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Use of genetic data, employment and insurance: an international perspective.

In this paper, I will say first of all a few words on what is novel in the potential exclusionary use of genetic information in the domains of work or insurance and to what extent legal protection specifically relating to genetic discrimination may be justified. Subsequently, I will briefly examine some of the proposed restrictions on the collection of genetic information for purposes of selection and the scope for international consensus on the issue; in doing so, I will deal separately with employment and private insurance. Finally, I will raise the question whether these issues require international handling and which international steps could be envisaged.

Employment↗

Bioethics in a low key: a report from Germany.

I now, by way of reporting rather than analysing (see my title) would like to do two things; first to give a sketch of bioethical priorities as implied in public political debate and legislation, and second to mention some of the bioethical research activities on the academic level. Important under the first heading seem to me three contexts of activity: the passing of a genetic engineering law (Gentechnikgesetz)in 1990, the passing of a law for the protection of embryos (Embryonenschutzgesetz) in 1990 too, [and] the reforming of the presently divided status of the penal code on abortion this year, 1992 (Schwangerschaftsabbruch).

Abortion, Induced↗

Privatization and just healthcare.

When advocates of insurance-privatization consider whether private insurance-dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance-dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance-privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance-dominated system will achieve justice. A private insurance-dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.

Altruism↗

Community and justice: the challenges of bicultural partnership to policy on assisted reproductive technology.

Listening to other cultures offers challenges to our fundamental assumptions and worldviews. In New Zealand public policy on Assisted Reproductive Technology (ART) is being worked out in a society committed to the development of bicultural partnership honouring the Treaty of Waitangi, a treaty with the indigenous people. Strong claims to the cultural significance of genetic heritage by Maori have made apparent to non-Maori (Pakeha) their own assumptions. These claims also resist reductive understandings of genetics. In this paper I review, as a Pakeha ethicist, initiatives taken in New Zealand, and the impact of bicultural development on public policy on ART. I also discuss some of the issues this raises for western bioethics as it relates to non-western approaches and include reference to the significance of genetic heritage as it is affecting guidelines for donor insemination and surrogacy.

Advisory Committees↗

Experimenting with embryos: can philosophy help?

Beyond the well-known ethical issues involved in medical experimentation on human subjects, experimenting with embryos raises unique and particularly hard problems. Besides the psychological obstacles connected with the fear of "playing God" and the awe with which we hold the process of the creation of human beings, there are three philosophical problems which are the main subject of the article: 1. The logical problem of circularity: the morality of experimenting on embryos is dependent on the status of the embryo, which in turn is partly decided by experimentation; 2. The metaphysical problem: experiments are justified by the benefits they bring to human subjects; but it is doubtful whether an early embryo is a "subject" and whether coming into being is a "benefit"; 3. The moral problem: the standard constraint on medical experiments is that they benefit either the individual subject or at least members of a relevantly defined group of patients suffering from the same syndrome. But embryo experimentation is often associated with potential cure to people of a completely different category (like geriatric patients). Finally, the article discusses the limits of the force of philosophical arguments in the formation of actual policies for regulating such practices as experimenting with embryos. The widely-shared fourteen-day limit is shown to be a sound practical compromise despite the difficulties in justifying it philosophically.

Attitude↗

Moral aspects of risk and innovation.

In all areas of technological innovation and application, there are nontechnical (moral, cultural, religious, political, and regulatory) risk factors and uncertainties that have to be taken into account if research design and introduction of new devices and applications are to be successful. Products and methods will be beneficial to the patient if they meet personal and cultural expectations. Value assessment of individual patients and of cultural preferences and obstacles therefore has to be included in complex technology assessment. Successful recognition and management of moral and cultural risk factors may require changes in governmental regulation and research design and the development of risk recognition competence within professional organizations.

Beneficence↗