General Medical Ethics OLD News

Extracts from EEIN 1991-1994. Latest news is at the bottom. Provided by Eubios Ethics Institute , at http://eubios.info/index.html.

Note that this file includes scientific ethics and law and medical ethics sections

The Nuffield committee in Britain has announced that it will fund and launch a National Bioethics Committee in Britain, from May 1991, for an initial three years; NS (2 March 1991), 10; Biotechnology 9 (1991), 318. It will consist of about a dozen people, including a majority of nonscientists and physicians who will offer advice on the general field of bioethics. There have been earlier calls for a national bioethics committee, see J. Medical Ethics 16 (1990), 146-7. For background information on national ethics research committees, and the call for a Canadian advisory board see the study paper from the Law Reform Commission of Canada, Towards a Canadian advisory council on biomedical ethics (1990, 57pp (plus French language version)).
An English text of most of the French Medical Research law (passed in Dec 1988 and Jan 1990) is reproduced in the BME 66 (March 1991), 8-11. The European Commission is issuing a directive that will force European countries to include laws on medical research in each country. The French Parliament is debating more medical ethics issues, and possible legislation; BMJ 302:746-7.
The situation of medical ethics in Eastern European countries is discussed in several papers in the BME 66 (March 1991), 13-24. There are discussion of bribery and medical ethics in Hungary, and on building libraries in those countries formerly under communist rule.
Letters responding to papers on the Nazi hypothermia experiments are in NEJM 324:845-7.

A report by the ethics committee of the Norwegian Ministry of Health and Social Affairs has been prepared, which will provide the basis for a report on the ethics of biotechnology related to human beings to be presented to the Norwegian Storting in 1992. It is entitled Man and Biotechnology and English summaries are available from the Royal Norwegian Ministry of Health and Social Affairs, Grubbegt 10 - P.O. Box N-8011 DEP., 0030 Oslo 1, Norway. It covers a wide range of issues.
On the subject of inochi, which is the Japanese word meaning life or nature, see M.Morioka, "The concept of inochi: A philosophical perspective on the study of life", Japan Review 2: 83: 83-113. It presents in English some of the approach used to the study of bioethics that the author has presented in a Japanese language book, and also contains impressions obtained from the Japanese public. On another approach to ethics, that using the ideas of the Maori of New Zealand, see R.W.Perrett & J.Patterson, "Virtue ethics and Maori ethics", Philosophy, East & West 41: 185-202.
A new book on the history of medical ethics is D.J.Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (320pp., US$25, Basic Books 1991) is reviewed in Nature 350: 530. This book is generally limited to the situation in the USA.
A short letter on the use of the word "patient" versus "client" appears in MJA 154: 183-4, 432. Generally the word patient is preferred by the people themselves, and the word client sounds more like a business word. We should remember the origin of patient, which is from Latin, pati , to suffer, and the effect the word may have on the relationship to a doctor or counselor.
The Nuffield committee in Britain has been established for an initial three years; EEIN 1: 41; BME (May 1991), 6; Nature 350: 641. The chairman is the Rt.Hon. Sir Patrick Nairne. One of the first areas of inquiry will be into the implications for humans of developments in genetic and molecular biological research in animals and plants as well as in humans.
On the poor level of recruitment of patients for clinical trials see BMJ 302: 1099-1100. See also A. Brett & M.Grodin, "Ethical aspects of human experimentation in health services research", JAMA 265: 1854-7.
The Linacre Centre has several publications on the topics of IVF, prenatal diagnosis, nursing ethics, and euthanasia. For details of these books contact the Linacre Centre, 60 Grove End Road, London NW8 9NH, U.K.
On scientific ethics regarding the Baltimore paper issue see JAMA 265: 2309-11; Nature 351: 85, 94-5, 180-3, 341-5; Science 252: 768-70. There was even a debate on the legal costs which initially partly came from federal grants; NS (4 May 1991), 15; Lancet 337: 1274-5. On another case see Nature 351: 13.
A recent successful experiment on the implantation of an artificial pancreas into diabetic dogs is in Science 252: 718-21. It used a selectively permeable membrane to surround the implants to prevent host rejection.

A comment on ethical committees is by G.J. Annas in the Hastings Center Report (May/June 1991), 18-21. the role of committees must be examined, they are not legal agents, but they need to focus on ethics. On the increasing number of ethical committees and reports see an editorial in Nature 352: 359-60. Also see R.A. Hope, "The birth of medical law", Oxford J. Legal Studies 11: 247-53.
There are several papers in the June issue of Bulletin of Medical Ethics , on the situation for patients at the end of life in Poland, the rebirth of medical ethics in Czechoslovakia, and ethics teaching for Hungarian nurses.
For reviews of Albert R. Jonsen, The New Medicine and the Old Ethics (188pp., 15, Harvard University Press 1991) see NS (17 Aug 1991), 44, and JAMA 266: 574-5. A gender difference in clinical decision making is discussed in JAMA 266: 559-62, 566.

The FDA has adopted a common federal policy for the protection of human subjects; JAMA 266: 1482. It applies to IRBs, and informed consent. On free speech and clinical trials see Science 254: 23. On randomised clinical trials see Obstetrics & Gynecology 78: 703-4. On informed consent see Lancet 338: 665-6, 952; BMJ 303: 610-3. In the U.K. the Dept. of Health has published its initial guidelines for proposals involve human subject research; Nature 352: 746; BMJ 303: 488, 873-4; JRSM 84: 755-7. There are new regulations on clinical trials in Spain; Lancet 338: 304.
On medical ethics in general see CMAJ 145: 696-9; Medical Education 25: 280-2; A.R. Jonsen, "Of balloons and bicycles. The relationship between ethical theory and practical judgement", HCR (Sept/Oct 1991), 14-17. A book review of Social Science Perspectives in Medical Ethics , ed. George Weisz (Kluwer 1990) is in Social Science & Medicine 33: 635-6. On the quality of life, and methods to assess this see BMJ 303: 699-701; Lancet 338: 350-1, 636-7.
A general paper by I. Kennedy, "Health law and ethics: an agenda for the 90s", is in BME (Aug 1991), 16-21. It introduces the UK Forum for Health Care Ethics and Law, and looks at what teaching is required. On professionalism and the AMA see JAMA 266: 1694. Book reviews are in JAMA 266: 851, 1047-8, 1273-4, and a list of some books on medical ethics on p. 1706. On medical education see Lancet 338: 297-9, for the conclusion of a six part series of comments. On educational malpractice see JAMA 266: 905-6, and on patient encounters see JAMA 266: 1390; BMJ 303: 261-2. On healing and medicine see JRSM 84: 516-8. On the way ethical decisions are made by family doctors in Canada, USA and Britain see Social Science & Medicine 33: 647-53.
On medical ethics committees see G. J. Agich & S. J. Younger, "For experts only? Access to hospital ethics committees", HCR (Sept/Oct 1991), 17-25. A 1-day symposium on Oct 27 was held in Jikei Medical School in Tokyo, Japan, looking at medical ethics committees. It was organised by K. Hoshino, and included J. Miller (Canada) and W.A. Atchley & S. Spicker (USA). A survey of Japanese medical ethics committees has been conducted by K. Hoshino, and by the end of this year all 80 Japanese medical schools will have an ethics committee, the average size is 10 members, 13 include one female member, and one has two! 68 had at least one academic in addition to doctors, of these: 48 include a lawyer, 29 include a philosopher. Of hospitals, 14% have ethics committees, and 14% are studying about whether to have committees (in Feb. 1990).
On the effect of medical litigation on U.K. obstetric practice see Lancet 338: 616-8, with some use of defensive medicine. A book review concerning 19th century medical malpractice in America is in NEJM 325: 591-2. On the poor effect of malpractice claims on reimbursing negligence see NEJM 325: 245-51. Recently a nationwide group of lawyers in Japan held a free telephone call in day for people who thought they had been mistreated by doctors. In Japan very few medical malpractice suits are successful. On that day, at the 58 offices receiving calls, 852 cases were brought to the attention. After examination, the lawyers criticised the actions of 56 private clinics/hospitals, 28 individual doctors, and 24 public hospitals. The number of cases in which legal action will be taken is not available.
On scientific ethics see Science 253: 1344-8, 1479.

On independent committees for biomedical research see a paper by J.-P. Demarez in IJB 3: 171-7. It looks at the situation in France, and the paper is in French. In December 1991, the French Government unveiled a code of biomedical ethics that will be the draft for the legislation expected in 1992. The code bans payment for donated blood or organs, and donors must remain anonymous. The code limits the use of genetic identification to trace a child, born after AID, to parental lineage. AID would only be allowed for cases of infertility. It would forbid surrogate motherhood.
A paper on health promotion and education by S.A. Doxiadis is in IJB 3: 179-86. Medical education is discussed in Social Science & Medicine 33: 1163-70. The duty to attend upon the sick is the subject of an editorial in JAMA 266: 2876-7, especially in regard to treatment of patients infected with HIV.
On bioethics in Turkey see BME (Nov 1991), 13-17; in Rumania see IJB 3: 251-3 (in French); BME (Oct 1991), 22-3; and in Czechoslovakia see BME (Oct 1991), 21, 23-4. On the Soviet national bioethics committee see BME (Oct 1991), 7. It was established by the Academy of Sciences, so maybe it will continue as the Russian national bioethics committee. Also on general medical ethics see CMAJ 145: 848. A review of Owsei Temkin, Hippocrates in a World of Pagans and Christians (John Hopkins University Press 1991, 315pp., US$40) is in JAMA 266: 2761. A more practical book for today's medical issues is William F. May, The Patient's Ordeal (Indiana University Press 1991, 218pp., $US25) is reviewed in JAMA 266: 2471-2. A statement by the AMA Council on Ethical and Judicial Affairs is "Sexual misconduct in the practice of medicine", JAMA 266: 2741-5, which calls for education of these issues to students.
An outline of the U.K. Patient's charter is in BME (Nov 1991), 8-9; BMJ 303: 1153, see also Lancet 338: 1199. Effective communication between doctor and patient is essential; M. Simpson et al., "Doctor-patient communication: the Toronto consensus statement", BMJ 303: 1385-7. The role of ethicists in medicine is seen in the light of doctor-patient communication in a book review in Lancet 338: 1325, see also NEJM 325: 1650-2. On informed consent see BMJ 303: 1138; Lancet 338: 1072; and on the right to know; BMJ 303: 937-8, 1271-2. Some early trials of patient access to their own psychiatric records in the UK is reported in BMJ 303: 967. In Japan, there was a recent court case where a patient wanted to see part of their medical record, and the court judged that they could see part of it; Asahi Newspaper (26 Dec 1991).
On the clinical trials of a drug tamoxifen, to treat breast cancer, in the U.K., see BME (Oct 1991), 3-5. Also on clinical trials see CMAJ 145: 1018-9; Lancet 338: 1151; NEJM 325: 1513-5.
. The medical profession is discussed in a book review in NEJM 325: 1256-7, and on physicians and self-referral see JAMA 266: 2330, 2335. Practicing physicians have been found to often treat their own family members; J. La Puma et al., "When physicians treat members of their own families. Practices in a Community Hospital", NEJM 325: 1290-4
A summary of a Scottish Law Commission report on decisions and the mentally disabled is in BME (Oct 1991), 34-5. On an international study on this topic see CMAJ 145: 947-52.
Malpractice litigation is discussed in JAMA 266: 2087-92, 2856-60, 2886-91. In Britain two junior doctors have been convicted of manslaughter for a mistake; BMJ 303: 1157, 1218.
Cheating in medical schools is said to be common; JAMA 266: 2453-6. On scientific ethics; see mention of the Gallo case in Science 254: 507; on David Baltimore's resignation from Rockefeller University; Science 254: 1447; Nature 354: 419-20; and on plagarism see Nature 354: 422.

