, Lack of Reporting, PSQIA and (Medicare Fraud)	312
	e)	Doctoring Business with Fraud and Waste; and Use of "Double Standards" for Admission to Medical Schools	322
	4.	The Vagueness of Bioethical Principles and the Need for an Alternative	325
	5.	The Teaching of Bioethical Ethics and the Law; Ethical Lapses	328
	6.	The Role of Biomedical Ethics Committees and the Meaning of Care	331
	a)	JCAHO's Requirement of a "Mechanism" for Ethical Issues	332
	b)	The Lack of Standards for Membership Credentials	336
	c)	The Goals of Medicine and of Bioethics Committees; "Clarification" and Other Goals	338
	d)	Physician Dominance in Hospital Ethics Committee Decision Making	341
	e)	Hospital and Ethics Committee Records	345
	7.	Organizational Ethics	348
	a)	Health Maintenance Organizations (HMOs); ERISA and Rationing	349
	b)	Fraud in Medicare and Medicaid; Contracting Practices of Healthcare Organizations and Needs of Guidelines of the FAR	356
Part II
The Issues Bioethics Must Continue to Solve During the Twenty-first Century	363
Chapter 7
To Conceive or Not to Conceive-The Ethics of Family Planning and Birth Control	365
	1.	Births within Marriage, Divorce, Same Sex, and Births Outside of Marriage	366
	2.	The Great Ethical Problem of Overpopulation	378
	a)	The Current Increasing Population	378
	b)	The Ethical Need to Establish a National Goal for Family Planning; President Nixon's Goal	383
	c)	Immigration Ethics and Population Increase	387
	d)	Environmental (and Bioethical) Problems Growing Out of Overpopulation	392
	3.	Ethical Actions That Can and Should Be Taken	396
	a)	Involuntary Birth Controls	396
	i)	Involuntary Sterilization, Castration, and Mental Retardation	398
	b)	Voluntary Birth Controls	404
	i)	Voluntary Sterilization	405
	ii)	Contraception; Breast-feeding	408
	iii)	Unintended Pregnancies	415
	iv)	Emergency Contraception	418
Chapter 8
Infertility, Impotence, and Cloning
	1.	Fertility and Impotence	422
	a)	Some Causes of Impotence	422
	b)	Public Subsidizing of Reproductive Assistance and Mandatory Insurance Coverage	428
	c)	Fertility Clinics and Preimplantation Genetic Diagnosis; Lack of Regulation by Many States; Embryo Detraction 	433
	d)	Sperm Banks and Sperm Problems	446
	e)	Egg Banks	450
	f)	Frozen Embryos and Agreements to Donate Them, Posthumous Reproduction	453
	g)	Multiple Births Resulting from Fertility Pills	460
	h)	Artificial Insemination of Single Mothers	465
	i)	Surrogacy	468
	2.	Cloning in the Third Millennium	472
	a)	Origins of Cloning	472
	b)	Some Religious Reactions	479
	c)	Some Political and Legal Statements on Human Cloning and Stem Cell Research	481
	d)	Some Views of Scientists and Physicians on Human Cloning	488
	e)	Proposed Limits on Cloning in Ethics and the Law	490
Chapter 9
The Choice of Abortion	497
	1.	Legality, Privacy, and Substantive Due Process	498
	2.	Restrictions on Public Funding of Abortions	508
	3.	Religion and Abortion	512
	4. 	Abortion Pills and Other Devices	517
	5. 	Unwanted Pregnancies, Unmarried Mothers, and Abortion Rates	521
	6.	Spousal and Parental Consent for Abortions	527
	7. 	Harassing and Bombing Abortion Clinics	532
	8. 	Formerly Mandated C-Sections to "Save" a Viable Fetus	537
	9. 	Genetic Testing and Prenatal Counseling; Gender Selection 	541
	10. 	Partial Birth and Post-viability Abortions	549
	11.	Shortage of Physicians for Abortions	556
Chapter 10
Fetal Abuse and Severely Defective Newborns	561
	1.	Current Liberty Interests of Most Pregnant Drug Users	561
	2.	Withholding Medical Treatment from Severely Defective Premature Infants with Low Birth Weight	570
	3.	Newborn Screening Requirements: Intersex Conditions	577
	4.	Attempts to Prevent Premature Infants with Very Low Birth Weight and Futile Results in Certain Prenatal Births	581
