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Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
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Index

A

Abortion, 47, 172

as bioethics topic, 187-188

fetal research and, 97, 98, 138, 173, 481, 482-483, 484, 496-497nn.37-38

French debate, 488

grassroots movements, 8, 138-139

legal environment, 106, 107, 341-342, 344

in National Commission deliberations, 267

political conflicts over, 94, 353, 477-478

women's movement and, 50, 52

Abram, Morris B., 246-247, 269

Academic-industry collaboration, 2, 3, 27, 39-41

benefits of, 60-61

ELSI Working Group on, 441-442

Access to care, 3, 359

antipoverty programs and, 48

hospital resources and, 37

insurance trends in, 37-38, 57

new medical technology and, 38-39

President's Commission on, 92, 93, 101, 102, 162, 266, 289

social justice issues in, 247-248, 350

Accountability in health care, 35-36

in policymaking, 337

of science, 79-80

in science research, 62

Accreditation, 7, 125, 181, 412-413

ACT-UP. See AIDS Coalition to Unleash Power

Action-forcing power of national commissions, 91, 101, 174, 191

of supra-agency ethics commission, 21-22, 191

Adams, Arlin, 482

Advance directives, 100, 105, 163, 309, 313, 317, 318, 322, 324, 412

legal conceptualizations, 343

Advisory Committee on Human Radiation Experiments, 33-34

African Americans, 48-49, 139-140, 141, 156

Agency for Health Care Policy and Research, 120-121

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

AIDS Coalition to Unleash Power (ACT-UP), 8, 53, 137, 138, 469, 471

AIDS/HIV, 96, 119

antidiscrimination legislation, 349, 350

confidentiality in autopsy reports, 117

confidentiality in research, 459-463

ethical issues in, 168, 458

ethicist-activist collaborations, 475

gay and lesbian concerns, 52-53

grassroots organizations, 137-138

hospital utilization and, 56

in minority populations, 49

new drug research, 470-472

policy conflicts in, 459

political context of policymaking in, 352, 458-459, 474-475

public health classification, 336-337

research funding, 52-53, 352

research protocols, 468-472

screening for, 463-466, 491

testing pregnant women and newborns, 467-468

tuberculosis and, 472-474

women's issues, 51, 467-468

American Academy of Pediatrics, 7, 119, 411

American Association of Bioethics, 120

American Association of Colleges of Nursing, 82

American College of Obstetricians and Gynecologists, 7, 118, 120, 180, 485

American College of Physicians, 7, 119

American Council of Life Insurance, 451

American Dental Association, 82

American Fertility Society, 118, 180, 485

American Foundation for AIDS Research, 470

American Hospital Association, 36, 411, 412

American Medical Association, 7, 69, 117-118, 120, 348, 411, 419, 484

American Thoracic Society, 7, 119

Americans with Disabilities Act, 348-350, 352

ELSI and, 442, 447, 452

Antibiotics, 15, 170

tuberculosis resistance, 472

Argentina, 110

Arizona, 480

Arkansas, 313

Armstrong, John A., 61

Arras, John, 247

Artificial insemination, 499n.59

Asilomar conference, 78, 95, 435

Assisted suicide, 36, 119, 184, 317-318, 319-320

state regulation of, 18-19

vs. refusal of treatment, 309, 315

Association of American Medical Colleges (AAMC), 81, 83

Association of State and Territorial Health Officials, 464-465

Augenstein, Leroy, 69

Australia, 109, 110

B

Baby Doe issues, 102, 119, 121, 318-319, 411

Baby Mcase, 100

Barnes, Barry, 394-395

Bauer, Gary, 481, 482

Bayer, Ronald, 247

Bayh-Dole Patent and Trademark Laws Amendment Act, 59

Beckwith, Jonathan, 438-439

Beecher, Henry, 32

Beneficence, 91

Bentham, Jeremy, 206

Bernard, Claude, 30

Bernard, Jean, 491, 492

Beta-thalassemia, 140

Bioethics

academic development, 67-70

centers for study of, 8, 69, 131-133

complexity of moral decision making in, 252

conceptual evolution, 4, 176

core issues, 358, 359

current deliberations, 73, 168

as government domain, 5-6

multidisciplinary investigations, 74- 75

as philosophic discipline, 70-73

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

professional forums for consideration of, 7-8

professional practitioners, 68, 423

in public discourse, 68, 72-73

scientists in, 5, 75-80

Biomedical Ethics Advisory Committee, 6, 437

expiration, 94, 187, 305n.1, 454n., 477

mandate, 94, 436, 454n.1, 477

membership, 94, 454n.1, 514-515

origins of, 436

political context, 94, 103, 187

Biomedical Ethics Board, 93-94, 172, 436

Biotechnology Industry Association, 59

Birth control pills, 51

Blackmun, Harry, 340-341

Bleich, J. David, 324, 328, 483

Blood transfusions, 359

religious objection to, 248

Bouvia v. Supreme Court, 342, 425

Boyle, Robert, 397, 398

Breast cancer, 51

British Medical Association, 113

Brody, Baruch, 247-248

Brooklyn Jewish Chronic Disease Hospital, 32

Bush administration, 348, 352, 445, 477, 483, 485

Bypass surgery, 15, 170

C

Califano,Joseph, 94, 95

California, 313, 314, 480

Natural Death Act, 105, 313

Calvin, John, 370

Canada, 110, 115, 428n.3, 485-486

Cancer, 480

research, 63, 96

Canterbury v. Spence,34

Capron, Alexander, 269

Cardiopulmonary resuscitation, 324-325

Carter administration, 135, 269, 300, 306n.4

Centers for Disease Control, 94

in AIDS/HIV research, 459, 460, 461, 467

Changeux, Pierre, 491-492

Civil rights movement, 4, 48

Clinical practice guidelines, 116

artificial nutrition and hydration, 121-122

problems of, 120-121

for seriously ill newborns, 121, 411

Clinton administration, 8, 27, 33-34, 58, 62, 157, 173, 353, 485

Cloning, 14-15

Closed meetings, 11-12, 156-159, 171, 299

in hospital ethics committee deliberations, 416

Cobbs v. Grant,34

Comité Consultatif National d'Éthique pour la Santé et les Sciences de la Vie (CCNE) , 478-479, 486-493