Several publications in French from the Groupe de Recherche Ethos , Universite du Quebec a Rimouski, 300 Allee des Ursulines, Rimouski, Quebec G5L 3A1, Canada, are available, as well as a twice annual journal, Ethica. The objectives of this group are interdisciplinary research about the ethics of professions and social interactions, to partcipate in research and to diffuse the results nationally and internationally, and education of MA students in ethics. Two monographes are available, one on Incest, from the viewpoint of the law; L'inceste et le rapport a la Loi, and another on an ages persons reception center; Intervenir, aupres des personnes agees en centres d'accueil.
The 1991 Bibliography of Bioethics is available, for US$45 from The Kennedy Institute of Ethics, Georgetown University, Washington DC 20057-1065, USA.

The draft law on bioethics in France will go through the Parliament in the spring session, if the schedule is maintained; Biotechnology 10: 116. It includes protection of genetic privacy.
There are some points from the UK General Medical Councils guidelines on medical confidentiality reproduced in the BME (Dec 1991), 9-11.
A report on a 1991 eastern European conference on bioethics co-sponsored by the Hastings Center is in the Hastings Center Report (Nov 1991), 5-6.
On health trials and warnings about risks; Lancet 338 (1991), 1495-6. On informed consent when an investigation is interrupted see Lancet 339: 51; and patient's rights in research; BMJ 303 (1991), 1498. On the general philosophical question of ends and means see A. Gerwirth, "Can any final ends be rational", Ethics 102 (1991), 66-95. A review of Human Life in the Balance is in JAMA 267: 431-2. The legal status of "dead patients" is discussed in Lancet 339: 173-4. On the quality of life, see several articles in Dispatches 2 (Spring 1992).
The quality of health care should be improved, and one way is to use new sources of data; JAMA 266 (1991), 3429-32, 3433-8, 3472-3. Increasing the length of patient time in general practice does improve health promotion according to a study reported; A. Wilson et al., "Health promotion in the general practice consultation: a minute makes a difference", BMJ 304: 227-30. Alternative medicine has a role in medical care and this needs to be considered; R.H. Murray & A.J. Rubel, "Physicians and healers - Unwitting partners in health care", NEJM 326: 61-4. On professionalism in health care see JAMA 266: 3338.
On the problems of newly trained doctors from developing countries see Lancet 339: 110-1. In this case, his medical qualification was "de-recognised" by Indian authorities, as can happen in Pakistan and Chile. It is usually in tit-for-tat response to moves on not recognising national qualifications by other governments. In addition to such problems, the difference in facilities could also be a great contrast. One could also add scientists to the type of specialists who may face very different situations when they return to their home in developing countries after being trained in industrialised countries.
Some further comments on the Gallo case, scientific misconduct, and the role of the press are in Science 255: 10-12, Nature 355: 6-7.
New Books
(some others are mentioned in the text of the newsletter):

Social Protection on the Horizon 1992. Debate of experts, ed. J.-C. Sailly et al., 208pp, ISBN 2-905972-23-8, FF231)
Le Diagnostic Antenatal. Quels Enjeux?, (a multi-volume set);
From: Editions Alexandre Lacassagne
162 Avenue Lacassagne, 69003 Lyon, FRANCE

Medicine, Ethics and Law. Canadian and Polish Perspectives, ed. D.J. Roy et al., 383pp., ISBN 2-9802538-0-4, CAN$23.50 + postage; Center for Bioethics, Clinical Research Institute of Montreal, 110 Pine Avenue West, Montreal, Quebec, Canada H2W 1R7.

Challenges in Medical Care, ed. A. Grubb, 208pp., ISBN 0471931020, 25/US$53; John Wiley & Sons, Baffins Lane, Chicester, West Sussex, PO19 1UD, England.

An unethical breast cancer treatment trial is being conducted in Japan, by a group of 25 surgeons from 19 large hospitals. It began this year, and they intend to continue for two years, though hopefully ethical committees will stop it. It involves different methods of treating breast cancer, but the principle reason it is unethical is that the patients are not informed about the alternatives but are randomly assigned to one method of treatment, so there is no consent; Asahi newspaper (26 April 1992), 17, (27 April 1992), 15. To date 10 patients have been involved, and it is intended to involve 400 cases, randomly assigned to four methods. The options include complete removal of the breast, and also cases where no radiotherapy is given. The surgeons claim that Japanese cancer is different to Western cancer; presumably they don't know about the many Japanese residents of the USA and other countries! Breast cancer treatment in Japan tradionally uses complete removal of the breast rather than targetted surgery, and it has become contentious only in the last year or so, when people have begun to question medical practice more than before, and since people learnt about informed consent.
In April there were several television programs on NHK in Japan looking at the uncovering of the biological warfare experiments and live human vivisection conducted by Japanese researchers during World War II in Manchuria, China, at camps like Unit 731. Some of the scientists are still alive, they were protected from prosecution by the war crimes tribunal by American's in exchange for exclusive use of the reports of the research. Actually, the Americans only learnt of the existence of human vivisection trials following Soviet interrogation of Japanese soldiers who worked at the research site in China, and the Soviet accusations were stalled by the Americans who wanted to have the research results. Also, recent analysis of skulls buried in Shinjuku, Tokyo, has found that they are from foreign Asians, whose bodies and decapitated heads may have been used to practice brain surgery; Japan Times (24 April 1992), 3. They skulls had holes drilled into their heads, probably after death. Citizens protested against the original intention of immediate cremation of the remains, so that the origins could be investigated. Several government departments refused to examine the skulls, so that a private University examination was conducted.
The ethics of biotechnology is being debated in Europe, and a unified approach may be developed; Lancet 339: 483-4; Nature 356: 368; BMJ 304: 434-6. A convention is aimed to be ready by the end of 1993, based on adoption of a number of principles. Europe is setting the world pace in such government based directives, though we should remember that they are only part of what is needed to develop bioethical consciousness.
On teaching medical ethics in Germany see comments on experience in BME (Feb 1992), 13-15. Comments on Polish philosopher-physicians and a draft medical ethics code in Poland is in BME (Feb 1992), 22-4. The recent Polish physician's code (EEIN 2: 22) that outlawed abortion, also included permission of research on mentally ill persons, children, and prisoners, without their consent, so the Polish courts need to decide on its legality; NS (7 March 1991), 13. It came into effect from May. A list of medical ethics publications that have been sent to Eastern European Libraries to establish medical ethics collections see BME (Feb 1992), 16-21.
In New Zealand , a Human Rights Commission has found that medical authorities in Auckland took excessive action in locking hospital wards for three weeks at Kingseat and Carington psychiatric hospitals in May 1991, following the "escape" of two patients. Even voluntary patients were locked up, who should normally be allowed to leave at their own free will; NZ Herald (3 March 1991), 1.
A report on the ethical issues involved in the large multinational trial of the drug Tamoxifen against breast cancer is in BME (Feb 1992), 29-33; NS (29 Feb 1992), 5; NEJM 326: 852-6, 885-6. Many subjects in medical trials are white males, and this is the subject of a paper by R. Dresser, "Wanted single, white male for medical research", Hastings Center Report (Jan/Feb 1992), 24-29; see also SA (March 1991), 10-2. The UK MRC recommendations on research ethics using children and mentally incapacitated persons are in BME (March 1991), 8-10.
A new paradigm for medical care is called for in M.R. Greenlick, "Educating physicians for population-based clinical practice", JAMA 267: 1645-8. A study suggesting that religion has a positive effect on health is K.F. Ferraro & C.M. Albrecht-Jensen, "Does religion influence adult health?", J. Scientific Study of Religion 30 (1991). 193-202, 203-11. The January issue of the American J. of Sociology Vol 97 (4), 909-1138, looks at new directions in the sociology of medicine. Marital breakdown also can have adverse effects on health; BMJ 304: 457-8.
On European law and medicine and conflicting rules in EC member countries; BMJ 304: 700-3. The reasons behind malpractice suites in the USA have been examined by contacting families who filed legal suits (with a 35% response rate); G.B. Hickson et al., "Factors that prompted families to file medical malpractice claims following perinatal injuries", JAMA 267: 1359-63. A book review of Medical Malpractice on Trial, P.C. Weiler, is in NEJM 326: 844.
A paper questioning whether there can be informed consent is V. de Vahl Davis,"How informed is informed consent?", BME (March 1991), 13-18; see also NEJM 326: 896-7; JAMA 267: 1118-9; G.J. Annas, "Changing the consent rules for desert storm", NEJM 326: 770-3; M. Drickamer & M.S. Lachs, "Should patients with Alzheimer's disease be told their diagnosis?", NEJM 326: 947-51. On the rarity of medical students taking oaths in British Medical schools see BME (March 1991), 19-23. A general paper on bioethics is R.M. Sade, "The different drummer, the double agent, and future dilemmas in bioethics", Annals of Thoracic Surgery 53: 183-90. An analysis of the way physician's treat their own families is in JAMA 267: 1810-2. The advantages of using telephone care for routine clinic follow-up identified from a study in the USA is in JAMA 267: 1788-93. Physician's warnings about recovery from alcoholism treatment may be associated with recovery from alcoholism; JAMA 267: 663-7.
The approaches that ethics committee's can take is discussed in D.C.Blake, "The hospital ethics committee. health care's moral conscience or white elephant?", Hastings Center Report (Jan/Feb 1992), 6-11. Ethics and clinical research in anaesthesia is discussed in Lancet 339: 337-8, and ethical emergencies in Lancet 339: 399.
On ethics in government and public administration see the Spring 1991 volume of Canadian Public Administration. The NIH has formed a policy centre to look at research ethics; Nature 356: 367. The conflict of interest problems that scientists on review committees face because of the large proportion of scientists with commercial interests, are discussed in Nature 355: 751, 3. We can question where we can obtain neutral advice, and should impose strict guidelines on chosing committee members.