	5. 	Poor and Expensive Outcomes at Neonatal Intensive Care Units (NICUs)	585
	6.	Proposal that Parents Share Some Expenses and Time	593
	7.	Infanticide and Abortions after Viability of Certain Types of Severely Defective Infants	595
Chapter 11
Restrictions on the Sources and Allocation of Organ Transplants	605
	1. 	Restrictions on Sources for Organ Transplant and Embryo Transfer in the Twenty-first Century	606
	a)	The Need for Consent to Organ Transplants	613
	b)	Religious and Cultural Restrictions on Transplants 	618
	i)	Embryo Transfer for Stem Cell Research	621
	c)	Donations to or by Living Mature Minors and Other Legal Incompetents	633
	d)	Sales of Organs	638
	e)	Organs from Suicidal Donors and Executed Criminals (Murderers)	643
	f)	Organs from Anencephalics	648
	g)	Fetal Tissue and Mortality Rates in Hospitals; Age Limits	650
	h)	Whole Brain Death (by Neurologic Criteria) and Persistent or Permanent Vegetative State (PPVS)	657
	i)	Xenotransplants (from Animals to Humans)	668
	2. 	Allocation of Donated Organs	674
	a)	Allocation Priority to the "Sickest" Nationwide; HIV Patients	675
	b)	Non-direct Donations by Living Individuals	680
	c)	Directed Donations by Living Persons	683
	d)	Transplants to Patients with End-Stage Renal Disease (ESRD)	684
Part III
The Right to Die with Dignity	689
Chapter 12
The Right to Dignity in the Dying Process	691
	1.	The Need for End-of-Life-Care Professionals in the Dying Process	692
	2.	The Refusal to Acknowledge the Right to Die	704
	3.	Culture, Longevity, and Quality of Life Decisions; Monism and Dualism	707
	a)	Increasing Longevity	710
	b)	Decreasing Longevity and Quality of Life	719
	c)	Obesity and Deaths	735
	4.	Attempts to Change from the "Slow Course to Death" to "Varieties of Approaches to Death," Kubler-Ross	745
	5.	Pain and Its Partial Management	749
	a)	Pain	749
	b)	Pain Management and Its Limitations	751
	6.	Costs Incurred Nearing End-of-Life Healthcare	761
	a)	Entitlements and Their Limitations; Social Security	763
	b)	Inequitable Allocations and Deceiving Healthcare Payers v. HMOs	766
	c)	Long-term Home Care and Nursing Homes	773
Chapter 13
Improvements Needed in the Twenty-first Century Right to Die	779
	1.	Training for End-of-Life Care	780
	a)	Advance Directives, Living Wills	782
	2.	Surrogates, Durable Powers of Attorney, and Emergency Treatment (EMTLA)	791
	3. 	Withholding and Withdrawal of Treatment; Limitations on Nonbeneficial (Futile) Treatment: DNR vs. CPR	798
	a)	Withholding Equals Withdrawal	802
	b)	Withholding Nutrition and Hydration	803
	c)	Patients in a Persistent or Permanent Vegetative State (PPVS) Without a Living Will or DPA; Subjective Personhood	808
	4.	The Rights of Mature Minors to Die and Jehovah's Witnesses	813
	5. 	The Choices of Do Not Resuscitate (DNR) vs. Cardiopulmonary Resuscitation (CPR): Legal and Ethical	818
	a)	Presumed Consent to Cardiopulmonary Resuscitation (CPR)	820
	b)	Best Interests v. Substituted Judgment	826
	6. 	Limitations on Nonbeneficial (Futile) Treatment	828
	a)	Treatment Beyond the "Goals of Medicine"	831
	b)	Treatment Regardless of a Lack of Consensus on "Futility"	833
	c)	The Unique Direction of Informed Consent	836
	d)	A Way to "Free" Physicians from Self-Interest or Self-Protection in Connection with Life Support; Anencephalics	838
	e)	The Authority and Responsibility of Physicians with ICUs and Authorized Executions	843
	f)	The Current Method of Stopping Futile Treatment of Dying Patients by the AMA and by Texas	851
	7.	Slow Code	855
Chapter 14
End-of-Life Choices of Terminal Patients	857
	1. 	The Choice of Suicide	858
	a)	Some Religious Views of Jews and Jehovah's Witnesses	858
	b)	Various Reasons for Possible Suicides; Taking Risks (Motorcycles)	862
	c)	Limitations on the Duty to Deny Suicide	868