Commercialization, 3, 440

See also Academic-industry collaboration

Commission on the Cost of Medical Care (1930), 263

Commissions on bioethics

bureaucratic location, 114, 299

commitment of participants in, 303-304

complete consensus in, 242-243

composition, 256

compromise in, 161, 244-245

congressional, 6, 90-94

consensus-building in, as evaluation criterion, 13, 160-162, 257-258

contextual assessment of, 331-332

contributions of , x, 297-299

credibility of, 479-480

decision by majority rule in, 245-246

decision-making methods, vs. moral philosophy methods, 217-218, 223 , 239

deductivism in moral reasoning of, 224-226

democratic values in, 11-12, 77, 155- 159

design as performance factor in, 299

dissemination of findings, 159-160

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

effectiveness of, 12-13, 103, 159-164, 297-299

elitist model, 112

ethical-political scope of, 217-222, 234-235

evolution of, viii-ix

explicit moral systems in, 234-235

in federal agencies, 19, 94-99

in France, 478-479, 486-493

goals of, 216-217, 332

growth of mandate and effectiveness of, 285

ideological conflict in, 293, 299

implementation of recommendations, 305

institutional settings, 7

as instrument of consensus, 217

intellectual integrity in, 9-11, 77, 153-155

international comparison, 6, 107-115 , 492-493

leadership, 299

methodology, 165-166

moral reasoning in, 215

national, role of, 103, 115, 178

open vs. closed meetings, 156-159, 171,299, 416

overlapping consensus in, 243-244

policy/practice impact, 304-305

in policymaking, 1-2, 216-217

populist model, 110-112

potential negative outcomes of, 14, 164-167

prestige factors, 305n.3

private model, 112-113

problems of process, 256-257

professional dominance of, 114

professional ethicists in, 222-223

in professional scientific societies, 7-8

public access, 114

public education role, 111, 217

report-writing style, 12, 159

role of, 261

role of consensus in, 252-253

single-interest advocacy in, 14, 164-165, 475

sponsorship, 114, 299

staff structure, 115, 302-303, 306n.6

state-sponsored, 6, 19, 99-100, 184-185

supra-agency national organization, 15-16, 19-23

trade-offs in design/activities of, 301

See also Evaluation of commissions;

Mechanisms of ethical decision making;

Membership of commissions;

specific commission

Community-based organizations, 8-9, 137, 139-141, 143-144

Compromise, 161, 232, 244-245, 258n.4, 475

See also Consensus

Confidentiality, 97

AIDS/HIV and, 458, 459-463, 464, 465, 466

American Medical Association on, 117

in genetic research, 440, 450, 451

in hospital ethics committee deliberations, 416

in human subjects research, 123

legal basis of medical privacy, 341, 342

National Commission on, 284

President's Commission on, 92, 93, 266

supra-agency commission on, 186

Congress, U.S.