As was reported in the last issue (EEIN 2: 40), an unethical breast cancer treatment trial was being conducted in Japan. They have changed the trial to make it more ethical by informing the patients of the alternatives and then giving them the treatment they chose. Related is a paper looking at the situation in the USA, A. Butler Nattinger et al., "Geographic variation in the use of breast-conserving treatment for breast cancer", NEJM 326: 1102-7; and a paper D.C. Farrow et al., "Geographic variation in the treatment of localized breast cancer", NEJM 326: 1097-101. On the attempts by Japanese nurses to seek more status and recognition see Japan Times (25 June 1992), 17.
A new book suitable for a textbook on medical ethics is A. Campbell, G. Gillett and G. Jones, Practical Medical Ethics (Oxford University Press, 1992, 177pp.). The three authors are members of the Otago University Biomedical Research Centre, New Zealand.
The variable performance of British research ethics committees has been reviewed in a report by Rabii Julia Neuberger, reviewed in BME (April 1992), 1, 3-5. A series of articles on medical ethics subjects in Eastern europe is in BME (May 1992). It is also suggested that ethics committees should have more power; Nature 356: 737. Explanatory comments on UK guidelines for local research ethics committees are in BMJ 304: 1293-5; see also BMJ 304: 1129-30; Lancet 339: 935, 1106.
The ethics of physical restaints are discussed in In Keeping with the Trends (June 1992). It is interesting and disturbing that in North America it is estimated that 550,000 adults are tied to their beds or wheel chairs every day in North America.
A retrospective review of health law is S.S. Fluss, "25 years of health law: a retrospective from WHO", IJB 3: 15-23. It points out the successes of health law inpromoting people's well being, and how useful it is to have international transfer of data about health legislation. A recent charter on patient rights in the Basque region of Spain is in Int. Digest of Health Legislation 43: 84-92. The human rights abuses in Burma are discussed in Lancet 339: 1288-9.
Guidelines for physicians are under review in many countries as discussed in Lancet 339: 1197-8; a review of the 45th World Health Assembly is in Lancet 339: 1287. The diversity of ethics, even within the Council of Europe is discussed in Lancet 339: 861-2, in the context of the moves to establish a bioethics convention. See also NS (11 April 1992), 46-7.
Different models of the doctor-patient relationship, the paternal, informative, interpretive and deliberative, are discussed in E.J. Emmanuel & L.L. Emmanuel, "Four models of the physician-patient relationship", JAMA 267: 2221-6. The perceptions of physicians by the public and in literature are discussed in JRSM 85: 314-6. On medical ethics see: JAMA 267: 2256-7; 2819; NEJM 326: 1440-2. An editorial on the autopsy of former-President Kennedy is in JAMA 267: 2791, 2794-9. Letters on the relationship between physicians and "healrers" are in NEJM 326: 1503-4.
Methods for making medical decisions for incompetent adults are discussed in JAMA 267: 2082-4; E.J. Emmanuel & L.L. Emmanuel, "Proxy decision making for incompetent patients An ethical and empirical analysis", JAMA 267: 2067-71. On surrogate decision-makers see BMJ 304: 1060.
On the relationship between science and the soul, see comments in Nature 356: 729-30; 357: 29. A discussion of QALYs is in E. Nord, "Methods for quality adjustment of life years", Social Science & Medicine 34: 559-69; and C.A. O'Boule et al., "Individual quality of life in patients undergoing hip replacement", Lancet 339: 1088-91. Our concept of health is important and it may change as the population ages; J. Showstack et al., "Health of the public The academic response", JAMA 267: 2497-502. Peer review of hospitals and medical care is discussed in JAMA 267: 2349-54.
On scientific ethics, another case of fraudulent data in scientific journals is reported in Nature 357: 427, relating to a paper in Cell ((1991) 64: 1103, that was retracted in the 29 May issue of Cell . The Gallo case may be over, with an NIH enquiry clearing Gallo of misconduct; but the issue of patent rights for HIV tests is still unresolved, with the USA playing very slow on the issue. France now claims to have complete rights to the royalties from HIV tests, since French researchers discovered HIV; Chemical & Engineering News (May 11), 37; Nature 357: 3-4; Science 256: 735-9, 955. Scientific misconduct is discussed in Nature 356: 730-1, 357: 7, and a recently approved bill in the US (The same one allowing fetal tissue research funding) would force journals to follow misconduct rules, though already most journals would retract papers if misconduct was found. A critical analysis of scientific misconduct is in The New Republic (18 May 1992), 24-31.
The rules over financial ties of scientists and neutrality are being debated. It is very important, especially in biotechnology where many scientists have commerical links, that commercial neutrality is ensured. However, to what degree should this go, in the NIH current rules are said to be too strict, but are awaiting new guidelines; Nature 357: 180. related, the subject of physician ownership of medical facilities is discussed in JAMA 267: 2366-9.