	d)	The Option of Knowing That You Can	871
	2. 	The Goals of the Hospice Option	873
	a)	Assistance and Lack of Hospice Assistance in Dying	879
	3.	The Choice of Physician-Assisted Suicide; Double Effect; Costs of Capital Punishment Procedures	881
	a)	Some Religious Views on PAS	889
	b)	The Choice of Double Effect (or Euthanasia) by the Use (or Abuse) of Lethal Doses of Pain Medication	891
	c)	The Choice of PAS and/or Double Effect in Oregon	896
	4.	Limitation in Model Statutes; Mandatory Psychiatric Examination	907
	5.	Progressive Nullification of Anti-PAS Statutes	910
	a)	Civil Disobedience Actions by Physicians and Nurses 	910
	b)	The Prohibition Analogy (Nullification) 	911
	c)	The Example of Dr. Kevorkian	912
	6.	Other Choices of Euthanasia	914
Part IV
Bioethics and Future Somatic and Germline Gene Therapy	921
Chapter 15
Bioethics on Genetics Superseding the Human Genome Project	923
	1.	The Human Genome Project	924
	2.	Genetically Modified Crops	934
	3.	Genetic Approaches to Disease; Confidentiality; Non-disease and Privacy	941
	4.	The Absence of Ethics and Morals in Patents on Genetically Engineered Living Things	952
	5.	The Possible Future of Inheritable Genetic Interventions and Changes in Homo Sapiens	960
	a)	Clinical Trials on Genetic Research	964
	b)	Distinctions Between Somatic and Germline Therapy	969
	c)	Somatic Gene Therapy and Some Needs for Mandatory Testing	972
	d)	The Publicity Needed for Recombinant DNA Research by Public and/or Private Entities	982
	e)	Germline Gene Therapy 	985
	i)	Age Limits	991
	ii)	Intelligence Quotient; Millionaires; Brains of Males and Females; and Sizes in Animals	996
	iii)	The Importance of Germline Gene Therapy for Space Travel	1008
Chapter 16
Epilogue	1021
	1.	Twenty-first Century Bioethical Decisions within Traditional Cultural, Religious, or Nontraditional Categories by Federal and State Courts	1033
Appendix A: 
Environmental Crises at the Turn of the Third Millennium	1045
	1.	Life's Ecological Needs and Purposes According to Existential Philosophers; Environmental Crises	1046
	2.	Biomass and the "Lack in Accounting" for the Loss in its "Capital"	1049
	3.	A Sustainable Environment in Forests and for Animals	1053
	4.	Social Structures of Humans and Two Other Primates	1061
	5.	The Ocean and Their Fish and Whales	1062
	6.	The Human Need for Protection Against Release of Chemicals into the Atmosphere 	1065
	7.	Ozone Depletion	1069
	8.	Global Warming and the Loss of Biological Diversity	1073
	a)	Solar, Moon, and Wind Power vs. Coal, Gas, and Oil	1076
	b)	The Hydrogen Engine vs. Electric Cars	1078
Appendix B:
Some Views on Medicine in the Two Chinas and Tibet at the Turn of the Millennium	1081
	1.	Documentary Video "Beyond The Clouds" and Interview with an Experienced Doctor	1082
	2.	Birth Control for Han Chinese Majority vs. Minority	1084
	a)	The "Critical Appraisal" of Dr. Ruiping Fan	1085
	b)	Some Remarks on Articles Contained in the Volume "Chinese and International Philosophy of Medicine" (1998)	1086
	3.	Adoptions of Abandoned Girls by Foreigners in Beijing	1088
	4.	Reactions to a Presentation on American End-of-Life Laws in Beijing	1088
	5.	Reactions by Lawyers in the "Other China" (Taiwan)	1089
	6.	Tibet	1091
	a)	The Herbal Medicine Hospital in Lhasa, Tibet, a Teaching Hospital	1091
Appendix C:
False Claims Act Settlements and Rulings in Healthcare Organizations	1093
Appendix D:
Millennia	1103
Appendix E:
Genetic Research and Economic Advantage of Abbreviated New Drug Applications	1103

Library of Congress Subject Headings for this publication:

Medical ethics -- United States.
Bioethics -- United States.
Bioethical Issues -- United States.
Bioethical Issues -- legislation & jurisprudence -- United States.
Bioethics -- United States.