bioethics advisory boards, 6

ELSI Working Group and, 445-447

legislative authority, 345-346

Office of Technology Assessment, 130, 346-347

political functioning, 45-46

in regulation of scientific research, 33, 40, 62, 78, 90-94

supra-agency national commission and, 189, 190

Conroy case, 99, 122

Consensus, 13, 102, 151

in AIDS/HIV research design, 470-471

in bioethics commissions, 252-253, 257-258

closed meetings and, 157-159

complete form, 242-243

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

composition of deliberating body and, 256

compromise and, 244-245, 258n.4

in construction of moral belief, 202, 203, 211-212, 217, 237-238

in design of resource allocation guidelines, 254-255

diversity of views in, 332

as evaluation criterion for bioethics bodies, 13, 160-162, 257-258

forms of, 242

groupthink in, 256-257

investigative process as obstacle to, 77

legislative process and, 350

majority rule and, 245-246

meaning of, 241, 257

moral pluralism and, 249-251

multitiered decision-making system for, 177-178

normative value of, 248-249

overlapping form, 237-238, 243-244

problems of, 256-257

process, 29

as role of ethics commissions, 217

in state-level forums, 184-185

strategic role of, 246-248

value of, 253-254

Consumer groups, health care, 3, 4, 36, 53-54, 136

Contraception, 50, 51, 79, 106, 156, 339

legal environment, 341, 342

private research, 138-139

Contractualist philosophy, 207, 259n.7

Cooperative Research and Development Agreements, 40, 59

Cost of care, 4, 56, 359

distribution of spending, 58

ethical debate and, 164

hospital ethics committees and, 426-427

hospital management trends, 37

trends, 350

Cost-shifting, 37

Council for International Organizations of Medical Science, 108

Council of Europe, 108-109

Criminal justice system, 97

genetic research in, 440

Cruzan v. Director, Missouri Department of Health, 105, 122, 343, 412

Cystic fibrosis, 131, 140, 289, 435

ELSI program, 447-449

D

Dalkon Shield, 51

Daubert v. Merrell Dow Pharmaceuticals, 76, 80, 340

Death, definition of, 79, 322

moral values in, 372, 373

President's Commission on, 92, 93, 101, 151-152, 164, 216, 266, 286, 306n.12

public education on, 111

state ethics commissions on, 6, 99, 100, 105, 184, 185, 322

Declaration of Helsinki, 31

Deductive reasoning, in moral justification, 223-226, 229, 231, 232

Deinstitutionalization, 343-344

Democratic process

American tradition, 43-44, 335-336

in bioethics forums, 11-12, 77, 155-159

citizen participation in health care decisions, 143-144

ethical pluralism in, 238

legislative process, 345-346

moral legitimacy in, 212

moral pluralism in, 251

policymaking in, 45-46

religious activism in, 364

scientific process and, 76

Denmark, 110-112, 163

DES. See Diethylstilbestrol

Diabetes, 480

Dialysis, vii, 37, 39

Dideoxyinosine, 53

Diethylstilbestrol, 51

Dinnerstein, In re, 314, 316

Disease screening

HIV, 459, 463-466, 467-468

sickle cell anemia, 49

state responsibility, 19, 184

tuberculosis, 473-474

Do not resuscitate orders, 99, 163-164, 323-325, 328-330

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Documentation

for do not resuscitate orders, 325, 329

of hospital ethics committee proceedings, 417, 419

Down's Syndrome, 319, 409

Drug testing, 112

Duty to care, 426

as HIV issue, 458

E

Economic issues

abortion funding, 106, 341

academic-commercial relationships, 3

AIDS research funding, 52-53

biomedical research funding, 39-40

biomedical research spending, 58

biotechnology industry, 59

funding for bioethical investigations, 16

government funded research, 58-59, 62

government funding of social impact research, 97

government health insurance, 54-55

health care financing, 2, 37-38

health care industry, 58

health care spending, 350

in hospital ethics committees, 426-427

in life-prolonging therapy decisions, 321, 326

pharmaceutical research spending, 59-60

political contributions, 346, 347-348

research grant review process, 443

selling of fetuses for research, 483, 484

Eichner, In re, 314, 316

Elderly persons

artificial nutrition and hydration for, 121-122

ethical dilemmas in care for, ix

health care reform and, 57-58

ELSI Working Group. See Ethical, Legal, and Social Implications Working Group

Emergency medical services, 329

Energy, Department of, 97, 437

Epistemology

moral philosophy, 201-203

trust-dependency in scientific knowledge, 392-396

in utilitarianism, 207

Equal Employment Opportunity Commission , 352, 452

Eschatology, 362, 379

Ethical, Legal, and Social Implications (ELSI) Working Group, ix, x, 6, 74

on Americans with Disabilities Act, 442, 447, 452, 453

budget, 437 bureaucratic status, 438, 446, 453-454

cystic fibrosis screening program, 447-449

development of, 437-438

on family genetic research, 450

genetic research bioethics prior to, 434-436

grants program, 443-445, 447

on insurance issues, 450-452

membership, 97, 438-439, 442, 512

opportunities for improvement, 454

origins, 28-29, 96-97, 433-434, 436-437

in policymaking, 442, 445-447, 451-452 , 453-454

in public education, 444, 453

recommendations for, 16, 179

reports, 513

on research procedure, 449, 450

research topics, 440-442

role of, 3, 97, 135, 175-176, 512

scope of deliberations, 439-440, 512

significance of, 453

Ethics Advisory Board (EAB), 172, 454

demise of, 93, 95, 173, 305n.1

mandate, 94, 173, 495n.22, 504

membership, 94, 504

as model for ethics commissions, 19, 186

origins, 94

reports, 94-95, 504

European Community, 109, 113-115

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Euthanasia, 18-19, 36, 184, 317-318, 319-320

ethical vs. policymaking perspectives in, 219, 223, 224-225, 227-228, 234-235

vs. refusal of treatment, 309

Evaluation of commissions

citations to National Commission as criterion for, 270-274

citations to President's Commission as criterion for, 270-272, 274-276

comparative, on life-prolonging medical treatment, 307-308

consensus as criterion for, 13, 160-162,257-258

criteria, 9-14, 114-115, 152-153, 171-174, 262-263

as educational mechanisms, 152

hospital ethics committees, 427-428

institutional review boards, 17-18, 125, 181-182

legal influence as criterion for, 13

methodology for, 269-270, 276-280

obstacles to, 150-152, 166, 171-173

by participants, 276-280

policy influence as criterion for, 152, 280, 304-305

Expert witnesses, 76, 80, 118, 340-341

Experts in ethics

qualifications, 10

resources of science and law in, 76-77

F

Facts, 80

Faden, Ruth, 467, 468

Federal Coordinating Committee on Science and Technology, 442

Federal government

absence of bioethics review in, 116-117, 118, 168, 173

bioethics advisory bodies, 6, 94-99, 186

biomedical research funding, 58-59

executive branch in policymaking, 351-353

on fetal tissue research, 481-484, 485

genetic testing issues in, 175

in health care policymaking, 335-336

health insurance programs, 54-55

human research regulation, 7, 31, 32-34, 89

legislative authority, 345-346

in new medical technology development, 38-39

political process, 45-46

recommendations for, 19, 186

in scientific research, 61-63

See also Congress, U.S.; specific agency;

Federal Technology Transfer Act, 59

Feminist philosophy, 73, 79, 165

Fetal disorders, viii

Fetal protection laws, 337

Fetal tissue research, 168, 306n.4

abortion and, 97, 98, 138, 162, 173, 481, 482-483, 484, 496-497nn.37-38

bioethics commissions on, 481-486

Biomedical Ethics Board on, 94

in Canada, 485-486

contributions of, 480, 486

ethics issues in, 482-483

federal guidelines, 481

French bioethics commission, 479, 486-493

funding for, 481, 485

HFTTRP on, 6, 97-99, 172, 173, 191, 482-484, 495n.26

moral arguments in, 244

National Commission on, 283

political context of policy debate, 353, 479, 480, 495n.29

professional societies on, 484-485

state regulations, 480-481

supra-agency commission on, 186

transplantation, 97-99

Fialuridine, 124

Firth, R., 71

Fletcher, Joseph, 34, 69

Florida, 315

Food and Drug Administration, 17, 40, 51, 53, 182, 468

Foundationalist beliefs, 225-226, 232, 239n.6

Fox, Renee, 82

France, 112, 114, 478-479, 486-493

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Freedom of Information Act, 91, 95, 266

Futility of medical care, 320-321, 327, 330

G

Gays and lesbians, 52-53, 137

HIV screening, 459-463, 464

political mobilization of, 459, 469

General Accounting Office, 347

Genetic research, 7, 27, 130, 362

academic-industry relationships in, 40

commercialization issues, 440

conflict of interest in, 442

ELSI in policymaking for, 453-454

ethical dilemmas in, 3, 29, 39

evolution of ethics concerns in, 434- 437

in families, guidelines for, 450

in France, 487

government oversight, 15, 93-94

insurance issues and, 442, 450-452

marker cells, 96

multilevel impacts, 175-176

President's Commission on, 152, 266, 289

public education, 453

religious thought on, 135

social impacts, 97

somatic cell vs. germ cell in, 435

supra-agency commission on, 186

See also Human Genome Project; Recombinant DNA research;

Genetic screening, 19, 129

community response, 139-141

for cystic fibrosis, 447-449

ELSI program research topics, 440

in France, 489-490

state responsibility, 19, 184

Golding, Martin, 69

Gore, Albert, Jr., 93, 435, 436, 437

Government. See Congress, U.S.; Federal government; Policymaking; State governments