Informed consent in Japan: a Tokyo District court has upheld a case brought against Tokyo University Medical School involving informed consent; Yomiuri Shimbun (1 Sept 1992), 30. The operation was a medical success, but the patient was not informed of the chances of failure, and brought a case against the hospital. In what appear to have been more serious cases two years ago, courts did not uphold informed consent. This could be an important case for Japanese medical practice, though it may still be appealed.
The attitudes of Greek people to truth telling depends on the case, P. Dalla-Vorgia et al., "Attitudes of a Mediterranean population to the truth-telling issue", JME 18: 67-74. A debate on lying is in JME 18: 49, 63-6. The way patients are told of cancer by their doctor needs to be sensitive, as illustrated by the letter in BMJ 305: 62. A study on the way patient's react to making decisions is S.Legg England & J. Evans, "Patients' choices and perceptions after an invitation to participate in treatment decisions", SSM 34: 1217-25.
A criticism of the process of ethical review in human research trials is, P. Pettit, "Instituting a research ethic: chilling and cautionary tales", Bioethics 6: 89-112. A study on why parents volunteer their children for research is S.C. Harth et al., "The psychological profile of parents who volunteer their children for clinical research: a controlled study", JME 18: 86-93. The establishment of a system to monitor health standards in the UK is discussed in BME (June 1992), 3-5.
A useful and substantial compilation of materials for research ethics committees has been compiled by C.G. Foster of King's College London, Manual for Research Ethics Committees. Articles on ethics committees appear in Cambridge Quarterly of Healthcare Ethics 1: 5-74. Criticism of the UK guidelines for ethics committees are in BMJ 304: 1696. One ethical dilemma of clinical trials is when to stop them, S.J. Pocock, "When to stop a clinical trial", BMJ 305: 235-40. See also NEJM 327: 273-4.
A French law on medical research is discussed in C. Huriet, "The French Law on the protection of persons participating in biomedical research: origins and history", IDHL 43: 391-3. Comments on the Milazzo group by C. Byk are on p.393-7. On p.299-304 a Danish code of conduct is reproduced, in English, and on p.304-11, the Patients' Rights Ordinance of Switzerland. The adopted recommendations on bioethics, autopsies and drug abuse at the Council of Europe are in IDHL 43: 399-401. UN General Assembly principles on mental health policy are on p.413. The April issue of the Journal of Medicine and Philosophy is devoted to "Philosophical issues concerning psychiatric diagnosis". A special issue of SSM 35 (1) is on "The cultural construction of diagnostic categories: The case of American psychiatry".
A description of bioethics at Monash University in Australia by P. Singer is in IJB 3: 111-5. Descriptions of some ethics programs are in Ethically Speaking 1(2), 5-10. A description of the University of Toronto Centre for Bioethics is in Humane Medicine 8: 219-24. Bioethics in Russia is discussed in HCR (May-June 1992), 5-6.
General articles of interest to medical ethics appear in Humane Medicine 8 (July 1992), including G. Merikas, "Hippocrates: still a contemporary", Humane Medicine 8: 212-8; and JAMA 268: 354-5. Regarding confidentiality see BMJ 305: 140. Other papers: J.S. Horner, "Medical ethics and the public health", Public Health 106: 185-92; E.H. Loewy, "Suffering as a consideration in ethical decision making", Cambridge Quarterly of Healthcare Ethics 2: 135-42; the July issue of Ethics has a series of articles on pluralism. Some book reviews are in Ethics 102: 846-77, 891-3; SSM 34: 1299, 1425-7; IDHL 43: 424-33. Doctor's responses to domestic violence are the subject of papers in JAMA 267: 3157-60, 3190-3, 3194-5. The supportive attitudes of physicians to some corporal punishment are reported in JAMA 267: 3161-5. A call to reject death penalties is in BMJ 305: 381-2. Reports on torture and human rights abuses are in JAMA 268: 579-90; BMJ 305: 380-1.
In the UK Appeals Court , judges upheld the clinical judgement of a doctor who refused to put a brain damaged 16 month boy on a ventilator; BMJ 304: 1589; Lancet 339: 1472-3. However, the UK court of appeal also decided that a 16 year old could be forcifully feed against her will, an anorexia nervosa case; BMJ 305: 76; Lancet 340: 108-9, 169-70. Also there is comment on forcing treatment on pregnant women. The court also approved the enforced blood transfusion into a 20 year old women who is a Jehovahs Witness; BMJ 305: 272; Lancet 340: 345. The retreat from Gillick in the UK is discussed in The Modern Law Review 55: 569-76.
A forum on the status of nursing in different countries is in World Health Forum 13: 1-9. Of relevance to medical students is S. Bewley, "The law, medical students, and assault", BMJ 304: 1551-3.
A paper arguing that the mixing of scientific and ethical arguments can result in some methodological errors in bioethics is in IJB 3: 121-3. An essay on the nature of practical ethics is in Ethically Speaking 1(2): 1-3.
Legal trends in bioethics are discussed in J. Clinical Ethics 3: 83-7; JAMA 268: 98, 364-5. On no-fault compensation in the UK see JME 18: 59-60, and casuistry and heath care ethics see p.61-2. Legal discussions of causation are in The Modern Law Review 55: 584-83. A new book is David B. Collins, Medical Law in New Zealand (Wellington: Brooker & Friend 1992, 312pp.). On rights, C.M. Vazquez, "Treaty-based rights and remedies of individuals", Columbia Law Review 92: 1082-163. Also on rights see BMJ 304: 1641. On Japan, D.H. Foote, "The benevolent paternalism of Japanese Criminal Justice", California Law Review 80: 317-90.
The issue of sexual abuse of patients has been long hidden, but there are signs that discussion of the issue is now possible - which should aid protection of the victims of it and development of better awareness of the problems. A major report on the subject was released on Nov. 25, 1991 by an Independent Task Force commissioned by The College of Physicians and Surgeons of Ontario, and the College's address is 80 College Street, Toronto, Ontario M5G 2E2, CANADA. A paper on a sexual contact survey is D. Wilbers et al., "Sexual contact in the doctor-patient relationship in the Netherlands", BMJ 304: 1531-4, 1519-20. They compared gynaecologists and throat specialists, and 4% of the doctors had had sexual contact with patients at some time. Related, see the case of sedating a mentally retarded woman to conduct a pelvic examination; J. Clinical Ethics 3: 76-7.
The philosophy of 'alternative' or 'scientific' medicine is discussed in JRSM 85: 436-8; and on explanation of historical healing rituals see Lancet 340: 223-5. In this section I could mention a paper R.P. Bentall, "A proposal to classify happiness as a psychiatric disorder", JME 18: 94-8. At least happiness is a disorder we can enjoy. Karl Popper is the subject of a commentary in Nature 358: 363. A book review of M. Midgley, Science as Salvation: A Modern Myth and its Meaning (Routledge 1992, 239pp., US$25) is in Nature 357: 550-1. How to make ethical investments is discussed in The Modern Law Review 55: 587-93.
On scientific ethics see P.J. Friedman, "Mistakes and fraud in medical research", Law, Medicine & Health Care 20: 17-25. A letter on physician self-referral is in NEJM 327: 58-9. The case of Gallo and the discovery of HIV is continuing to get comments (see also the patent section); Lancet 339: 1594-5; Nature 358: 3; Science 257: 323. Another longer standing question of scientific ethics, the Baltimore and Imanishi-Kari case, has been dropped from official investigation; Nature 358: 177; Science 257: 318. In Denmark a system to allow such investigations is underway; Lancet 340: 41. On the effects of military-funded research see Nature 358: 178-9. Conflicts of interest are featured in Science 257: 595, 616-25.
An Ontarian Government Enquiry on Non-therapeutic Medical Procedures on Behalf of Mentally Incapable Individuals is calling for contributions. A report is due this autumn. Send comments to: Prof. D.N. Weisstub, Centre de Recherche, Universite de Montreal, Place du Canada, bureau 2260, Montreal, Quebec, H3B 2N2, CANADA.
Details on the International Association of Bioethics from Mrs Kay Boyle, Centre for Human Bioethics, Monash University, Clayton, Victoria 3168, Australia (FAX Int+61-3-565-3279;
EMAIL: hub116e@vaxc.cc.monash.edu.au).
A new Master's level Bioethics program is being offered at McGill University. For information, contact:
McGill Centre for Medicine, Ethics and Law
2020 University St., Suite 2410
Montreal, Quebec, CANADA
The teaching of bioethics in science classes in the USA is increasing, see Ag Bioethics Forum June 1992, (address in announcements section). In Tsukuba, I am teaching some bioethics in basic biology courses, it would be interesting to hear from others with similar experience, or interested in introducing bioethics into science curriculum.

Medical ethics in Western countries has been very autonomy or individual centred. A call for more consideration of the family is J.L. Nelson, "Taking families seriously", HCR (July-Aug 1992), 22: 6-12. The problems of applying ethical theories to life are discussed in C. Elliot, "Where ethics comes from and what to do about it", HCR (July-Aug 1992), 22: 28-35. A study of how different cultures have different family relationships is P.Moore Hines et al., "Intergenerational relationships across cultures", J. Contemporary Human Services (June 1993), 323-38. Papers on medical sociology are in SSM 35: 959-65; Mayo Clinic Proceedings 67: 876-8. A paper on whether we have rights is F.J. Leavitt, "Inalienable rights", Philosophy 67: 115-8. Book reviews on the topic of suffering are in HCR (Sept.-October), 22: 43-4.
Models of the physician -patient relationship are discussed in JAMA 268: 1410-3. A book review of Doctors, Patients, and the Law is in Lancet 340: 777-8; and of The Great White Lie, in JAMA 268: 924. On when to retire from practice is in Lancet 340: 776-7. An editorial on how and whether to assess clinical instability at discharge is in JAMA 268: 1321-2. The attitudes of elderly patients to medical students is surveyed in Medical Education 26: 360-3.
In Japan , Tsukuba University Medical Ethic's Committee has said it will respect the religious choices of patients, and perform operations without blood transfusions for Jehovah's Witnesses; Yomiuri Shimbun (10 Sept 1992), 24. Kagoshima and Kyoto had earlier said that they would also do this. An interesting "medical case" in Japan has lead to the suspension of a hospital doctor in Fukuoka, who aided a Yakusa (Japanese mafia) in removing their finger; Yomiuri Shimbun (22 Sept 1992), 31. The small finger is removed in a gangster ritual to request apology - but this gangster wanted to do it under anaesthetic, and the doctor helped! The doctor said he was threatened, so he had to help.
The value of medical education , and the types of education are reviewed in a special issue of JAMA (2 Sept 1992). The results of a trial on continuing medical education are positive, D.A. Davis et al., "Evidence for the effectiveness of CME. A review of 50 randomized controlled trials", JAMA 268: 1111-7. The role of the media in dessiminating research is generally supported by researchers in a survey in JAMA 268: 999-1003, 1026-7. The media can also influence clinical use of treatments, see JAMA 268: 1004-7.
Nursing ethics is discussed by E.W. Bernal, "The nurse as patient advocate", HCR (July-Aug 1992), 22: 18-23. A model for nurses behaviour is discussed. The third version of the UK Central Council for Nursing is reproduced in BME (July-Aug 1992), 10-11. A call in Britain has been made for allocating a specific nurse to each patient; BMJ 305: 603. The ethics of using open methods in sociology research are discussed in Brit. J. Sociology 43: 321--32.
Several papers of interest to the question of competent patients and informed consent are in HCR (March-April 1992), 56-9; HCR (July-Aug 1992), 22: 24-5, 26-7; Dispatches 3 (1) (Autumn), 1-4. Discussion of two recent UK appeals court decisions (EEIN 2: 68), that make us ask who can refuse treatment is in BME (Sept 1992), 18- 21. Guidelines on research with children are reported and extensively discussed in BME (July-Aug 1992), 13-28. Letters on the topic of whether the patient does know best are in BMJ 305: 582-3.
Research ethics committees in Germany are discussed in BME (July-Aug 1992), 40-44. Recently a clinical experiment involving keeping children with asthma in a smoke-filled room was conducted without approval from an ethics committee because the researcher said it was conditions like those found in ordinary life, such as in a smoking car in a train, however, others say he should have obtained approval; Lancet 340: 782.
The case of a British breast cancer treatment trial, that did not offer informed consent to women undergoing it, and the legal support for paternalism, is discussed in R.H. Nicholson, "Paternalism no problem", HCR (March-April 1992), 4-5. In EEIN 2: 40, 52, a more recent unethical trial in Japan was discussed, which has subsequently been altered to include informed consent. Breast cancer treatments are discussed in AJPH 82: 1345-51; JAMA 268: 869-70. A book review relevant to ethical and legal issues in cancer research is in BMJ 305: 722-3. A book review of The Crisis in Clinical Research: Overcoming Institutional Obstacles, is in Nature 358: 722. The selection of people for clinical trials is discussed in J. H. Gurwitz et al., "The exclusion of the elderly and women from clinical trials in acute myocardial infarction", JAMA 268: 1417-22, 1460-1; BMJ 305: 785-8. The exclusion of certain groups does limit the generalisations that can be made from the results.
Comments on the inadequacies of the Olympic Committee's list of banned drugs, as many of them have no evidence of enhancing performance but are only restoring health in medical use, is in BME (July-Aug 1992), 3-7. On the issue of enhancement, a related problem arises with the use of enhancement improving drugs in any realm of activity. The case of using propranolol and the question of what is ethical enhancement is discussed by J. Slomka, "Playing with propranolol", HCR (July-Aug 1992), 22: 13-7.
Teaching of values in medical school curriculum at Harvard University are reported by J. Neuberger in BME (July-Aug 1992), 33-9. Methods to include ethics in the curriculum are reported in JRSM 85: 594-7. Scientific fraud is discussed in the Australian McBride case in Medicine, Science and Law 32: 199-203. Methods for investigating scientific fraud in the USA are being introduced; JAMA 268: 848.
A paper of possible interest in psychology is a study of 80 male confessed criminals in G.H. Dugjonsson & I . Bownes, "The reasons why suspects confess during custodial interrogation: data for Northern Ireland", Medicine, Science & Law 32: 204-12.
Copies of the Manual for Research Ethics Committees, prepared by Claire Foster of King's College Centre of Medical Law and Ethics in London are available for 20 including postage. From:: Centre of Medical Law and Ethics, King's College London, Strand, London WC2R 2LS, U.K.
The proceedings of a meeting in Cape Town, South Africa, have been published for those interested in issues in South Africa. Titled, Bioethics debates in a changing South Africa, ed. S.R. Benatar, ISBN 0-7992-1384-5, 157pp., see the Bioethics Centre address below. It includes papers on the topics of whether their is a right to health care, AIDS, general medical ethics and teaching medical ethics.
The Ministry of Welfare, Health and Cultural Affairs of the Netherlands has issued a report titled, Choices in Health Care, ISBN 90-346-2840-X, 160pp. It was made by a Government Committee on Choices in Health Care, and looks at the issues facing health care systems, particularly in the Netherlands. For copies contact Ministry of Welfare, Health and Cultural Affairs, P.O. Box 5406, 2280 HK Rijswijk, The Netherlands.
A journal intending to promote creativity is R&D Innovator, editor W.J. Brill, 4134 Cherokee Drive, Madison, WI 53711, USA.

