I come to bioethics without any particular training or credentials, except for those qualifications that any reasonably observant and thoughtful general clinician might bring. I probably also share with most clinicians the willingness, sometimes even without a specific invitation, to share with others what is on my mind.

In the last 7 years, Russia has seen deep changes in all spheres of political and economic life. Some new realities have appeared in Russian medicine as well. This paper tells the story of how these changes came about, what kind of unusal situation were created, and how these situation are recognized in professional and public debates.

The ethics committee of the University of São Paulo Medical College Hospital and Clinics has authorized partial liver transplantation from living donors. The request for this type of transplantation was brought to the committee by a team of professors of surgery operating at the university, headed by Dr. Silvano Raia. Their request and justification are presented here, with discussion following.

It is a common assumption in ethics that everyone is due equal access to basic human goods. In our modern society, at least since the French Revolution, healthcare is counted along with food, shelter, and security as such a basic good. Anyone suffering from a treatable life-threatening disease can therefore, be seen as having a prima facie claim on medical treatment.

Not that long ago, any thought of transferring body parts, or fluids like blood, among individuals was expressed in terms of a nightmare. Consider the problem of involuntary blood transfusions to Count Dracula! Or recall the infamous brain transplant to the brutish body under Dr. Frankenstein's ministrations. The very thought of bodily transference stimulated writers to create monsters. The stuff of evil seemed to surround any attempt. Hubris was considered the evil that exceeded the normal limits of scientific research and development. Transplantation seemed to make humans into gods who defied death but who, like Icarus and his wax wings, flew too close to the sun.

The recent case of Baby Theresa has once again raised the dilemma of organ donation from anencephalic infants. Baby Theresa's distraught parents wanted to create something good from something tragic, by donating the baby's organs so that other children could live. If the physician waited for their baby to die naturally, the organs would not be suitable for transplantation. If they took them before death they could be harvested. For this reason, the parents petitioned the Florida courts to declare their baby dead at birth so the organs could be removed at an earlier, more propitious time. The court refused. The infant died, its vital organs unusable.

Baby Theresa, in her short 9-day life, cast a national spotlight on the question “Should anencephalic infants be used for organ procurement?” In denying her parents′ wishes to donate the baby's healthy organs to other children in need of kidneys, liver, heart, and lungs, Circuit Court Judge Estella Moriarty said, “I cannot authorized someone to take your baby's life, however short, however unsatisfactory, to save another child.”In citing a1988 Florida statute that does not allow a person to be declared dead while any part of the brain is functioning, Judge Moriarty ruled that doctors could only remove organs not vital to Theresa Ann's life. As the baby slowly died, so too did her vital organs.

The ethics of clinical research may be viewed from three different perspectives: the process of acquiring new knowledge, the moral use of the knowledge acquired, and the ethics of the investigator seeking this knowledge.

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent work has included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed.

Historically, patients have deferred to physicians′ judgments about appropriate medical care, thereby limiting patient participation in treatment decisions. In this model of medical decision making, physicians typically decided upon the treatment plan. Communication with patients focused on securing their cooperation in accepting a treatment decision that essentially had already been made.

During Operation Desert Shield and Operation Desert Storm, USNS Mercy (T-AH 19) was one of two American hospital ships deployed to the Persian Gulf. She arrived in the Gulf on 15 September 1990, following a 12,000-mile transit from her homeport of Oakland, California, and remained on station until 18 March 1991, when she passed through the Straits of Hormuz on her return voyage home. During the height of her deployment, Mercy was staffed with nearly 1,200 men and women, including physicians, nurses, dentists, representatives of affiliated health-care disciplines (including physical therapy, pharmacy, clinical psychology, social work, dietetics, and environmental health), hospital corpsmen, dental technicians, healthcare administrators, chaplains, and various nonmedical support personnel. The staff included a mix of active duty military providers and recalled reservists.

Smokers impose a terrible cost on all of the rest of us. Those who choose to smoke are more likely than nonsmokers to suffer from cancer, heart disease, and a host of other diseases that require intensive and expensive medical intervention. Although they may suffer these diseases, we all pay for their habit through higher healthcare costs, which are reflected in higher insurance premiums, higher taxes, and fewer healthcare resources available for nonsmokers. It is simply unfair for smokers to impose this cost on the rest of us; they should bear this self-induced cost themselves.