Grant applications

ELSI program 443-445 447

ethical implications reviewed in, 16

federal ethics board for review of, 477

at National Institutes of Health, 443

reductionism in review process, 443

trends, 40

Grassroots organizations, 5, 8-9, 87, 88, 165

bioethics deliberation in, 136-139

in policymaking, 43-44, 46, 178

in state policymaking, 185

Griswold v. Connecticut,105-106, 341

Groupthink, 256-257

Gustafson, James, 69

H

Harris, Patricia, 95

Hastings Center, 8, 69, 132-133, 410, 461-463, 466

Health, Education, and Welfare Department of, 6, 32, 33, 90, 91, 93, 94-95

Health and Human Services,

Department of, 118, 173, 341, 351, 445-446, 453-454, 477

Human Fetal Tissue Transplantation Research Panel, 97-99

recommendations for, 19, 22, 186, 192

Health care agent, 325-326

Health Care Financing Agency, 175

Health care professionals

bioethicists, 68

conscientious objection to lifeprolonging therapy decisions, 328, 331

ethics training for, 18, 81-84, 182-183

with HIV, 349n., 350

humanistic training for, 82

status of, 35, 55

training in technology vs. caretaking, 80-81

women as, 51

Health care reform, ix

advocacy in, 14

aging population and, 57-58

American political tradition and, 45

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

citizen participation in, 143-144

ethical decision making in, 8, 177-178

ethical issues in, 15, 27, 170

evaluation of process in, 353-354

insurance trends, 55

legislative effort, 350-351

lobbying in, 351

patient rights issues in, 36

state role in, 18, 185

Health care resource allocation, 7, 359

dialysis technology, vii-viii, 39

ethical dilemmas in, vii-viii, 2, 15, 30

ethical system for transplant allocation, 254

Institute of Medicine on, 7, 128

in intensive care units, 119

in legislative process, 350

Oregon program, 141-143

participants in design of, 143

practitioner guidelines, 120

supra-agency commission on, 186

Health care system

accountability in, 35-36

Americans with Disabilities Act and, 348

consumers in, 53-55

deliberative capacity in, 177

development of hospitals in, 55-57

employment-based health coverage in, 54

ethical issues in, 2-3, 34

ethics advisory bodies in, 7

executive branch in policymaking for, 351-353

finance issues, 37-38

financial structure, 58

gays and lesbians in, 52-53

judiciary in policymaking for, 339-345

legislative processes in policymaking for, 345-351

life-prolonging treatment decisions, conceptual evolution of, 311-313

minorities in, 48-50

new technologies in, 35, 38-39

policymaking goals, 335

policymaking process, 335-336

reimbursement systems in, 54-55

self-care movement in, 136, 137

women in, 50-52, 78

See also Health care professionals;

Health care reform

Health maintenance organizations, 35, 116, 120

Healy, Bernadine, 442, 445-446

HFTTRP. See Human Fetal Tissue

Transplantation Research Panel

Hippocratic tradition, 30

HIV. See AIDS/HIV

Hobbes, Thomas, 203-204, 205, 210, 211

Hospital ethics committees, 3, 5, 77

administrative structure, 419

consensus-making in moral decisions, 248

consultative process, 415-418

cost containment issues, 426-427

disagreement with decisions of, 417- 418

documentation, 417, 419

educational role, 414-415

effectiveness of, 127

evolution of, 125-126, 325, 327-328, 409-412

future of, 127

genetic testing issues, 175

guidelines for, 119

leadership, 419-420

legal liability, 425-426

in long-term care settings, 424-425

membership, 126, 420-423

networks, 126-127, 423-424

performance evaluation of, 427-428

prevalence, 413

professional ethicists in, 422-423

recommendations for, 17, 180-181

role of, 7, 126-127, 181, 411, 413-418

standard of care issues, 426

Hospitals, 178

financial management in, 37

in life-prolonging treatment decisions, 308, 311

spending in, 58

trends, 55-57

Human Fetal Tissue Transplantation Research Panel (HFTTRP) , 6, 97-99, 172, 173, 191, 482-484, 495n.26

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Human Genome Project, ix, 3, 6, 28-29, 39, 63, 74, 168, 351-352

budget, 432

goals, 433

origins of, 432

significance of, 432-433

See also Ethical, Legal, and Social Implications Working Group

Human research subjects, x, 1, 27, 113

AIDS and, 468-470, 471

compensation/incentives for, 123, 266, 290

confidentiality issues, 123

federal oversight, 90, 94, 266

historical concerns/developments, 2, 30-31, 89

informed consent for, 123

institutional review boards for, 122-124

international bodies on, 108

minorities as, 51

National Commission on, 216, 266, 284

President's Commission on, 289, 290

regulations for protection of, 2, 31-34, 91, 172, 174

risk assessment, 123

subject truthfulness, 471-472

vulnerable populations, 123

women as, 51, 129

Human rights, 339

AIDS/HIV issues, 459-460, 466

antidiscrimination legislation, 348-349

in legal health care decisions, 345

tuberculosis control and, 472-473, 474

Hume, David, 203, 205-206

I

Idaho, 313,314

Ideal Observer theory, 71

Immunizations, 15, 170

Impartiality

in ethics commissions, 102, 156

as moral philosophical concept, 208-209

in policymaking, 337

In vitro fertilization, 15, 116-117, 170, 490

government oversight, 94, 95, 173

research funding, 118

Individual interest

in American social tradition, 3-4, 43-44

collective self-interest and, 203-205

in construction of moral belief, 202, 203

in ethical debate, 29

impartial resolution of conflicts in, models of, 208-209

in moral system, 233

in natural rights formulation, 205,206

public interest vs., viii, 213

public interest vs., in research protocols, 470

in reproductive decisions, 105-106

in universalizability formulation of morals, 207, 208, 213

in utilitarian philosophy, 205-207, 208, 211

Infectious disease

classification of, as policy issue, 336-337

state responsibility, 19, 184

tuberculosis, 472-474

Informed consent, 2, 119

conceptual development in health care, 34-36

as HIV issue, 458

in human subject research, 31

in institutional review board criteria, 123, 124

in Patient Bill of Rights, 36

President's Commission on, 92, 93, 162, 266, 286-289

right to refuse treatment, 105

Institute for Society, Ethics, and Life Sciences, 69

Institute of Medicine, 7, 261-262

bioethics deliberations in, 127-130

membership, 127-128

recommendations for, 17, 181

Institutional ethics committees. See Hospital ethics committees

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Institutional review boards, 2, 5, 91, 178, 283

development of, 428n.1

documentation, 124

evaluation of, 17-18, 125, 181-182

Hasting Center on, 133

limitations of, 124

origins of, 33, 122

review procedures, 123

role of, 7, 122

structure, 122-123

Insurance system, 2

antidiscrimination regulations, 352

ELSI and, 442

employers in, 54

expenditures, 58

genetic research and, 97, 450-452

HIV and, 458

Medicare and, 54-55

participation in, 54

recent developments, 37-38

risk selection, 54

rends, 55

Intellectual property rights legislation, 59

Intensive care units, 119

International Association of Bioethics, 109

International comparisons

bioethics forums, 6, 107-115

French bioethics commissions, 478-479, 486-493

Intuitional ethics, 77-79, 211, 221-222, 239n.6

Italian Americans, 140

IUDs, 51

J

Japan, 133

Jehovah's Witnesses, 248, 359

Jewish people, Tay-Sachs disease risk for, 140-141

Jewish thought, 134, 156

Johnson administration, 48

Joint Commission on Accreditation of Health Care Organizations (JCAHO) , 36, 125, 126, 181, 411, 412, 413, 414, 415-416, 419, 423, 427