A report from an Oslo conference on bioethics held in September is in HCR 22 (6), 5. It mentions inadequacies remaining in the discussion of academic subjects among academics, or their representatives, in formerly communist countries, and proposes that Western philosophers boycott next years' XIXth World Congress of Philosophy in Moscow.
The need for reestablishing trust between patient and physician is called for in papers in Humane Medicine 8(4), 268-9, 286-93. The right kind of spirit of caring is discussed in p. 294-9. A survey of problems that patients feel are appropriate to discuss with their physicians in the U.K. is in JRSM 85: 669-73. The reliability of patient answers to questions about their treatment is discussed in BMJ 305: 1109-10. A discussion of whether dentists or physicians should be called Dr. or Mr. is in JRSM 85: 658-9. The need for global and interprofession solidarity in delivery of health care is made in BMJ 305: 848. Nursing ethics is discussed in The Canadian Nurse (Nov 1992), 16-21. A study and survey of the moral reasoning used by nurses, and other health care professionals is in Nursing Research 41: 324-331. The teaching of medical ethics at Creighton University in the USA is designed to make ethics a habit of thought; JAMA 268: 2349-50. Medical education and student selection in the UK is criticised in BMJ 305: 1277-80, 1352-4.
A commentary by D. Macer, "The Far east of biological ethics", Nature 359: 770, looks at the similarities in attitudes of individual Japanese but at the differences in applying ethics in Japan compared to some other countries. In a letter to the Yomiuri Shinbun, the Vice President and former dean of the Medical School at the University of Tsukuba, wrote that the views in the commentary were not those of the university. In Tsukuba University there is a medical ethics committee which has been mentioned in past newsletters. They have just commenced a survey of 4,000 university staff on the acceptability of proposed University guidelines for diagnosis of brain death and organ donation. The results are expected early in 1993. The university is sensitive to the issue of organ transplantation following a legal case involving a pancreas and kidney transplant 7 years ago.
In Japan, a scandal has broken out following the arrest of several doctors including one at Tokyo University Medical School . They are accused of accepting bribes from a cardiac pacemaker company to use a particular pacemaker. Because an endorsement by Tokyo University is a signal to other Japanese hospitals that a product is good this is regarded as a particularly serious case and will lessen trust in Japanese doctors in general. It follows continual discussion of political bribe scandals, which has resulted in very low confidence in the government.
A paper looking at Asian and Western ethical concepts and possible models to conduct transcultural biomedical research ethically is N.A. Christakis, "Ethics are local: engaging cross-cultural variation in the ethics for clinical research", SSM 35: 1079-91. A review of Nigel M. de S. Cameron, The New medicine: Life and Death after Hippocrates (Wheaton, Ill., Crossway Books 1992) is in Bioethics Research Notes 4: 31-2. A special issue of Social Science and Medicine 35 (11) is looking at building research capacity for health social sciences in developing countries. Discussion of truth telling in Italy versus USA is in JAMA 268: 1661-2, 1734-5. Letters on informed consent in Africa are in NEJM 327: 1101-3; and in wartime see NEJM 327: 1096-8. The understandability of consent forms is discussed in BMJ 305: 1242, 1263-4, 1266-8, 1294.An essay on the practical basis of medical ethics is B. Hoffmaster, "Can ethnography save the life of medical ethics?", SSM 35: 1421-31. Confidentiality and research is important, CMAJ 147: 1299. On confidentiality for lawyers; The Modern Law Review 55: 822-38.
A code of ethics for Occupational Health Professionals by an International Commission is in BME (Oct 1992), 7-11. In the UK protection is being given for "whistle-blowers", who make important issues known to the authorities about incidents they see in the health service; BMJ 305: 977, 1308-9, 1343-4; Lancet 340: 1277-8. A review of research ethics in eastern Europe by Z. Szawarski is in BME (Oct 1992), 13-8. An English text of the Polish Code of Medical Ethics is in BME (Oct 1992), 19-25.
Several papers on the lessons from the infamous Tuskegee (Alabama, USA) Syphilis Study are in HCR 22 (6), 29-40. It is twenty years since that 1932-1972 ended. It was a study where people were deliberately not treated for syphilis, as an experiment. In 1974 the US implemented the National Research Act, which mandates institutional review board approval of all federally funded human research protocols. The use of a mock trial to make a difficult clinical decision is discused for children's marrow transplantation in BMJ 305: 1284-7.
The ethical issue of physician referral to facilities they own is considered in several research papers in JAMA 268: 2055-9; NEJM 327: 1497-501, 1502-6. On self-referral see also JAMA 268: 2561-2; NEJM 327: 1522-4. However, in Japan , the system of medical funding for drug use, and the physician-dispensing of drugs, illustrate how self-referral and prescribing to make profit are common - and will be so until the system is fundamentally changed so that physicians do not make profit off selling medicines. Letters on the subject of gate-keeping, the possible role of a physician in referrals to specialists or keeping medical expenditures down, are in NEJM 327: 1532-3, 1241-2.
The role of medical journals in knowledge accumulation is the subject of a book review in Science 258: 1382-3. On conflicts of interest in peer review see Nature 360: 205; and on acceptance of papers see NEJM 327: 1238. The media can be used in different ways for ethical and legal issues; CMAJ 147: 1321-4.
The drug tamoxifen is being used in large trials as a study to attempt to lower breast cancer rates in women; Lancet 340: 1143-7. There must be concerns about the safety of these trials, in an estimate by R. Nicholson, BME (Oct 1992), 6, he calculates there are 1.6 major side effects (Death, blindness...) per 10,000 woman years of use, while the trial is hoped to prevent 6.6 breast cancers by each 10,000 woman years of use. On surgical approaches used in Japanese cancer therapy, and a call for trials for rectal cancer therapy see Lancet 340: 1101. Robodoc performed the first robotic artificial hip operation in November, in Sacramento, California; NS (28 Nov 1992), 17. The robot was supervised by a human surgeon, and drilled the cavity in the patient's femur for the new hip joint with precision. On the need to try new methods of surgery to assess their safety NS (7 Nov 1992), 12-3.
A bibliography of recent papers and publications on issues in law and mental health is in a 12 page supplement (July 1992) to the International Bulletin of Law & Mental Health 3(2). A paper on how to obtain legal and ethical consent from children in research is in Australian J. Social Issues 27: 194-208.
For a review of a new book on why there are more males in science than women see Science 258: 829-30. Gender disparities in alcohol treatment are described in JAMA 268: 1872-6. On sexual harassment see BMJ 305: 944-6; Obs. & Gyn. 80: 873-83. Various papers on minorities (in US terms!) in science are in Science 258 (13 Nov 1992), 1175-1237, 1087. On the role of scientists in American culture see Science 258: 333-4. Book reviews on professions and medicine are in Amer. J. Sociology 98: 670-8; Science 258: 334-5. A discussion of the portrayal of the physician in religious writings is in JRSM 85: 659-62. An interview with Sir Karl R. Popper is in SA (Nov 1992), 20-1.
The Proceedings of the 3rd International Symposium for Bioethics organized by the Institute of Medical Humanities, Kitasato University School of Medicine, (contact: Prof. Koichi Bai, Institute of Medical Humanities, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228) has been published including papers both in Japanese and English. It also includes papers from the 1st and 2nd Symposium, in either English or Japanese depending on the speakers. 374pp., 8,240, B4 size. It includes papers by well known North American bioethicists, A.M. Capron, H.T. Englehardt, J.C. Fletcher, E.W. Keyserlingk, E.D. Pelligrino, S. Spicker and L. Walters. The main audience is Japanese, because there are only two papers by Japanese contributors in English.
Another recent Japanese publication is the Journal of Japan Association for Bioethics (Contact Prof. Kazumasa Hoshino, Director, International Bioethics Research Center, Kyoto Women's University, Higashiyamachi, Kyoto 605, JAPAN)). The 1992 volume, 92pp., 2500, is in Japanese, with English summaries. A variety of papers are included.
A monthly journal trying to promote creativity is R&D Innovator, editor W.J. Brill, 4134 Cherokee Drive, Madison, WI 53711, USA.

