Developing countries are faced with the mutually perpetuating obstacles of poverty and inadequate development. Their needs are often so vast that their scarce resources prove too meager even to begin to address the problems.

It is estimated that close to 2.2 billion people live in a state of severe poverty. The precarious housing and health of these people, 60 percent of the population of developing countries, are compounded by hunger and dangerous environmental conditions. Generally, they have large families and their incomes are extremely low. Malnutrition is widespread despite the fact that 80 percent of their earnings are spent on food.

If there is one ethical concept considered to be central to human social life it is the idea of justice. Although there are several competing principles of justice, the core concept of justice embodies the obligation to treat like cases alike, in relevant respects. Women may differ from men in some respects, but the fact that women get sick, become injured, and die from preventable causes renders them similar to men in the need to carry out biomedical research, develop therapies, and attend to health problems specific to women. An ethical perspective on women’s health begins and ends with principles of justice. Although particular circumstances and conditions differ in developed and less developed countries, the ethical conclusions regarding justice are the same for women in all societies.

The new reproductive technologies, especially in vitro fertilization (IVF), have extended the possi- bilities of assisted reproduction to the benefit of the childless couples. At the same time these technologies and their added techniques, however, have fragmented reproduction and exposed the human egg to intervention yet unknown:

• The embryo may be divided into several embryos; may be sold; donated; cryopreserved; borne by another woman and returned; or used for research;

• Genetic parentage may be present without sexual intercourse, may be different from social parentage and the natural time-span between fertilization and birth may be interrupted.

The first “test-tube baby” in Japan was born in March, 1983 at Tohoku University Hospital. Since then ten years have passed. Table 1 indicares the clinical results of in vitro fertilization in this country. As it shows, more than 145 institutions perform IVF, and more than 3,000 babies have now been born using this procedure.

According to the recommendations issued in October, 1983 by the Japan Society of Obstetrics and Gynecology, IVF is defined as a medical practice for treating infertility, and this procedure is performed only on married couples de jure. Eggs and embryos are not donated for IVF in Japan, nor does any “lending” or “leasing” of wombs take place. However, inFebruary, 1988 the Japan Society of Obstetrics and Gynecology issued new recommendations which allow clinical use of frozen embryos and eggs. The first baby from a frozen embryo was born in 1989, and 60 babies have been born to date.

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world.

The U.S. Supreme Court’s most recent pronouncement on abortion rights resembles the dieter’s dilemma: one knows exactly how to get where one is going but lacks the willpower to follow through. In an opinion filled with exceptionally progressive, equality-based arguments for reproductive freedom, the Court nonetheless manages to back away from its own ineluctably drawn conclusions. In the end it not only ignores its own best arguments but eviscerates its previous analyses of fundamental rights and judicial protection of personal liberties from the excesses of the polity.

Traditional medical ethics and law draw a sharp distinction between allowing a patient to die and helping her die. Withholding or withdrawing life sustaining treatment, such as by abating technological nutrition, hydration or respiration, will cause death as surely as a lethal injection. The former, however, is a constitutional right for a competent or once-competent patient, while the latter poses a risk of serious criminal or civil liability for the physician, even if the patient requests it.

As of December 1991, the Patient Self-Determination Act (PSDA) mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state

Over the next 15 years, the government-funded human genome project will map and sequence each of the human cell’s estimated 100,000 genes. The project’s first fruits will be a vast quantity of information about genetic disease. This information will contribute to the design of quicker, cheaper and more accurate tests for identifying deleterious genes in individuals. Because genetic conditions are often regarded as “immutable, heritable taints that intrinsically implicate the bearer’s identity,” overly-deterministic interpretations of genetic information can readily distort genetic risk and become enshrined in institutional policies of social isolation and discrimination.