Jonas, Hans, 69

Jonsen, A. R., 239-240n.7

K

Kaback, Michael, 140

Kant, Immanuel, 203, 207-208, 250, 258-259n.5

Kennedy Institute of Ethics, 8, 69, 90, 132, 133

Koop, C. Everett, 53

Krim, Mathilde, 461

L

Leake, Chauncey, 68-69

Legal system, 5

accountability of science in, 79-80

advance directives in, 343

antidiscrimination legislation, 348- 349

care for severely impaired newborns in, 411

cites to National Commission, 272- 273

cites to President's Commission, 274

context of ethics commissions in, 220

definition of death in, 102

in do not resuscitate guidelines, 324

documentation of hospital ethics committee proceedings, 417

establishment of hospital ethics committees, 412

as ethical decision-making mechanism, 6, 104-107, 171

evaluation of ethics advisories in, 13

fetal protection laws, 337

forms of public discourse and, 76-77

in health policy formulation, 339-345

informed consent concept in, 34-35

liability of hospital ethics committees, 425-426

life-prolonging treatment decisions, 121-122, 308, 313-316, 342

malpractice claims, 38

mental health policy in, 343, 344-345

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

in policymaking process, 337

professional organizations in, 180

regulation of biomedical research, 58-59

as regulatory mechanism, 106-107

reproductive issues in, 105-106, 341- 342

right to refuse medical treatment, 36, 105, 313-316

scientific method and, 76

scientific testimony, 76, 80, 118, 340-341

surrogate decision-making apparatus in, 318

Levine, Carol, 470, 471

Life-sustaining procedures/ technologies, 7

allocation dilemma, vii-viii

components of moral decision making, 376-377

concept of futility in, 320-321, 327, 330

conceptual evolution in health care, 311-313

conscientious objection to decision making, 328, 331

current consensus, 308-309

economic justification, 321, 326

institute of Medicine on, 128

institutional responsibilities in decision making, 308, 311, 315, 317, 324

legal conceptualizations, 105, 180, 313-316, 342-343

moral evaluation in decision making, 372, 379-380

New York State Task Force on, 307, 308, 322-332

nonpersonhood issues in, 320

patient classification systems for decisions in, 311, 312

patient competency in decision making, 308, 309, 313, 315-316, 322 , 329-330

patient's perspective in, 308, 312, 317

for persistent vegetative state patients, 320

practitioner guidelines, 118, 119

President's Commission on, 101-102, 307, 308, 310-311, 313, 316-322

refusal of, euthanasia vs., 309, 314, 319

refusal of, suicide vs., 309, 314, 315, 319

right to refuse, 36, 308, 342

for seriously ill newborns, 121, 318-319, 411

state regulation of, 18, 172, 184

supra-agency commission on, 186

surrogate decision making, 309, 313, 314, 315, 316, 318-319, 324, 325-326

withdrawal of, x, 105, 313-322, 342-343

Living wills, 309, 314, 317, 318, 326

Lobbying, 346, 347-348

Locke, John, 203, 204-205, 206, 208, 393, 397

Long-term care facilities, 424-425

Lowe, Charles U., 267-268

M

Majority rule, 245-246

Malpractice, 38, 118

hospital ethics committees and, 425-426

Managed competition, 55, 57

Maryland, 412, 413, 425

Massachusetts, 315-316, 317

McGann v. H & H Music Company,352

McKusick, Victor, 438

Mechanisms of ethical decision making

citizen participation in, 143-144

contributions of, 87-88

dimensions of, 113-115

ethics centers as, 8, 69, 131-133

formal vs. informal style, 77

goals of, 88-89

grassroots efforts in, 136-139

historical developments, 2-3

impartiality in, 29, 71

Institute of Medicine as, 129-130

legal system as, 104-107

in multitiered system, 177-178

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Office of Technology Assessment as, 131

professional forums, 115-122

professional guidelines as, 120-122

public forums, 5

range of, 87

religious formulations in, 134-135, 371-377

role of, ix-x

scientific and legal models for, 76-77

in state government, 19, 184-185

See also Commissions on bioethics

Medicaid, 48, 343

Medical schools, bioethics training in, 69, 81-84, 182-183

Medicare, viii, 37, 54-55, 56, 125, 343, 424

Membership of commissions Biomedical Ethics Advisory Committee, 94 , 454n.1, 514-515