The names and subjects of recipients of the European biomedical ethics research grants are in BME (Dec 1992), 3-4. An editorial in the Communique 3 (Nov/Dec 92), 1-2 of the Canadian National Council on Bioethics in Human Research calls for public participation in research ethics review. The issue includes other information on research ethics and procedures in Canada.
A bibliography of publications on bioethics in French compiled by Gwen Terrenoire has been published. It also contains lists of bioethics centres, and sources of information about bioethics, especially in France and also in other countries. For details contact Gwen Terrenoire, Centre de Sociologie de l'Ethique (EHESS et CNRS), 54 Bd Raspail 75270 Paris Cedex 06, FRANCE. The French Medical Ethics law has been passed onto the Senate for voting; NS (5 Dec 1992), 8. The possible creation of a European bioethics organisation is discussed in Lancet 341: 169.
An English translation of the Finnish Act on Patient Rights is in BME (Dec 1992), 8-11. Book reviews on the subject of patient rights are in JAMA 268 (1992), 3493-5; also on rights see Health & Social Work 17 (1992), 247-52. Letters on patient compliance are in BMJ 305 (1992), 1434. Criticism of the readibility of consent forms, following a US study, is in D. E. Hammerschmidt, "Institutional Review Board (IRB) review lacks impact on the readibility of consent forms for research", Amer. J. Med. Sciences 304 (1992), 348-51. Questions about children's ability to consent is in JME 18 (1992), 119-24. Other papers on informed consent include: MJA 157 (1992), 335-6, 336-8, 642; Nature 361: 102; JME 18 (1992), 135-7, 153-7; BMJ 306: 298-300.
A paper asking whether psychiatric patients know what is best for them is JRSM 86: 28-30. There is a scandal involving possible overdoses of drugs at mental hospitals in the UK which are linked to 6 deaths; BMJ 306: 402-3. On the mothering skills of people with mental disease see BMJ 306: 348-9. In the UK mentally ill people are encouraged to enter the community, and a call for noncompulsory treatment, but compulsory supervision is in BMJ 305 (1992), 1381-2, 1448-9, 306: 159-60. In New Zealand compulsory assessment of people with mental disorders who might be a risk to others is now law; NZ Med. Association Newsletter (8 Dec 1992), 9. Compulsory treatment for drug-dependent persons is argued for in L.O. Gostin, "Compulsory treatment for drug-dependent persons: justifications for a public health approach to drug dependency", Milbank Quarterly 69 (1992), 561-93. Book reviews on psychiatry are in NEJM 327 (1992), 1763-6.
Counseling is discussed together with the results of a survey of U.K. counselors in BMJ 306: 2-3, 29-33, 390-1. An Australian study of verbal interactions in general practice is in MJA 157 (1992), 677-82. The question, "How much ethics is needed to make a good doctor?", is asked in Lancet 341: 161-3. Papers on the use of gender in health research, and on gender differences in health are in a special issue of SSM 36 (1) 1-84; 36(4), iii-v, 393-402, 419-27. Sexuality in the doctor-patient relationship is discussed in BMJ 305 (1992), 1375-6; JAMA 268 (1992), 3142, 46; and on expert psychiatric evidence in sexual misconduct cases see AJLM XVIII (1992), 171-201..
A report from the workings of the Danish National Research Ethics Committee is in BME (Dec 1992), 13-6; and an English translation of the Danish law on research ethics is in p. 24-7. Another report on the Danish Council of Ethics is in IJB 3 (1992), 258-61. The rules of the Norwegian National Committee for Medical Research Ethics are in BME (Dec 1992), 28. The UK MRC advice on research ethics is in BME (Dec 1992), 18-23. A statement from the Luxembourg National Ethics Committees on ethics and science and biotechnology in French is in IJB 3 (1992), 262-5. Comments on Australian ethics committees are in MJA 157 (1992), 636-7. The SCOPE note 19 on ethics committees in hospitals is in Kennedy Institute of Ethics Journal 2 (1992), 285-306. The president-elect of World Medical Association had to stand down, following allegations of Nazi war crimes; Lancet 341: 297.
A US study suggests that the best person to make chairperson of a hosptial ethics committee is a lower-ranked non-physician colleague with extensive bioethics training; HCR 23(1), 2. Unfortunately in Japan, and perhaps in many other countries, most ethics committees are chaired by the head of the medical school. In the USA physicians hold a majority in only one quarter of all committees, and these committees are less successful than those with less physicians.
The NIH trials of growth hormone treatment of children have restarted, following a review; Lancet 341: 299. The clinical trials of tamoxifen in healthy women are questioned in NEJM 327 (1992), 1596-7; Lancet 341: 343-4. Book reviews on clinical trials are in JAMA 269: 289-91.
In Japan , the family of a woman whose breast cancer was misdiagnosed has been awarded 39 million Yen in compensation by a court; Yomuiri Shinbun (19 Feb 1993), 31. An Indian debate over medical compensation is in Lancet 340 (1992), 1400. In Australia, the long held Bolam principle, that a doctor who followed general practice would not be guilty of misconduct, has been overturned; Lancet 340: 1399. A paper reporting survey results from New York state is A.G. Lawthers et al., "Physician's perceptions of the risk of being sued", J. Health Politics, Policy & Law 17 (1992), 463-82; see also p. 143-61. An editorial on no-fault compensation is in JME 18 (1992): 59-60. In a rare UK case, the Privy Council has altered a penalty on a doctor imposed by the General Medical Council; Lancet 341: 45. A survey finding high use of unconventional medicine in the USA is in NEJM 328: 246-52, 282-3.
A review of Howard Brody, The Healer's Power, is in NEJM 328: 67. The position of medical associations towards capital punishment and treatment of patients on death row is in Lancet 341: 209-10. A paper on the ethics of "ignorance" is in JME 18 (1992), 117-8, 34. A history of Jewish attitudes to nursing is in N.Y. State J. Medicine 92 (1992), 529-36. A series of papers on theology and bioethics are in a special issue of J. Medicine & Philosophy 17(3), (1992), 263-364.
A paper encouraging cooperation in medical ethics in Central Europe is in IJB 3 (1992), 229-35. The use of electronic roundtables for medical ethics is discussed in Kennedy Institute of Ethics Journal 2 (1992), 233-52; also on computers, MJA 157 (1992), 693-5. It may be also be more environmentally friendly and cheaper than international conferences. Methods to expand the number of people involved in bioethics education , in various settings, is assessed in HCR 23(1), 25-9. Survey results investigating the development of moral reasoning during medical school training are in JME 18 (1992), 142-7, 148-52. Papers on education are in BMJ 305 (1992), 1409-11, 1449-50, 1482-5, 306: 284-5; JAMA 268 (1992), 3106. A critical comment on "Greed and the medical profession" is in BMJ 306: 151, while an international comparison of physician's salaries is in Int. J. Health Services 22 (1992), 217-20.
The re-election of Dr Hiroshi Nakajima as director general of WHO was very controversial; BMJ 306: 161, 289-90; NS (30 Jan 1993), 6; Lancet 340 (1992), 1399; 341: 277-8. It included claims that Japan had put economic pressure on third world countries to back his re-election, against the choice that Western nations had.
In one of the major scientific misconduct cases of recent times, a Dept. of Health and Human Sciences Report has concluded that Robert Gallo is guilty of misconduct for misrepresenting in a 1984 Science paper the work he had done with a French isolate of the AIDS virus; Science 259: 168-70; BMJ 306: 161-2; NS (9 Jan 1993), 7. They accuse Gallo of trying to mislead science, and at last the Pasteur Institute should find more voices in the USA ready to withdraw the US claim to half share in the patent on AIDS tests. On scientific fraud in general, NEJM 327 (1992), 1820-22; Science 258 (1992), 1503-4.

The US Congress OTA may soon release a report on Biomedical Ethics in U.S. Public Policy. The US Senate has voted for the establishment of an Ethics Advisory Board (on 18 Feb 1993). It would be appointed in the case that the president withheld funding , and its decision would be binding. A more permanent board may also be established; HCR 23(2), 5.
A review of the 10 years of activity of the French national bioethics committee is in BME (March 1993), 13-5. An outside review of the problems of paternalism and the role of the Church in Polish medical ethics is in BME (Feb 1993), 20-2. The role of medical ethics consultants in the USA is reviewed in HCR 23(2), 33-40. The proposed date for signing of the European Bioethics Convention of 1994, is said to be optimisitic in Lancet 341: 486.
A UK study of what factors affect the quality of informed consent is in BMJ 306: 885-90, 927-9. An editorial discussing the refusal by Jehovah's witnesses of transfusions is in Amer. J. Med. 94: 117-9. On the quality of consent from mentally incapable see BMJ 306: 519, 606, 768-71; Lancet 341: 668. Papers on informed consent include: Bioethics News 12(2), 27-32.
Truth-telling is discussed in In Keeping with the Trends (Feb 1993), 1-2. Truth telling in Japan is discussed in Lancet 341: 467-8; and in general in JAMA 269: 988-9. Doctor-patient communication is discussed in JAMA 269: 776-80, 1012-7, 1164-5, 1253-4, 1282-4, 1667-8, 1788-90. Confidentiality is a major concern of adolescents, as found in a US survey, and their concerns should be protected; JAMA 269: 1404-7, 1420-4; NEJM 328: 1128-9; BMJ 306: 896b.
An editorial in Nature 361: 479, is titled "Soldiers as experimental animals". It discuses some of the unethical US chemical weapon experiments. Papers on the ethics of clinical research trials include Lancet 341: 563-5, 790, 812-3. The ethics of research using children are reviewed in B. Freedman et al., "In loco parentis, Minimal risk as an ethical threshold for research upon children", HCR 23(2), 13-9. There are shorter reviews of the situation for children in research in the UK (p. 20-1), Hungary (p. 21).
A historical review is E.D. Pellegrino, "The metamorphosis of medical ethics. A 30 year retrospective", JAMA 269: 1158-62. A series of papers on the use of principles in bioethics in making decisions is in J. Med. & Phil. 17: 483-555; JME 18 (1992), 171-2. The issue of universal bioethics from an East German perspective is discussed in BME (Feb 1993), 28-30. Also on general bioethics see Bioethics News 12(2), 17-26; JME 18: 206-9.
An examination of constitutional rights is in Oxford J. Legal Studies 13: 51-78. The US Justice Department has ruled that doctors do not have to attend executions; JAMA 269: 721-3; BMJ 306: 813.
Papers on the aim of doctors and medical standards are R.J. Blendon et al., "Physician's perspectives on caring for patients in the United States, Canada, and West Germany", NEJM 328: 1011-6; JRSM 86: 125-6; Lancet 341: 498-9; JAMA 269: 1681-2, 1655-60, a list of German's top 500 doctors, Lancet 341: 623. On medical education see BMJ 306: 648; NEJM 328: 934-9; Lancet 341: 743-4; U.S. News & World Report (22 March 1993), 70-9. Sexual misconduct is discussed in BMJ 306: 113-4, 415, 881; CMAJ 148: 67-9. India is trying to stop the sale of places in medical schools to students; BMJ 306: 604-5. In Japan , such a practice, and the payment of large entrance fees for medical students, is common in many private universities.
On the history of diseases and how the ideas have changed see a review of The Cambridge World History of Human Disease, ed. K.F. Kiple (Cambridge Univ. Press 1993, 1,176pp., 75) in Nature 362: 675; and see also NEJM 328: 819-20. In Japan there have been reductions in the number of fatalities due to stroke (50%) and stomach cancer (30%) comparing the 10 year period 1977-81, and 1987-91. The stroke fatality annual rate average from 1987-91 was 99 per 10,000 and stomach cancer fatality rate was 50 per 10,000.
A report on Catholic hospitals in Canada is in CMAJ 148: 64-6. The role of religious beliefs in helping family members forgive is discussed in J. Contemporary Human Services (1993), 163-70. Book reviews on medical ethics are in Lancet 341: 478-9, 618-9; NEJM 328: 360-1, 363-4; Ethics 103: 616-20. Other general papers include BMJ 306: 527, 597-8; JAMA 269: 1485-6; Lancet 341: 746-7. A constructive theory of human behaviour is outlined in papers in Annals of the New York Academy of Sciences 661 (1992), 256-353.
The verdict of the UK body for governing doctors, the General Medical Council, has been found subject to law courts; Lancet 341: 685. Normally it is left to deal with medical misconduct. On the situation in Egypt see Lancet 341: 549-50. Papers on medical law include Oxford J. Legal Studies 13: 1-17; JAMA 269: 801, 923-4.
In court cases in Japan , a doctor was sentenced to two years jail for accepting bribes from a maker of pacemakers, and fined 21 million Yen. There are several cases involving bribed doctors and pacemakers still in court. In Japan a woman patient died as the result of being given type B blood instead of type O; Yomiuri Newspaper (28 Feb 1993), 27. This is not such a rare case, last year a famous politician suffered the same fate.
Dr William McBride, who reported the link between thalidomide and birth deformities, has been found guilty of scientific fraud for publishing misleading or false reports, BMJ 306: 541; NS (27 Feb 1993), 6; Lancet 341: 550. On the issue of fraud in research; Lancet 341: 678; JAMA 269: 895-7, 915-7; Science 259: 592-3, 1117. Gallo has appealed the misconduct verdict for his role in HIV discovery (EEIN 3: 26); JAMA 269: 723.

