oxford handbook of bioethics
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732 J O NAT H A N D . M O R E N O
GENET I CS AND BIOTER ROR ISM
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Finally, new scientific developments can become objects of interest for technically sophisticated groups bent on terror. In the late 1990s several government advisory groups warned that the conclusion of the human genome project and subsequent advances in genetics created risks for the United States concerning genetically modified bioterror organisms. In its extreme form, attempts might even be made to engineer bioweapons that target specific racial groups, though the scientific feasibility of such weapons is in grave doubt considering the genetic diversity within racial groups. More plausible are efforts to modify viruses so that they will elude currently available vaccines, or perhaps agents that could act on agriculture (Meslin 2003).
Fortunately, these worries are highly speculative. More immediate are the consequences of scientific security concerns for academic freedom and, in the long run, improved prevention and treatment of the ills that accompany bioterrorism. These improvements are most likely to occur rapidly in an atmosphere in which scientific cooperation flourishes, and the free flow of information is critical to that process. To help ensure that scientific progress for the public good is not stifled, the self-regulation of scientists with guidance from government seems preferable to heavy-handed restrictions on scientific exchange that, paradoxically, exacerbate the threat by preventing many groups of scientists from attempting to develop novel approaches.
In the era of bioterrorism a scientific event that would normally be a cause of unalloyed celebration, the publication on the World Wide Web of the ‘map’ of the human genome, raises concerns about the openness of science and the role of government in both utilizing and constraining scientific activity (Meslin 2003). This problem illustrates how far bioethics has traveled from its original concerns with the rights of patients and research subjects, the allocation of life-saving technology, and the implications of genetics for the future of humanity. Yet the bioethical issues stimulated by bioterrorism also revive each of these topics in a new light while they create new ones, challenging the creativity and resourcefulness of those interested in the life sciences and human values.
REFERENCES
ACHRE (ADVISORYCOMMITTEE ON HUMAN RADIATION EXPERIMENTS) (1996), The Human Radiation Experiments (New York: Oxford University Press).
ANNAS, G. J. (2003a), ‘Terrorism and Human Rights’, in Moreno (2003: 33 – 49).
(2003b), ‘Blinded by Bioterrorism: Public Health and Liberty in the 21st Century’,
Health Matrix, 13: 33 – 50.
CHILDRESS, J. F. (2003), ‘Triage in Response to a Bioterrorist Attack’, in Moreno (2003: 77 – 93).
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DERENZO, E. G. (2003), ‘The Rightful Goals of a Corporation and the Obligations of the Pharmaceutical Industry in a World with Bioterrorism’, in Moreno (2003: 149 – 66).
ECKENWILER, L. A. (2003), ‘Emergency Health Professionals and the Ethics of Crisis’, in Moreno (2003: 111 – 31).
FLEISCHMAN, A. R., and WOOD, E. B. (2003), ‘Research Involving Victims of Terror: Ethical Considerations’, in Moreno (2003: 185 – 97).
GOSTIN, L. O., et al. (2002), ‘The Model State Emergency Health Powers Act: Planning for and Response to Bioterrorism and Naturally Occurring Infectious Diseases’, JAMA 288: 622.
HODGE, J. G., and GOSTIN, L. O. (2003), ‘Protecting the Public’s Health in an Era of Bioterrorism: The Model State Emergency Health Powers Act’, in Moreno (2003: 17 – 32).
KIPNIS, K. (2003), ‘Overwhelming Casualties: Medical Ethics in a Time of Terror’, in Moreno (2003: 95 – 107).
MESLIN, E. M. (2003), ‘Genetics and Bioterrorism: Challenges for Science, Society and Bioethics’, in Moreno (2003: 199 – 218).
MILLS, A. E., and WERHANE, P. H. (2003), ‘After the Terror: Health Care Organizations, the Health Care System, and the Future of Organization Ethics’, in Moreno (2003: 167 – 81).
MORENO, J. (2001), Undue Risk: Secret State Experiments on Humans (New York: Routledge). (2002), ‘Bioethics After the Terror’, American Journal of Bioethics, 2: 60 – 4.