ELSI Working Group, 97, 438-439, 442, 512

Ethics Advisory Board, 94, 504

evaluation of national commissions by, 276-280

hospital ethics committees, 126, 420-423

individual commitment of, 303-304

leadership, 299

National Commission, 90-91, 100-101, 267, 505

New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care , 518-519

New York State Task Force on Life and the Law, 516-517

President's Commission, 92, 100-101, 268, 269, 507-508

qualifications, 154

Recombinant DNA Advisory Panel, 510-511

staff functioning, 302-303

supra-agency recommendations, 21, 22, 189

terms of, as performance factor, 299

Mental health care

deinstitutionalization, 343-344

hospitals, 90

legal decisions in, 343, 344-345

Mental hospitals, 91

Merton, Robert, 400, 401

Mexico, 110

Mifepristone. See RU-486

Mill, John Stuart, viii, 206

Minorities, 48-50, 51, 156

Missouri, 480

Mitterand, François, 488

Mondale, Walter, 89, 90

Moral philosophy, 27-29, 70-73

bioethical questions in, 252

in bioethics debate in France, 489-490, 491-492

Categorical Imperative, 207, 250, 258-259n.5

coherentist account, 232, 233

collective self-interest in, 203-204

concept of expertise in, 212

consensus in, 217

considered judgments in, 229-231

contractarian view, 207, 259n.7

critical screening process for judgments in, 229-231, 235-236

decision-making methodology of ethics commissions vs., 217-218, 223, 239

deductivism in, 223-226, 229, 231, 232

differences of taste vs. moral differences, 227-228

dimensions of religious belief, 359-360, 370-371

epistemological methodologies in, 203

as epistemological subject, 201-202

expertise in, 222

foundational beliefs in, 225-226, 232, 239n.6

generalizability of, 231, 233

goals of, 211-212, 213

good and evil in, 361-363, 379

guidance for conduct, 368-370, 373

human agency formulations in, 375- 376

in human embryo research debate, 244-245

identification of, in ethics commission justifications, 234- 235

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

impartial resolution of conflicts, 208-209

individual differences and, 375

individual moral systems, development of, 233-234

interaction of belief factors, 377-382

interaction of loyalties in, 374-375, 376, 377-379

intuition in, 77-79, 211, 221-222, 239n.6

justification of actions, 376-377

methodology, 215

moral knowledge vs. factual knowledge, 202-203, 388-389

moral way-of-life, 249-251

moral world-view, 249, 250-251

morality as consensus, 202, 211-212

natural rights formulations, 203, 204-205

notions of equality in, 208

overlapping consensus in policymaking, 237-238, 243-244

particularism in, 226-229, 239-240n.7

political legitimacy and, 201

priorities in, 209, 210-211

rational and reasonable behavior in, 251-252

reflective equilibrium in, 207-208, 232-236, 239-240n.7

relativism in, 236-237, 384

role of, 373

self-interest as basis of, 233

situational analysis and, 372-373

sources of moral authority, 366-368

universalizability formulation, 203, 207-208, 213

utilitiarianism, 205-206, 207, 208, 210, 211, 223-224, 226, 244, 258-259n.5

Moreno, Jonathan, 242

N

Narrative ethics, 165

National Abortion Rights Action League, 8, 137, 138

National Academy of Sciences, 7, 77, 127, 434-435

National Advisory Board on Ethics in Reproduction, 7, 118-119, 180 , 485

National Cancer Institute, 449

National Center for Human Genome Research, 3, 63, 96-97, 135, 437-438 , 446

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission) , viii, 33, 157

accomplishments of, 70, 102, 163, 171, 172, 174, 269, 297

action-forcing power, 91, 101, 174, 191

assessing effectiveness of, method for, 269-270

bureaucratic location, 267-268, 299

citations to, 269, 270-274

consensus in, 243

evaluation by participants, 276-285, 291-293

on fetal research, 481

mandate, 90, 101, 266, 285, 505

membership, 90-91, 100-101, 265, 267, 505

origins of, 2, 6, 90, 481

on patient rights, 36

policy influence, 280-283, 294-295, 304

President's Commission and, 100-102, 263-265, 266-267, 294-296

products of, 91-92, 101-102, 262, 506

role of, 70, 101, 216

staff role, 302

structural factors in performance of, 103, 267-268, 269, 293, 296-297 , 299

National Council of Churches, 135

National Heart Institute, 89-90

National Institutes of Health, 129, 353

bioethics advisory bodies, 6

in biomedical research funding, 38, 39, 48, 62

genome research, 437-438

grants management in, 40, 62, 443

human research guidelines, 31, 51

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

National Center for Human Genome Research, 3, 63, 96-97

National Commission and, 267-268

National Research Service Award, 189

pedigree studies workshop, 450

Recombinant DNA Advisory Committee, 95-96

recommendations for, 16, 17, 179, 182

in vitro fertilization research, 94

National Organization for Women, 50

National Research Act of 1974 , 33, 90, 122, 267, 481

National Research Service Award, 189

National Right to Life Committee, 8, 138-139

National Science Foundation, 58, 62

Natural rights, 203, 204-205, 206

Nazi Germany, 2

Nevada, 313, 314

New Jersey, 314, 410

New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care, 6, 99-100, 103, 156, 157, 163, 185, 518-519

New technologies, ix

bioethical deliberation in development of, 16, 78-79, 178-179

government funded, 58-59

government oversight, 89-90

medical ethics and, 35, 38-39

socially-constructed value of, 77-78

as source of ethical dilemmas, 2, 3, 30

training of physicians in, vs. caregiving skills training, 80-81

New York, 316, 317

New York State Society of Surgeons v. Axelrod,336

New York State Task Force on Life and the Law, x, 19, 99, 157, 162, 163, 171, 172

on advance directives, 163

closed meetings of, 157, 171

on do not resuscitate orders, 323-325, 328-330

on hospital ethics committees, 327-328

on life-sustaining medical treatment, 172, 307, 308, 322-332

mandate, 6, 99, 323, 516

on medical staff conscientious objection, 327-328

membership, 516-517

origins, 99, 322

reports, 99, 172, 517

on surrogate decision making, 325-331

on surrogate parenting, 162

Newton, Isaac, 398-399

Noninvasive assessment, 30-31, 57

Norplant, 156

North Carolina, 313, 314

Nuffield Foundation Council on Bioethics, 113

Nuremberg Code, 2, 31, 89

Nurses/nursing, 82, 416, 421

O

Office of Science and Technology Policy, 22, 192

Office of Technology Assessment

bioethics deliberations in, 7, 127, 130-131

on cystic fibrosis screening, 449

in evaluation of bioethics commissions, 171

on genetic research, 176, 435, 442

political process and, 131

recommendations for, 17, 181, 192

role of, 130, 261, 346-347

structure, 130

Oklahoma, 480

Oregon, 141-143, 185

right to refuse life-prolonging treatment in, 313, 314

Organ transplantation, 99, 184

Outcomes research, 36

Outpatient care, 57

P

Pan American Health Organization, 109

Parkinson's disease, 480, 481

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Patents and trademarks, 59, 442

Patient Bill of Rights, 36

Patient competency, 308, 309, 313, 315-316, 322, 329-330

Patient rights, 91

conceptual development, 34, 91

ethical dilemmas in, 35

hospital accreditation and, 125

hospital ethics committees and, 181

infant patient, decision making for, 318-319

proxy authority. See Surrogate decision making to refuse treatment, 105, 308

social movement for, 4, 34, 36

terminally ill, 94, 99

See also Informed consent

Patient Self-Determination Act, 105, 184, 343, 412, 415

Patriotism, 374

Peer review, 76, 89

in grants process, 443

Pennsylvania, 480

People with AIDS Coalition, 469

Persistent vegetative state (PVS), 314, 316, 318, 320

Personhood issues, 320

Pharmaceutical industry

AIDS treatments, 53, 138, 470-472

contraception research, 138-139

new product development, 59-60

physicians and, 119

women's movement and, 51

Philanthropy, 37

Physicians

disagreement with hospital ethics committee, 417-418

hospital ethics committee consultations, 415-417

as hospital ethics committee members, 420-421

malpractice risk management, 38

pharmaceutical industry relations, 119

training of, recommendations for, 18, 182-183

See also Health care professionals

Planned Parenthood of Southeastern Pennsylvania v. Casey,106, 341-342

Policymaking

abortion deliberations, 187-188, 477-478

AIDS issues, 458-459, 474-475

American tradition, 43-44

bioethical philosophy in, 72-73

bioethicist-activist collaborations, 475

classification of disease in, 336-337

diversity of views in, 332, 454

ELSI program in, 442, 445-447, 451-452, 453-454

ethical decision making in, viii, 218-222, 239

ethical issues as subjects of, 5-6

as evaluation criteria for bioethics bodies, 152, 280, 304-305

evaluation of advisory reports in, 9-14

evaluation of proposals, 338-339

executive branch in, 351-353

expert ethics advisors in, 8, 67-68

fetal tissue research in, political context of, 479, 480

forums for ethical debate, 5

framework for, 336-339

French bioethics commissions in, 478-479, 486, 493

gay and lesbian issues in, 53

genetic research in, 434-437

as goal of bioethics commissions, 1-2, 216-217

grassroots movements in, 8-9

in health care, 335-336

HIV screening, 463-466

human rights considerations in, 339

impartiality in, 29, 71

information-gathering for, 337-338, 347, 351

interest group lobbying in, 346, 347-348, 351

judiciary in, 339-345

legislature's role in, 345-351

long-term perspective in, 348

minorities in, 48-50

moral conceptualizations in, 210, 212-213

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

moral philosophy in context of, 201, 210, 212-213

multilevel approach, 15-16, 174-176, 177-178

national bioethics commissions in, 115

National Commission influence, 280-283

nongovernmental participants in, 16-18, 178-183

overlapping moral consensus, 237-238

participants in, 336

political process and, 45-46, 346, 347

President's Commission influence, 286, 289

professional organizations in, 116

public participation in, 337

religious groups in, 44, 46-48

research funding, 62, 444-445

research grant review process and, 443, 444-445, 449

restrictions on reasons for justification, 237-238

right to die legislation, 343

role of consensus in, 217

role of New York State Task Force on Life and the Law in, 323

single-interest advocacy in, 14, 156, 164-165, 475

systems of moral justification in, 223-228

value of commission consensus in, 247

women's movement in, 50

Power of attorney, 317, 318, 326

Preexisting conditions, 38, 54

Prenatal diagnosis, 489

Presbyterian Church, 8, 134

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (President's Commission) , viii, ix, x, 73, 107, 157, 171

