In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.

Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? Presumably everyone wants the same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each.

In a familiar moral dilemma faced by physicians who care for the dying, some patients who are within days or hours of death may experience suffering in a degree that cannot be relieved by ordinary levels of analgesia. In such cases, it may sometimes be possible to honor a competent patient's request for pain relief only by giving an injection of narcotics in a dosage so large that the patient's death is thereby hastened. Doctors rightly worry that taking an action likely to result in a patient's death may violate the Hippocratic injunction against the direct killing of anyone in their care.

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute a consult. As one bioethicist commented:

if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics.

Research on human genetic variation can present collective risks to all members of a socially identifiable group. Research that associates race or ethnicity with a genetic disposition to disease, for example, presents risks of group discrimination and stigmatization. To better protect against these risks, some have proposed supplemental community-based reviews of research on genetic differences between populations. The assumption behind these appeals is that involving members of study populations in the review process can help to identify and minimize collective risks that otherwise could go unnoticed. In contrast to this position, critics have argued that supplemental community-based reviews are unnecessary, impractical, and morally problematic. This paper is our attempt to advance this debate by distinguishing the various goals of community review and the forms that it can take.

In the late twentieth century the United States experienced a wave of cases concerning compelled obstetric interventions, cases which attracted much legal and philosophical interest. Behind and alongside them, however, lies a little known strand of authorities which concerns a parent wishing to refuse life-sustaining treatment and a hospital seeking to prevent this on the basis of the State's interest in protecting innocent third parties, usually the patient's dependent minor children. This issue appears to be unique to the United States. Although the leading case in point was influential in cases concerning compelled obstetric intervention, it has received little examination in its own right. This is a shame, since it spawned an intriguing line of cases worthy of reflection today.

Although the notion of physician value neutrality (PVN) in medicine may be traced back to the writings of Sir William Osler, it is relatively new to medicine and medical ethics. We argue in this paper that how physician value neutrality (PVN) has been cashed out is often obscure and its defense not persuasive. In addition, we argue that the social/political implementation of neutrality, Political Liberalism (PL), fails, and thus, PVN's case is weakened, for PVN's justification relies largely on the reasoning undergirding PL. For these reasons, we conclude that PVN has no philosophical or ethical warrant and thus should be abandoned. We suggest that the physician present to her patients some type of statement or creed that would give them an idea of where she stands on important axiological issues and how these stands are cashed out clinically.

In December 1998, two groups of scientists announced that they had successfully isolated and cultured human pluripotent stem cells. This news was greeted with both tremendous enthusiasm and concern. Because these cells can develop into most types of cells or tissues in the human body, they hold great promise for scientific research and medical advances. For example, stem cells can potentially be used to:

• Generate cells and tissues for transplantation and therapy for conditions such as Parkinson’s disease, spinal cord injury, stroke, burns, heart disease, diabetes, and arthritis;

• Improve scientists’ understanding of the complex events that occur during normal human development, as well as the abnormal events which cause conditions such as birth defects and cancer; and

• Substantially change the development and testing of drugs. New medications could be tested initially on stem cells, and only drugs which were safe and effective on the cells would be tested further on laboratory animals and humans.

As the shield preempting state suits under the Employee Retirement Income Security Act (ERISA) has been successfully pierced (see California Div. Of Labor Standards Enforcement v. Dillingham Constr. N.A. Inc., 519 U.S. 316 (1997) and Duke v. U.S. Healthcare, Inc., 57 F.3d 350 (3rd Cir. 1995)), plaintiff attorneys have begun to use the ERISA statute itself to further litigation against managed care organizations. The court in Shea v. Esensten, 107 F.3d 625 (8th Cir. 1997), held in a landmark decision that an HMO's failure to disclose financial incentives that discourage a treating physician from providing essential health care referrals for conditions covered under the plan benefit structure is a breach of ERISA's fiduciary duties.

Recent medical studies have indicated that medical professionals discriminate in their treatment practices on the basis of race and gender. Among the many concerns stemming from this realization are questions about the possibility of legal actions and the availability of individual compensation for the denial of equal care. By meeting legal evidentiary standards, the recent statistical data pointing to discriminatory trends have created the potential for legal recourse through Title VI of the Civil Rights Act which prohibits recipients of federal funding from treating people differently on the basis of race or national origin.