(2003), In the Wake of Terror: Medicine and Morality in a Time of Crisis (Boston: MIT Press).
TROTTER, G. (2004), ‘Chemical Terrorism and the Ethics of Decontamination’, Journal of Clinical Ethics, 15: 149 – 60.
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I N D E X
• • • • • • • • • • • • • • • • • • • • • • •
076 regimen for HIV infection 680; see also HIV/AIDS
Abdool Karim, Salim 680
abortion 157, 167, 170 – 1, 419, 421, 426, 430 – 1, 432
and embryo research 417, 422 – 3 debate 74
accountability for reasonableness 160 – 1 Ackerman, Felicia Nimue 324 – 5, 328, 329, 332
n. 20, 333, 337 – 8 n. 35, 342, 343 – 4 action theory, see mind, philosophy of ACTN3 gene 520
actors in research 625 – 32, 643 advance directives 349 – 74
practical problems with 353
Agar, Nicolas 517 see Liberal Eugenics Age, The 525
agency 91, 92, 95 – 6, 98, 108 autonomous 93 – 4, 96, 108, 111 unified 95 – 6
aggression 520 Agich, George 76
aging, deceleration of 306, 310 Agnetti, G. 97
AIDS 611; see also HIV/AIDS alcohol 518, 520
alcoholism 520 alienability 261 – 3
all purpose goods 523, see also Buchanan alternative sources of human pluripotent stem
cells 417, 423 – 6 altitude training 496 altruism 224 – 5
and altruistic values 599, 604 and commercialization 225 – 6
Alzheimer’s 110
Association 315, 317, 319, 612 diagnostic truthtelling in 315 – 317 disease 306, 310, 313, 316, 615, 616, 619 epidemiology of 313
euthanasia in 318
gastrostomy tube-feeding in 319 patients 201 – 5
quality of life in 318
reporting of 316 stages of 313
‘‘terminal’’ stage of 319 American Public Health Association
(APHA) 684, 687
American Society for Human Genetics (ASHG) 685
anabolic steroids 492, 514 Anderson, Elizabeth 264, 276 Andrews, Lori 684
Angell, Marcia 680 ‘‘animal rule’’ 722 Animals:
experimentation on 648 – 67 mental abilities of 651 – 3 moral status of 648 – 67
Annas, George 218 – 9, 516, 675, 684 – 5 anonymous testing 678 – 9
Anscombe, G. E. M. 121, 130, 148 anthrax 721, 722, 725, 727 antibiotics 494
‘anti-commons’ problem 541 appreciation 612; see also decision making Aquinas, St. Thomas 115, 129
argument from liberty 499 – 500 Aristotle 34, 101 – 2, 123
Arras, John 24, 27, 31, 33, 679, 681, 685 Ashcroft, Richard 574
assent 614 – 16
assisted reproductive technologies (ARTs) 500 atomic weapons 721, 723, 724
Austin, Lisa 684
Austin, Melissa 684, 686
Australia, Northern Territory of 76 autonomous agency, see agency autonomy 91 – 2, 95, 96, 98, 109, 217 – 19,
224 – 5, 235, 526 and abortion 74
in bioethics 72 – 4, 76 in the child 528
cultural influence of 78 – 80 definitions of 77 – 8, 80 – 1 diachronic 95
and genetic counseling 75
736 I N D E X
autonomy (cont.)