A special issue of the journal Bioethics 7 (2/3): 97-285 (April ) includes 19 papers from the International Association of Bioethics inaugural congress held in late 1992. It includes papers on many topics, and includes several papers discussing bioethics in developing countries. Rather than listing all the papers in each section all readers should see for themselves!
A general report by J. Miller of the First Round Table of Ethics Committees, held in Madrid, Spain, 24-25 March, is in IJB 4: 26-9. The moral responsibilities of research ethics committees are drawn in Dispatches 3(3), 10-12. A 13 page supplement on ethics committees is in Bioethics News 12 (3). A new national bioethics committee will be formed in New Zealand, called the National Advisory Committee on Health and Disability Ethics; Otago University Bioethics Research Centre Newsletter 2(2), 15. It will consider both research and clinical ethics, and New Zealand joins the countries that have a national bioethics committee. Currently there is a transition body.
A Jehovah's Witness refused a blood transfusion at Tokyo Women's University Hospital for an operation to remove a liver tumour, and the hospital agreed. However, during the operation they used a blood transfusion, and a court case is being brought by her for the anguish; Yomiuri Shinbun (15 June 1993), 31. This is the first case in Japan for a court case. A new Japanese report on the Biomedical Ethics Project at Hokkaido University (171pp., April 1993, in Japanese) has been released. For details contact Prof. Kunihiko Shoji Hokkaido University, Faculty of Law, Kita-ku, kita 9, Nishi 6, Sapporo 060, JAPAN. Informed consent appears to be rising in Japan, with more doctors informing patients if they have a terminal disease; Lancet 341: 1141; SSM 36: 1151-9.
A paper on the role of family in medical decision-making, with a US viewpoint is HCR 23(3), 6-13. There is a need for families to be involved, but how to balance this against autonomy. Also on autonomy and informing patients see papers in Bioethics News 12 (3): 31-6, 46-8; Pediatrics 91: 832-4; NEJM 328: 1348-9. The issues of sick chaildren and ethical decision-making are discussed in Humane Medicine 9: 131-40. On "rights" see Phil. & Phenomenological Research LIII: 181-94; Thomist 57(1): 97-121.
The publication of a list of doctors, surgeons, and their success rates for surgery, and death rate, and costs, in the USA is to be encouraged if it provides open information to consumers; Lancet 341: 1183-4. It was featured recently on Japanese television, being in contrast to the information given now. It also allows surgeons to improve themselves. A paper on how people can cope with uncertainty of today's medicine is in Humane Medicine 9: 109-20.
Papers on ethical dilemmas of treating incompetent elderly patients are in HCR 23(3), 14-7, 18-9, 19-27; and from the UK Law Commission,BME (May 1993), 33-6. In the UK a new law on consent and mental incapacity has been proposed; Lancet 341: 1123-4, 1143-4; BMJ 306: 1226. The question can children withhold consent is answered "yes" in BMJ 306: 1459-61. General papers on medicine include a special edition of SA. On ethical issues for medical students; Academic Medicine 68: 249-54; and on teaching communication skills, BMJ 306: 1322-7.
The right to refuse psychotic drugs is debated in The Canadian Nurse (May 1993), 27-9. A paper on ethics and psychiatry in Romania is in BME (May 1993), 13-6. On a extreme case of psychiatric abuse resulting to suicide see BMJ 306: 1500-1.
A comparison of Polish and Danish doctor's attitudes to capital punishment is in BME (May 1993), 17-24. More Polish doctors approved than Danes. In Japan an opinion survey shows general support for keeping the death penalty; Yomiuri Shinbun (1 June 1993), 2. On human rights abuses in Egypt; Lancet 341: 1085; Syria, BMJ 306: 1089. War and health damage in Bosnia is discussed in Lancet 341: 1193-6.
Letters on the use of Hippocrates in medical ethics are in Humane Medicine 9: 159-62; World Health Forum 14: 105+. A Japanese translation of Jean Bernard, De La Biologie a Ethique, has been released in book shops in Japan, translated by N. Fujiki. The problem of self-referral is discussed in BMJ 306: 1083-4; NEJM 328: 1274-8; Nature 363: 663.
The French bioethics law is undergoing a major rewriting, NS (22 May 1993), 9. A summary of English law regarding the refusal of medical treatment by pregnant women by A. Grubb is in Dispatches 3(3), 1-4. Also on law and ethics see The Canadian Nurse (May 1993), 39-40; BMJ 306: 1348.
The new New Zealand Privacy Act and changes to Health information are reviewed in Otago University Bioethics Research Centre Newsletter 2(2), 8-11.
A description of the Institute for International Sport is in Insights on Global Ethics (June 1993), 6, 8. They encourage sporting ethics, and suggest that this may be one way to introduce good ethics into community and international relationships. On the topic of Olympic spirit and medical health see Humane Medicine 9: 141-5.
Scientific misconduct is discussed in Science 260: 1714-5; NS (8 May 1993), 42-3; Lancet 341: 1204-5; Science 260: 1073-4; JAMA 269: 2782-4; NEJM 328: 1610-5; 1634-6.

Bioethics Centres - Lists In past issues of the newsletter addresses of some have already been given. The Kennedy Institute of Ethics is soon to publish an updated list of world bioethics centres.
UNESCO has published a World Directory of academic research groups in science ethics, as No. 73 in the series Science Policy studies and documents. For more information contact J.C. Mba-Nze, prgramme Specialist, Information and Data Base Unit, SC/IDB, UNESCO, 7 place de Fontenoy, 75700 Paris, France. It was published in May 1993, and contains 249 research groups. More could be added to the list, but it is a very useful list, with 56 of the groups being in the USA, and others throughout the world. This makes it especially useful as an international document.