On December 7,1999, a divided Oklahoma Supreme Court held in Nealis v. Baird that a claim may be brought under Oklahoma's wrongful death statute on behalf of a nonviable fetus born alive. The decision represents a departure from the traditional notion that “viability”—the ability of a fetus to sustain life outside the womb with or without medical assistance—is the standard for wrongful death recovery. In replacing the “viability” standard with a “live birth” standard, the majority maintained that live birth is the “unassailable point at which legal rights must be said to attach to the human person. “ By holding a nonviable fetus a legal “person” for the purpose of a wrongful death claim, the court's decision emphasizes the limited application of the United States Supreme Court's holding in Roe v. Wade that a fetus is not a person for the purposes of the Fourteenth Amendment.

In December 1998, the Office of Inspector General (OIG) and the Health Care Financing Administration (HCFA) solicited comments from health care providers regarding the federal anti-patient dumping statute, the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 USCA §1395dd). EMTALA is a federal health care law of unprecedented breadth—the first universal benefit guaranteed by the federal government. It requires Medicare-participating hospitals with public emergency rooms, emergency physicians, and ancillary surgical and medical specialists to render adequate stabilizing treatment to whoever requests it. The 1998 Special Advisory Bulletin (63 FR 67486-01) sought input on four principal dimensions of EMTALA: (1) the statutory obligation to furnish adequate medical screening to anyone who visits an emergency room; (2) the responsibilities of health care providers towards enrollees of managed care organizations (MCOs); (3) the prior authorization and payment rules for Medicare and Medicaid; and (4) what practices would promote hospital compliance with EMTALA.

In Kimber v. Thiokol Corp., 196 F.3d 1092 (10th Cit. 1999), the U.S. Court of Appeals for the Tenth Circuit upheld a U.S. District Court's grant of summary judgment against an employee's claim that an employeroperated disability insurance plan, which offered different levels of compensation for disabilities due to mental and physical conditions, violated Title I of the Americans with Disabilities Act (ADA). The Court of Appeals found that (1) the Thiokol plan administrator's interpretations of the plan were not arbitrary and capricious, and that (2) the plan's different treatment of disabilities caused by physical and mental conditions did not violate the ADA.

On November 4,1999, in South Central Regional Medical Center v. Pickering, 1999 WL 1000703 (1999), the Mississippi Supreme Court created a new legal standard that allows patients to recover damages for fear of exposure to AIDS even though they cannot prove actual exposure. By adopting this standard, the Mississippi Supreme Court joined the minority of jurisdictions seeking to encourage providers to use reasonable care when handling instruments capable of transmitting disease.

Plaintiff Jimmie Pickering is a female diabetic, who was receiving treatment at South Central Regional Medical Center (South Central) between September 30 and October 5, 1987 to regulate her blood sugar levels. Pickering used the hospital's Autoclix machine, which required that Pickering use lancets to prick her finger to draw blood.

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999, which instituted a 90-day comment period for the amended Organ Procurement and Transplantation Network (“OPTN”) Final Rule (“Final Rule”), a comprehensive set of guidelines that would affect how organs are allocated throughout the country. Barring further legislative action, the Final Rule, which has been over five years in the making, will be effective on March 16,2000.

The Final Rule, issued by the Department of Health and Human Services (‘‘DHHS”) pursuant to the National Organ Transplant Act, was originally publishedApril 2, 1998. It provided a number of substantive changes to the process through which organs are allocated by the United Network for Organ Sharing (UNOS), a private, non-profit organization charged with administering the national organ transplantation network.

Industry analysts estimate that Internet pharmacies will generate $1.4 billion in prescription drug sales by 2001 and over $15 billion by 2004. The recent rush by traditional brick and mortar pharmacies either to partner with existing Internet pharmacies or to create their own web counterparts illustrates the increasing importance of business on the Internet. Last summer, retail pharmacy giant CVS acquired the Internet pharmacy soma.com and changed its name to reflect the new ownership. Early this year, in another key industry move, Walgreen's launched an upgraded, full-service Internet pharmacy in order to compete more successfully in the pharmacy industry.