and heroic volunteers 220 – 3 key tenets of 81 – 2
and liberty 75, 82 – 4 and long term care 76
and medically assisted reproduction 74 – 5 the practice of 76
precedent or prospective, see precedent autonomy
principle of 674 procreative 526
and reason 75, 82 – 3
and right to forgo life-extending treatment 76 and trust in bioethics 76
see also informed consent azidothymidine (AZT) 679 – 80
trials 632
Bacon, Francis 308 Baier, Annette 38, 109
balancing 21, 24, 27, 28, 29 Bankowski, Zbigniew 687 Barry, Brian 50
Battin, Margaret Pabst 327 – 8, 339 – 42 Bayer, Ronald 673 – 6, 678 – 9 Beauchamp, Daniel 673 – 6
Beauchamp, Tom 15, 21, 22, 27, 28, 29, 31, 33, 34, 40, 47, 48, 53, 73, 77, 115, 117, 128 – 9
Beecher, Henry 622 – 3 behaviour 519
aggressive 524 antisocial 524, 525 criminal 520, 524, 525, maternal 520
violent 524 behavioural genetics 520 Belkin, Gary 682
Bell, Daniel 79 Bellah, Robert 79
Belmont Report of the National Commission on Ethical Issues in Human Subject
Research 73, 624 beneficence 523, 605, 612
principle of 674 benefit-sharing 477 – 8 Bennett, Jonathan 145 – 6 Bentham, Jeremy 650, 659
Berlin, Isaiah 73, 75 – 6, 82, 85 – 6 Beskow, Laura 685, 686
best interests 618 – 19 of donor 221 – 3
for children 231 – 2 principle of 353
Beyond Therapy 516
BiDil 545 Billings, Paul 685
biobanks, biobanking 240 – 57, 552 – 4 ethical principles 254 – 5
national 245
research using 242 – 4, 245 – 6 biogerontologists 306, 310 bioterrorism 677, 688 Blackburn, Elizabeth 328 n. 10 Blum, Lawrence 38
body modification 517 Boonin, David 431 Bostrom, Nick 331 n. 17 Boyd, Kenneth 684 Boyle, Joseph 33
Brand, Myles 124, 126, 128 – 9 Branden, Nathaniel 98, 101
‘Love and Psychological Visibility’ 98 Brandt, Richard 20
Bratman, Michael 95, 117, 125 – 6, 129 Brock, Dan 191, 193
Broder, David 682 Brody, Baruch 29, 648 – 9 Brunner, Han G. 524 Bryant, John 675, 676 Buchanan, Allen 523, 684
Buchwald, Ephraim 336 n. 29 Burdens of Judgment 159 Burris, Scott 685, 686 Bykvist, Krister 199
Callahan, Daniel 40, 41, 74, 329 n. 13, 675, 676 caloric restriction 311
Campbell, Harry 684, 690
Canadian Law Reform Commission 73 Caplan, Arthur 218 – 9, 684
Card, Claudia 343 cardiovascular disease 243 Carse, Alisa 35, 38, 39 case-based methods 29 – 34 Casky, Noelle 501
care, ethics of 38 – 40 Carruthers, Peter 661 – 6
casuistry 25, 29 – 34, 46 n. 1, 47, 53 Catholicism 118, 143, 148 Caulfield, Timothy 684
causation, intentional 122 – 3 Center for Disease Control 725 Chadwick, Ruth 684, 686 changes in values 197 – 201 Changi 110
Chaoulli v. Quebec 176 Charlesworth, Max 73 Cheitlin, Melvin D. 518
I N D E X 737
chemical attack 723, 730
child’s interests and child’s right to an open future 528
children 605
‘gifted’ and ‘perfect’ 530
Childress, James 15, 21, 22, 23, 27, 28, 29, 31, 33, 34, 40, 47, 48, 53, 73, 77, 115, 117, 672, 674, 676 – 7, 685
choice 612; see also decision making CIOMS 625 – 7, 640 – 1 ciprofloxacin 722
Clayton, Ellen 685 clinical care 606
decisions 617
clinical decision support systems (CDSS) 560 – 1 Clinical Laboratory Improvement Act
(CLIA) 555 – 6
Clinton, Bill (President) 681, 682 – 3 Clinton Health Security Act 682
cloning 518; see also somatic cell nuclear transfer Clouser, Danner 21, 23, 29