on access to care, 162

action-forcing power, 101, 191

on assisted suicide/euthanasia, 319-320

autonomy of, 103, 299

citations to, 269, 270-272, 274-276

consensus in, 246-247

context in evaluation of, 309

criticisms of, 286, 289

on defining death, 101, 151-152, 164, 216, 306n.12

effectiveness of, 174, 216-217, 269-270, 272, 297-299

evaluation by members of, 276-280, 285-291, 293-294, 306n.11

evaluation of, method for, 269-270

factors for success in, 293-294, 295-296

funding of, 92-93

on genetic research, 152, 435-436

on hospital ethics committees, 410-411 , 417

ideological conflicts, 293, 300-301, 306n.4

leadership, 268-269

on life-sustaining procedures, 307, 308, 310-311, 313, 316-322

mandate, 101, 266, 310, 507

membership, 92, 100-101, 268, 269, 507-508

National Commission and, 100-102, 263-265, 266-267, 294-296

openness of, 443

origins of, 92

on patient rights, 36, 105, 162

policy influence, 286, 289, 295, 304

products of, 93, 101-102, 153, 262, 269, 509

public education efforts, 163

role of, 3, 6, 92, 101

social justice issues in, 247-248

staff functioning, 302-303, 306n.6

structure of, 92-93, 265, 299

Prisons/prisoners, 90, 91, 209, 283, 284

Professional organizations/societies

bioethics commissions in, 7, 115-122

ethical decision-making guidelines, 7, 82

on fetal tissue research, 484-485

international, 109

patient advocacy by, 180

public interest in, 16-17

recommendations for, 17, 179-180

in sciences, 397

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Property rights, 205, 206

Psychosurgery, 283, 284

Public debate

fetal tissue research, 97, 98

in France vs. U.S., 492-493

national commissions in, 103

range of ethics forums, 87-89

role of courts in, 344

social context of, 143-144, 359

in state bioethics deliberations, 184

traditions of law and science in, 76-77

Public education, 13

ELSI Working Group in, 444, 453

as evaluation criteria for bioethics bodies, 152, 163

as goals of ethics commissions, 111, 217

national ethics commission in, 21, 110-111

open meetings and, 157

successful ventures, 163

Public Health Service, 32, 52, 90, 450, 453

Public interest

American tradition of, 3-4, 43-44

bioethics in, 27

biomedical research as, 58

ethics issues as, 1-2

individual interest and, viii, 203-204, 213

individual interest vs., in research protocols, 470

professional conduct as, 16-17, 180

in utilitarian view, 206, 208, 210, 211

Public opinion

authority of science in, 79

in construction of moral belief, 201-202

credibility of bioethics commissions in, 479-480

credibility of scientists in, 389-392

ethical decision-making capability of scientists in, 388

public participation in policymaking and, 156

role of government in, 44-45

science research in, 62-63

in shaping policy, 43-44

status of physicians in, 35, 55, 56

status of scientists in, 400-405

Q

Quinlan, Karen Ann, 6, 99, 104, 105, 171, 314-315, 342, 344, 410

R

Radiation studies, 33-34

Rahner, Karl, 69

Ramsey, Paul, 72, 372, 373, 378

Rationing of resources. See Health care resource allocation

Rawls, John, 208, 220, 229, 232, 238, 243

Reagan administration, 53, 173, 293, 294, 299, 300, 306n.4, 352, 353, 477, 481,482