clozapine 602 co-creators 312 coercion 526
and organ transplants 218 – 9 cognitive impairment 604
and the cognitively impaired 611, 615 see also noncompetent
cognitive vulnerability 599 Cogswell, Mary 686
Cohen, Carl 227, 656, 657, 659
coherence theory of moral justification 58 circularity objection to 65
and convergence 60 epistemological value of 63
commercial contract pregnancy 259 – 60, 263 – 6 and gender inequality 277 – 8
and genetic abortion 265 gestational v. genetic 263
and racial inequality 265, 277 – 8 and selective reduction 265
commodification 259, 261 – 2 downstream 265 – 6 incomplete 271
common good 590 – 2 communitarian perspectives 40 – 3 community 610 – 11
consultation 475 – 6, 611 dialogue 476
as a value 672, 673, 676, 683, 688 see also emergency research
competency 602 – 3, 612 to consent 603
competent moral judges 49
component analysis 607, 609 compromise 167, 170 – 1 conception view 420 – 1, 432
Conference on Ethical Aspects of Research in Developing Countries 680, 681
confidentiality 676, 684, 685, 724, 726, 730 in research 624 – 5, 641
consent 723, 724, 725 consequentialism:
general v. patient centered 587 consequentialist principles 17 – 20 considered moral judgments 49 consistency, argument from 521 contact tracing 678
continuity (of identity) 95 control arm 598
Cooper, John 102 Cordone, James 682
corporate ethics advisory boards 455 – 6 cost containment 682, 684
Coughlin, Steven 686, 687
Council of Regional Networks for Services 686 Counihan, E. A. Justice 223 – 4
Couzin, Jennifer 684
Crouch, Robert 218 – 9, 679, 681 Culver, Charles 23, 24 Cunningham, George 685, 686
Daar, A. S. 224
Daniels, Norman 52, 61, 160 – 1, 179, 181, 191 – 3, 339 – 41, 683
Danis, Marion 327 Darwall, Stephen 200 Davidson, Donald 128, 130 Davis, Dena. 528
de The, Guy, see The, Guy de dead-donor rule 226 Dearry, Allen 672
death 196 – 7, 324 – 45 deception research 605 decision making:
ability 613
capacity 599, 604, 612 – 13
Declaration of Helsinki 622 – 4, 634 – 8, 642 – 4 deCODE 553 – 4
DeGrazia, David 27, 524 n. 683 Dellen, Anton van 519 DeMarchi, Nicola 519 dementia 305, 312 – 13, 316 democracy:
deliberative 158, 162, 171 and bioethics 161
liberal 154 populist 158
738 I N D E X
democratic deliberation (cont.) democratic deliberation 611 deontological principles 20 – 4
Department of Defense, see U. S. Department of Defense
Department of Health and Human Services, see U. S. Department of Health and Human Services
Department of Health Education and Welfare, see U. S. Department of Health Education and Welfare
DePaul, Michael 54, 68 dependence 328 depression 102
Descartes, Ren´e´ 69, 651, 652 desire 124 – 8
desire fulfilment theories 522 Deveson, Anne 90, 95, 107 Deveson, Jonathon 90, 92, 95, 107 Dickens, William T. 519 Dickenson, Donna 259 n. 2, 272
dilemma of dignity or money 259, 266 – 8, 278 – 9
dilemmas 18, 26, 28, 36 disability 529, 530 discarded/created distinction 437 discrimination 678, 684, 685, 687
genetic 530
disease, aging as 304, 306, 321 dissent 614 – 16
distributive justice 526 Donagan, Alan 117, 121, 123 donor, living:
advocates for 228, 230, 236 benefit to recipient 215 children as 231 – 4
committee decisions about 233 – 4 court decisions about 234
incompetent adults 231, 233 – 4 need for 213 – 14
permissibility of 216 – 17 proposed rules for 235 – 6 protection of 228 – 31 registry of 230, 236
risks to 215 – 16 strangers as 223
donors of last resort 231 – 5
double-effect, rule of 114 – 149; see also principle of; doctrine of
double standard in research 636 – 7, 643 Dougherty, Christopher 682
Dove, Arielle 228
Dreier, James 341
Dresser, Rebecca S. 356, 368
drugs, addiction to 519; see also sport; recreational drugs; enhancement
Dula, Annette 686
duty of personal care 576
Dworkin, Ronald 56, 191 – 3, 200, 202 – 5, 338, 341, 344, 362 – 3, 370
Dyson, Freeman 307
ecogenetics 684
ectopic pregnancy and double-effect 118, 138 – 141
egalitarianism and justice between age-groups 194 – 6, 206 – 7
Elias, Sherman 684 Elliot, Carl 516 Elshtain, Jean Bethke 80
Emanuel, Ezekiel 41, 675 – 6, 679, 681 embryo, embryos 416, 418 – 20
cloned 417
moral status of 417, 420, 427
spare, see discarded/created distinction embryonic stem (ES) cells, cell research, see stem
cells
emergency care 728 – 30, 731 emergency research 599, 606
regulations 601, 608, 609, 611 end-of-life care 349 – 74 Englehardt, H. Tristram 21, 683 enhance 516, 517, 521, 523
enhancement 516, 517, 521, 523, 526, 529, 531, 533
arguments for/defense of 497 biological 516, 519, 523 cognitive 533
definition 491 ethical 532
ethical for a child 532
ethical for an incompetent human being 532 external 533
genetic 516 height 531 intelligence 531 life 533
limits to 527
mood 518, 525, 533
as moral boundary 493 moral diversity of 513 as moral signpost 494
reasons for ethical concern 506 – 13 social consequences of 532 technological 533
versus therapy 494 – 5 equalitarians 305 equipoise 607, 609
I N D E X 739
applied to populations or to individuals 581 – 2
clinical 573 – 4, 577, 579 – 81 collective 574, 577
matrix of possible formulations 577 overly restrictive of research 578 – 9 theoretical 573 – 4, 577
equitable access 675, 678, 681 Erikson, Erik 509 erythropoietin (EPO) 496
Ethical, Legal and Social Implications (ELSI) Program, NIH-NHGRI 686
eugenics 517, 526, 686, 687 European Union 447 euthanasia 17, 18, 20, 21, 37 events 121 – 2
event identity 131 evolution 529
rational 530 excuses 105
executive function 613 exemptions 105,106
exploitation 625, 627, 638 – 41, 644 of research subjects 681
Faden, Ruth 128 – 9
fairness 523, 530, 674, 676, 683 Fawzi, Wafaie 680
Feinberg, Joel 78, 81, 428, 528 feminism 260
and autonomy agency 263, 269 – 7, 279 and women’s altruism 268 – 9
feminist 39
feminist bioethics 46 n. 2 fiduciary duties 576, 584 First Genetic Trust 551 – 2 Fletcher, Joseph 18 Flynn, James R. 519
Food and Drug Administration (FDA), see U. S. Food and Drug Administration
Foot, Philippa 38, 146 – 7
frameworks for ethics and public health 672, 673 – 7, 678, 685
Frankena, William 34
Freedman, Benjamin 572, 574, 577, 579 – 81 French and Indian War 722
Frey, R. G. 652 – 3
Fried, Charles 572 – 3, 577 friendship 101 – 3, 109 Fukuyama, Francis 163, 516
future-like-ours (FLO) 417, 430, 432; see also Marquis, Don
and wrongness of killing 430 – 1
Gamble, Vanessa 686
Garreau, Joel 338 n. 36, 344 n. 48 Gauderer, Michael 319
Gaylin, Willard 76
Gems, David 326 – 7, 329 – 30, 333, 336 – 7, 342 gene patenting 247