Recombinant DNA Advisory Committee , 6, 95-96, 175, 289, 435, 436, 510-511

Recombinant DNA research, 59, 78

concerns in, 95, 435

government oversight, 95-96

Recombinant DNA technology, 59

Relativism, 236-237, 384

Religious communities

in bioethical discussion, 4-5, 8

bioethics deliberations in, 134-135

child abuse exemptions, 119

community relationships, 363-366

dimensions of belief, 359-360, 370-371

hospital ethics committees and, 422

interfaith, 135

on life-prolonging therapy, 322-323, 328

patterns of participation, 382-383

in policymaking, 44, 46-48

priestly religion, 381-382

prohibitions against lifesaving medical procedures in, 248

in public discourse, 74-75

in state bioethics commissions, 99

See also Theological thought

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Reproductive rights, 50-51

HIV testing and, 467

legal decisions, 105-106

legal proceedings, 341-342

political conflicts over, 352-353

Reproductive technologies, ix, 90, 97, 110

bioethics debate in France, 489-490

European commissions on, 112, 113

in medical research, 489

prenatal diagnosis, 489

professional self-regulation, 118-119

state regulation, 18, 106, 184

Research protocols

AIDS/HIV, 468-472

confidentiality in AIDS research, 459-463

ELSI contributions, 449, 450

fetal tissue transplantation, 97-99

germ-line cell manipulation, 96

government oversight, 6, 7, 89, 118

institutional review boards in review of, 122-124, 182

professional self-regulation, 119

psychosocial impact assessment in, 449

recombinant DNA, 96

Risk management, 38

Risk selection, 54

Robertson, John, 484

Roe v. Wade, 105, 106, 171, 341, 342, 344, 353

Roman Catholic Church, 72, 74, 134, 409

RU-486, 52, 112, 138-139, 168, 353, 478

Ryan, Kenneth, 268, 482, 485

S

Salz v. Perlmutter, 314, 315

Sandoz Pharmaceutical Corporation, 40

Schwitalla, Alfred, 31

Scientific community

advisers to Congress, 346-347

in bioethical decision making, 5, 75-76, 78-79, 80

credibility of, 389-392

ethical intuition in, 77-79

ethical sense in, 388-389

ethics advisory bodies in, 7

executive branch advisers, 351, 352

French, 479

integrity of members of, 396-398

legal accountability, 79-80

moral authority of, 403-405

policing of, 401-403

social authority of, 79-80

special insight of, 75, 78-79

virtuousness of, 398-400

Scientific method

credibility of, in public opinion, 392

as discursive model, 76-77

embedded values in, 79

ethical nature of, 75

facts in, 80

legal process and, 76

moral knowledge vs. factual knowledge, 202-203, 388-389

in style of public discourse, 76-77

trust-dependency in, 393-396

Scripps Research Institute, 40

Self-help movements

in health care, 136, 137

women's, 51

Shapiro, Harold, 61

Sickle cell anemia, 48, 49, 139-140, 141

Silicone breast implants, 51

Sinsheimer, Robert, 78

Situational analysis, 372-373, 376

Small Business Patent Procedure Act, 59

Smoking, 139

Social workers, 421

Society for Health and Human Values, 81

Sociology, 400

Sources of ethical dilemmas

anticipating, 168-169

cumulative effects, ix, 15, 170

in current environment, 2-3, 168

definitional issues, 27-29

evolution of, 1, 3-4, 27

Specialization in medicine, 3, 34, 35, 37, 56

Sperry, Williard, 69

Spina bifida, 319

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

Spring, In re, 314, 316

State governments

abortion regulation, 106, 342

bioethics advisory bodies, 6, 99-100

bioethics commissions, 99-100

constitutional authority, 346

death and dying legislation, 105, 313-316

executive branch in policymaking, 351-353

fetal tissue research regulation, 480-481

genetic testing regulation, 175

in health care policymaking, 335-336

national commission findings and, 103, 185

political process, 45

President's Commission influence, 272, 286

recommendations for, 18-19, 176-177, 183-185

See also specific states

Sterilization, 118

Stevenson-Wydler Act, 59

Storar, In re, 314, 316, 317

Superintendent of Belchertown Hospital v. Saikewicz,314, 315-316

Supra-agency ethics commission

action-forcing powers, 21-22, 191

advantages of, 20, 187

advisory role, 21-22, 190-191

appointment process, 21, 189-190

dissemination of findings, 190-191

duration, 20, 22, 192

educational role, 21

external advisory committee for, 23

funding and staff, 22, 191

government sponsorship, 189

interim operations, 23, 192-193

mandate, 20-21, 186-188

membership structure, 21, 22, 189

models for, 15

in multitiered system, 15-16, 174-175

public participation, 190

recommendations for, 19-23, 186-193

resources for, 22

Surrogate decision making

in absence of patient guidance, 326-327

best interest standard, 315, 324, 326, 327

documentation for, 329

health care agent for, 325-326

in home care, 329

for incompetent patients, 313, 318-319

legal environment, 342

legal instruments in, 326

New York State Task Force, 99, 324

parents in, 315

state statutes, 313, 314, 316

substituted judgment standard, 309, 315, 316, 324, 326, 327

Surrogate parenting, 99, 100, 106, 118, 162, 342

practitioner guidelines, 120

Swine flu vaccine, 306n.8

T

Tay-Sachs disease, 140-141

Technology transfer

genetic science, 40-41

legislation, 59

university-industry collaborations and, 61

Teel, Karen, 409-410

Terminally ill patients, 94, 99, 119, 266

artificial nutrition and hydration guidelines, 121-122, 309, 314

do not resuscitate orders, 163-164, 323-325, 328-330

legal guidelines for treatment decisions, 342-343

as research subjects, 124, 469-470

See also Life-sustaining procedures/ technologies

Testart, Jacques, 490

Texas, 313, 314

Theological thought

basic questions in, 385n.3

in bioethics, 73-74, 134, 383-385

concept of human loyalties in, 377- 379

Suggested Citation:"Index." Institute of Medicine. 1995. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press. doi: 10.17226/4771.
×

conceptualizations of deity in, 360-361, 365, 367, 377-378, 379-380

conceptualizations of good and evil in, 361-363, 379

in medical decision making, 371, 379-380

moral guidance in, 368-370

in moral philosophy, 72

sources of knowledge in, 366-368

Therapeutic misperception, 124

Thielicke, Helmut, 69

Toulmin, Stephen, 239-240n.7, 243, 258n.2

Transplantation technologies, vii, 99

allocation guidelines for, 254-255

fetal tissue research, 97-99, 162, 480, 484

heart, 89-90

organ procurement from anencephalic infants, 119

state regulation of, 19, 184

Troeltsch, Ernst, 359, 364, 365

Tuberculosis, 459, 472-474

Tuskegee syphilis study, 2, 32-33, 48, 49, 90

U

UNESCO, 108

Uniform Anatomical Gift Act, 480, 481

Uniform Determination of Death, 151

United Kingdom, 112-113, 114

United Nations, 108

United Network on Organ Sharing, 254-255, 258

Utilitarianism (consequentialism), 205-207, 208, 210, 211, 223-224

, 226, 244, 258-259n.5

V

Vaccines, 59

W

Walters, Leroy, 482, 484

Wanglie, Helen, 320

Warnock, Mary, 244

Warnock Committee, 114, 244-245, 258, 258n.3

Watson,James, 63, 78, 433-434, 437, 438, 442, 448

Weber, Max, 359, 362

Wexler, Nancy, 438

Whistleblowing, 290

Wilkinson v. Vesey, 34

Windom, Robert, 97

Wise, Bob, 445-446

Wolf, Susan M., 246-247

Women's health issues, 50-52, 79, 129

Working Group on HIV Testing of Pregnant Women and Newborns, 467-468

Workplace

drug testing in, 112

genetic research implications, 97

genetic testing in, 440

health care insurance in, 54

World Council of Churches, 135

World Health Organization, 108

World Parliament of Religions, 135

Wyngaarden, James, 97, 438

Y

Yesley, Michael, 268

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Society's Choices: Social and Ethical Decision Making in Biomedicine Get This Book
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Breakthroughs in biomedicine often lead to new life-giving treatments but may also raise troubling, even life-and-death, quandaries.

Society's Choices discusses ways for people to handle today's bioethics issues in the context of America's unique history and culture—and from the perspectives of various interest groups.

The book explores how Americans have grappled with specific aspects of bioethics through commission deliberations, programs by organizations, and other mechanisms and identifies criteria for evaluating the outcomes of these efforts. The committee offers recommendations on the role of government and professional societies, the function of commissions and institutional review boards, and bioethics in health professional education and research.

The volume includes a series of 12 superb background papers on public moral discourse, mechanisms for handling social and ethical dilemmas, and other specific areas of controversy by well-known experts Ronald Bayer, Martin Benjamin, Dan W. Brock, Baruch A. Brody, H. Alta Charo, Lawrence Gostin, Bradford H. Gray, Kathi E. Hanna, Elizabeth Heitman, Thomas Nagel, Steven Shapin, and Charles M. Swezey.

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