gene pool concept 478 – 9 genetic, genetics 684 – 6
Ethical, Legal and Social Implications (ELSI) Program, NIH-NHGRI 686
eugenics 686, 687 genetic counselling 75
genetic engineering 686, 732 genetic epidemiology 684 genetic essentialism 242, 246
genetic exceptionalism 242, 249 – 53 genetic information 241, 246 – 7, 249 – 51,
252 – 4
genetic discrimination 250 insurance 250
paternity testing 247 – 8 right to know 246 – 7, 247 – 8
genetic screening 481 – 2, 684 – 5 genetic solidarity 253
genetic testing 685 Guthrie cards 687
Human Genome Project (HGP) 684, 686 International HapMap Project 684 National Human Genome Research Institute
(NHGRI) 684 newborn screening 685 – 6
Office of Genomics and Disease Prevention, CDC 686
privacy 685
Secretary’s Advisory Committee on Genetic Testing (SACGT) 685
Sickle cell disease 686
see also, pharmacogenetics Gert, Bernard 21, 24, 29 Gielen, Andrea 677
Gill, M. B. 226 – 7 Gilligan, Carol 38, 39 Gillon, Raanon 22, 41, 73 Glantz, Leonard 679 Golden Rule, the 81 Goldsand, Gary 675 good life 522
Good Samaritan donors 224
Gostin, Lawrence 672, 675 – 7, 681, 684 – 8 Government Accountability Office (GAO)
685
Green, Ronald 421 Griffin, James 52 Guay, Laura 681
740 I N D E X
Gustafsen, Donald F. 130
Guthrie cards 687
Gutman, R. A. 327
Gutmann, Amy 158 – 9
Habermas, Jurgen¨ 158, 516 Hanis, Craig 684 Hantavirus 243
Haplotype Mapping Project 473, 474 happiness 522
Hare, Richard Mervyn 16, 26, 31, 35, 36, 54 harm 526, 529, 532
Harman, Laurinda 687
Harris, John 164, 335 – 6, 338, 343, 518 Haslett, D.W. 59
Hauerwas, Stanley 79
Haworth, Lawrence 78 health 522, 533
health care:
equal access to 179, 182, 183 institutions 726, 728, 731 power of attorney 352
public funding of 180, 181, 183, 184 reform 175, 176, 185 – 7
two-tiers of 176 – 187 health insurance 682 – 3
Health Insurance Association of America (HIAA) 683
health promotion 684 Helsinki declaration 723
Henig, Robin Marantz 329 n. 10 heroic donors 220 – 3 Hiroshima, Nagasaki 724, 728 HIV/AIDS 672, 675 – 81
076 regimen for HIV infection 680 anonymous testing 678 – 9
contact tracing 678 epidemic 677 – 9 HIVNET012 681
Kenya, and HIV research 680 Nevirapine 681
partner notification 679
vertical transmission of HIV 679 – 81 see also AIDS
HIVNET012 681 Hobbes, Thomas 661 Holden, Constance 522
Holloway, Marguerite 519 Holtzman, Neil 684 – 5
Holy Grail legend 471 – 2, 486 ‘home brew’ diagnostic tests 555 Hooker, Brad 19, 20
Hospers, John 342 hospice 329 n. 10
Hughes, Robert 80
Human Embryo Research Panel (HERP) 425, 433
Human Embryology and Fertilisation Authority 442, 445
human experimentation 722 – 23, 724 Human Genetics Commission 242, 253, 254 Human Genome Diversity Project 473 Human Genome Project (HGP) 471, 684, 686 human growth hormone (hGH) 491
and children 495, 509
ultimate ends/goals 496 – 97, 510 – 11 human nature:
as contours of the given 503, 504 as normative guide 503 – 4
as raw material 502 – 3 human spirit 531
human tissue archive 241, 242 human tissue samples:
consent to removal and use 245, 251 – 2 property rights over 248, 254
use of 251 – 2 Hurlbut, William 425 – 6 Hurlewitz, Mike 216
Hursthouse, Rosalind 35, 36 hypercognitive values 314
Ichikawa, Jonathan 325 identity 100, 103, 524 n.
immortality 325 – 6, 328 – 37, 343 impulse control 523, 528
in vitro fertilization 74 – 5 incoherency argument 497 – 8
indeterminacy, objections from 572 – 7 individualism 41
inequality 337 – 45
informed consent 217 – 19, 224 – 5, 235, 598, 600, 601, 619, 679, 685 – 6
legally valid 602
by proxy 604 – 5, 610, 614, 618
in research 621, 623 – 5, 626 – 7, 641, 643 waivers and modifications of written informed
consent 605
Institute of Medicine (IOM) 671, 684, 688 Institutional Review Boards 442, 452 integrative approach 576, 590 – 4 integrity, virtue of 159 – 60, 172
intelligence 518, 519, 521, 523, 531, 524, 555 intention 121 – 31
intention/foresight distinction 117, 131 – 7 interests 417, 428
basic vs. personal 591 – 2 and having a welfare 429 – 30 higher order 591
I N D E X 741
and moral status 428, 431 – 2 and sentience 428
International HapMap Project 684 international research 678 – 9, 684 Israel, Barbara 672
Jaworska, Agnieszka 203 Jennings, Bruce 76
Jewish Chronic Disease Hospital case 601, 610 John Paul II, Pope 21, 27
Jonathon, see Deveson, Jonathon Johnson, Haynes 682
Jonas, Hans 308 Jonsen, Albert 30, 54 Juengst, Eric 337, 493 justice 605, 608, 612
ideal and nonideal 268 principle of 674
Kadane-Sedransk-Seidenfeld clinical trial design 575
Kahn, Jeffrey 679, 681 Kamm, Frances 196 – 7, 517
Kant, Immanuel 20, 21, 72 – 3, 75 – 6, 77, 82 – 3, 94, 95, 109, 111
Kantian, see Kant, Immanuel Kaposi’s Sarcoma 248
Kass, Leon 305, 306, 308, 325, 328 – 33, 337, 506, 516
Kass, Nancy 671 – 2, 676, 677, 682, 685 Kaufert, J. K. 33
Kenya, and HIV research 680
Ketchum, Sara Ann 335 n. 28, 336 n. 31, 340 n. 39
Kevorkian, Jack 40 Khoury, Muin 684, 686 Khushf, George 164 killing 141
King, Patricia 684, 686
Kitwood, Thomas 318 Koch, T. 33
Kodish, Eric 684 Kolata, G. 327 Kohlberg, Lawrence 77 Kopelman, Loretta 33 Korean War 243
Korn, David 242, 248, 254 Korsgaard, Christine 95 – 6, 106 – 9
‘Creating the Kingdom of Ends: Repiprocity and Responsibility in Personal Relations’ 106
Kubler¨-Ross, Elisabeth 326, 336 – 7 n. 31 Kuczewski, Mark 29, 34, 40, 48
Kurzweil, R. 330 n. 15, 331, 335 n. 28, 338 n. 36, 343, 344 n. 48
Lappe, Marc 684 Larkin, Philip 332 n. 20 Lasch, Christopher 79 Lazzarini, Zita 675, 677
‘least restrictive standard’ 726 Lemmons, Trudo 684 leveling down 183
Liberal Eugenics 517 see Agar, Nicholas Libert, A. 329 n. 10
Libertarian 157
liberty 73, 75, 80, 82 – 4, 85, 156 – 8, 526, 598 Berlin on 85 – 6
of conscience 582 Mill on 82 – 5
negative conception of 73, 84 – 6, 87 positive conception of 73, 85 – 6
life, greatly extended 324 – 45
lifespan, maximum human 325, 328, 337 – 8 n. 35, 338, 343 – 4, 345 n. 49
Lim, Miranda M. 519 line-drawing objection 499 Little, Margaret Olivia 511 Liu, Zheng 519
liver transplants:
first performed with living donor 215 risks to living donor 215
living wills 352, 349 – 74, 618 Locke, John 82
London, Alex John 57 n. 7, 571, 636, 640 – 1
Lonely Crowd, The 79 see Riesman, David Louden, Robert 36
Lurie, Peter 680 lying 25
MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR) 613 – 14
McEwen, Jean 685, 687 McGee, Glenn 325 n. 3 MacIntyre, Alasdair 314 Mackenzie, Catriona 38, 76 McKerlie, Dennis 340 n. 39 Macklin, Ruth 641 – 2, 684, 685
McLeod, Carolyn and Franc¸ oise Baylis 258, 261 – 2
McMahan, Jeff 197, 199, 342 n. 45 magnanimity, virtue of 159 – 60, 172 majority 158, 171
Malory, Sir Thomas 325 – 6, 331 managed care 682, 687 Manchuria 722
Mangan, Joseph T. 115 – 16, 130