Several additional documents have been issued as supplements to the Research Ethics Committee materials produced from Mrs Claire Foster, Centre for Medical Law and Ethics, King's College, London, U.K. They include new MRC ethics booklets and various new papers to update the existing files. The working report from the Central Ethical Commission of the Czech Republic is in IJB 4: 156-8.
The Australian court decision that overturned the Bolam principle is discussed in BME (June 1993), 4. The court ruled that it was not up to the doctor or medical profession to determine how much information was appropriate, if the patient required more.
In New Zealand several discussion papers have been produced on health values, including Ethical Issues in Defining Core Services, and The Best of Health. They call for discussion of the issues. The background discussion papers were prepared by A.V. Campbell & G. Gillett, and D. Seedhouse. Contact the National Advisory Committee on Core Health and Disability Support Services, Ministry of health, P.O. Box 5013, Wellington, New Zealand. Discussion will continue for about 12 months to establish a new framework. Please note that the NZ health care delivery system and organization underwent a major change in July this year, and political changes could affect future policy; there is an election in November 1993. The function of the committee is to advise the Minister of Health what services people should expect to receive under health care, considering ethical aspects. On human rights, see JAMA 270: 640-4.
In the 1992 Bill of Rights in New Zealand is a very strong clause, that all people have the right to refuse medical treatment. Also patients can see all medical records about themselves. The Euthanasia Society has distributed advance directives which should be legally valid, considering the Bill of Rights, despite the contrary opinion of the minister of justice. Refusal of treatment is also established in case law in Canada and the UK. Further legal clarification is desired by doctors, especially in cases where the families may have a different view to that expressed in the directive by the patient.
A new book is Ruth MacKlin, Enemies of Patients (Oxford Univ. Press 1993, US$25). She looks at how third parties are interfering with the doctor-patient relationship. The additional parties in Ontario are discussed in SSM 37: 129-38. Another intruder may be excessive technology, on technological follies see JAMA 269: 3030-2, 270: 765.
On patient decision making see JAMA 270: 72-6, 160-2, 708-10; on patient views of outpatient clinic visits,pp. 835-40. Since 8 Sept. 1992 the International Covenant on Civil and Political Rights has been in force in the USA. It is now in force in over 110 countries, a legal discussion is in Human Rights Law J. 14: 77-83, 123-31. Health and human rights are discussed in JAMA 270: 553, 554-60, 565. A summary of an April meeting, "Beyond autonomy" is in Hospital Ethics (Jul/Aug 1993), 6-8. Also on beyond autonomy, in a specific case, NEJM 329: 354-7.
Informed consent is legally recognised in Australia, MJA 159: 25-7. The UK situation (observed) for patient participation in decision-making in general surgery is surveyed in Sociol. Health & Illness 15: 315-36. Patient satisfaction with communication in surgery is surveyed in SSM 37: 591-602. General ethics and clinical practice guidelines are discussed in CMAJ 148: 1133-7, 1459-62. A Canadian case of a refusal of blood transfusion for a child in a Jehovah's witness family is in Human Rights Law J. 14: 112-23. A call for replacement of the term non-compliant patient with non-compliant doctor is made in JME 19: 108-10.
C. Goodey, "Social history, the disabled and consent", BME (June 1993), 13-8; A. Etherington, "Consent and self-advocacy", BME (June 1993), 19; M. Oliver, "What kind of society are we expected to consent to?", BME (June 1993), 20-4. In the USA only New York and Missouri have specific laws to say that family members cannot make decisions for patients without capacity, Hospital Ethics (May 1993), 14-6. On mental incapacity see Lancet 342: 52-3; children's consent, BMJ 307: 260-1; consent to make consultation videos, BMJ 307: 348.
Papers on biomedical ethics in Europe and the bioethics convention are in JME 19: 3-4, 5-6, 7-12, 13-16. Reforms to the Japanese health care system are discussed in BMJ 307: 343; and a critique is K. Imamura, "A critical look at health research in Japan", Lancet 342: 279-82; see also p. 309. On health financing for the elderly in Japan, SSM 37: 343-53. A recent meeting on Jewish medical ethics was held in Israel , BMJ 307: 404.
Other comments on medical ethics include NS (26 June 1993), 41; JAMA 270: 153-4, 202-3, 520-6, 577-8. Medical practice and guidelines are discussed in BMJ 307: 218, 313-7. A new code of medical ethics in Italy, is in IDHL 44: 353-4; and an "International Code of Ethics for Occupational Health Professionals", is in IDHL 44: 354-9. Clinical trials are discussed in BMJ 306: 1706-7; MJA 158: 656-7; JAMA 270: 459-64; and on the need to include women in trials, NEJM 329: 288-96.
A review of the SCOPE notes and bioethics information resources is in Humane Medicine 9: 220-2. A journal including some English papers but mainly Japanese is the Journal of Health Care, medicine and Community, No. 3, published in June 1993. If interested contact Prof. Shinryo N. Shinagawa, Institute on Public Issues Relating to Health Care and medicine, Fujimo-cho 32-3, Hirosaki 036, JAPAN. The teaching of ethics at the University of Sydney is reported in MJA 159: 33-6. The need for scientists and surgeons to have ethics training is put in NS (26 June 1993), 45-6.
A discussion of saving lives for rescuers is E. Rakowski, "Taking and saving lives", Columbia Law Review 93: 1063-1156. Sexual harrassment is discussed in CMAJ 148: 1797-8; Science 261: 408-12; and a study of sexual abuse by physicians in Manitoba, Canada, is in CMAJ 148: 815-6. Some women's health issues are in NEJM 329: 271-2, 478-82. On the link between literacy and health, CMAJ 148: 1201-3. Medicine in prison is discussed in Lancet 341: 1656-7; BMJ 307: 258; JAMA 270: 365-8, 606-11.
Some legal issues of computer mistakes in health systems are raised in CMAJ 148: 2034-5. A call for computer network ethics is in Science 261: 632, and a conference will be held in December in California. Malpractice insurance is discussed in New York, BMJ 307: 283; and Ireland, Lancet 342: 295. A remedy for malpractice suits of talking and listening to patients is suggested in West J. Med. 158: 268-72. General news in medical law is in JAMA 270: 225-6.

Scientific Ethics This is a new section, in the past papers were added to the end of the General Medical Ethics section, but the topic is getting discussed much more these days, so a separate section is justified. One wonders whether greater discussion is because of more fraud happening or more notice is being made of it. Probably both. One Day Science and Ethics Workshops were held in New Zealand in four cities in August, in which I participated. The response to these workshops was enthusiastic and active, and a full paper will be published in a forthcoming book by the Eubios Ethics Institute early in 1994.
The US Supreme Court has clarified some rules on the use of scientific evidence , making judges responsible to ensure the evidence is reliable, not just a suitable topic; Nature 364: 94; Science 261: 22; JAMA 270: 423. In the UK also, the Royal Commission on Criminal Justice is also changing the way scientific evidence is used; Nature 364: 178. In several recent cases judges have ordered the sharing of confidential data, which is upsetting some scientists and may, more importantly, conflict with confidentiality ethics; Science 261: 284-6.
The Australian doctor, S.E. McBride , who exposed the dangers of thalidomide, has been struck off the NSW medical registrar in response to the fraud tribunals report, Time (16 Aug 1993), 45; BMJ 307: 404; Lancet 342: 361-2. He added imaginary results to his study of a morning sickness drug, Debendox, which resulted in it being drawn off the market. It was probably safer than many of the alternatives available. Scientific fraud is discussed in JAMA 269: 3105-6, 3160; Newsweek (26 July 1993), 52; Science 260: 1714-5, 261: 148-9, 183, 631; BMJ 307: 271; FASEB J 7: 723-4; Lancet 342: 235.
Financial conflicts of interest are discussed in NEJM 329: 570-1, 573-6; Science 261: 11, 289. Issues in medical authorship and values are discussed in SSM 37: 521-30; and accountability in JAMA 270: 495-6. Asking the question whether a study is worth doing is something that scientists should all do; Lancet 342: 221-3; and bad science in Nature 364: 497. Two opposing views of the NIH funding mechanisms are in Science 261: 16-7, 112-3; and also on peer review reform, Nature 364: 183-4; Lancet 342: 315-6. Bias is discussed in Lancet 342: 286-8; and competition in Nature 364: 665. Speaking out may also be considered unethical in some quarters, Science 260: 1861, but openness is generally to be commended.

A proposal for international action on human rights is M.A. Grodin et al., "Medicine and human rights. A proposal for International Action", HCR 23(4), 8-12. They call for universal medical ethics and an international medical tribunal to consider issues and problems. On cultural issues and medical practice see HCR 23(4), 15-7. A general paper on Japanese society and bioethics is D. Macer, "What can bioethics offer to Japanese Culture?", Nichibunken Newsletter (Aug 1993), 3-6 (I can send copies if requested). Also on ethics in Japan see a paper in Global Ethics 3 (10), 1, 4-5, looking at the views of Rev. Shojun Bando. A conference report on the International Association of Law, Ethics and Science Colloquy on Bioethics and Cultures in Budapest, Dec 1992, is in IDHL 44: 517-20. A book review of Regional Developments in Bioethics: 1989-1991 is in IDHL 44: 556-8. Cultural issues in the mixed US population are reviewed in Amer. J. Medical Sciences 306: 160-6.
The legal trends in i nformed consent cases and standards in the USA are reviewed by A.M. Capron in HCR 23(4), 13-4. A paper on maintaining integrity in the doctor-patient relationship is in Bioethics 7(4): 289-314. On children's consent see Bioethics News 12(4), 24-32. Parent participation in case conferences is debated in Archives of Diseases in Childhood 69: 455-8. Family-doctor relationships are discussed in JAMA 270: 1426-7, 1606-7.
Letters on how patient's should be encouraged to voice their concerns, and on how to provide an opportunity for this, are JAMA 270: 1195-6. A methodological paper on patient satisfaction with communication in general surgery is in SSM 37: 591-602.
The French national bioethics advisory committee has recommended changes in the laws on medical confidentiality, data protection, and free and informed consent to enable psychological research to be conducted without making the subjects biased in responses; Nature 365: 597. They recommended the establishment of "Consultative Committees for the Protection of Persons in Behavioural Research", which will judge what information can be withheld from the subjects until after the research. The also suggest the disclosure of some data to the researchers can be justified, also that the results be released to the subjects after the research. A paper on the use of secret videos during consultation to diagnose Munchausen syndrome is in BMJ 307: 611-3.
A national commission on biomedical ethics is called for in a recent OTA report in the USA, Biomedical Ethics in U.S. Public Policy (OTA-BP-BBS-105, June 1993, 92pp), in addition to several papers and numerous unofficial discussions. The report by the Office of Technology Assessment reviews efforts in the past in the USA with lessons that they give that may aid the establishment of a new forum, and also briefly reviews the situation world-wide, which is also interesting. It is to be recommended given the number of ethical issues, and the problems of applying rigid law to grey problems. Comments are in HCR 23(4), 5; Nature 365: 687.
The American Association of Bioethics was voted into existence on the 25 March 1993. The inaugural meeting will take place in 1994. The members of the board and aims are reported in HCR 23(4), 2. Another new society is the Latinoamerican Federation of Bioethics, contact the president, Alfonso Llano-Escobar, Carrera 10, No. 65-48, Santafe de Bogota, Columbia (Fax 571-3105163).
On the general value of being alive see G. Meilaender, "Terra es animata. On having a life", HCR 23(4), 25-32. Truth-telling is discussed in NEJM 329: 815. Non-compliance and prejudice is discussed in Lancet 342: 909-13. A review of two recent bioethics journals is in JAMA 270: 1255. Papers on ethics n general practice include O&G 82: 603-4; NEJM 329: 1048.
A review of recent FDA guidelines on women in clinical trials is in JAMA 270: 1290, 1521. Also on clinical trials, Lancet 342: 653-7, 877-8. Sexism is discussed in Lancet 342: 627-8; NEJM 329: 661-3; BMJ 307: 500. A review is S.H. Johnson, "Judicial review of disciplinary action for sexual misconduct in the Practice of Medicine", JAMA 270: 1596-600. The ethical issues in castration of sexual offenders who wish it as an alternative to prison are debated in BMJ 307: 790-3.
A woman whose fetus was removed though she only consented to a hysterectomy is suing the surgeon, BMJ 307: 754-5. An error in radiotherapy in the UK in 1982 has been disclosed which may have caused 492 patients to suffer ill effects, BMJ 307: 888. So far, 401 of them have died. The error resulted in underdoses being given to these patients. Another UK legal case, of laparoscopy is discussed in Lancet 342: 674.
In Switzerland a doctor has been found guilty of homicide by negligence, Lancet 342: 610. The doctor perforated the patient's lung during an operation.
A review of G.J. Annas, The Law of American Bioethics (Oxford University Press 1993, 291pp., US$25) is in Lancet 342: 853. It asks why the law has been so important in guiding the debate in the USA on many issues. A paper on the state dominance in medical decisions in Ontario is SSM 37: 841-50. A recent statute on ethical responsibility in Ontario is in IDHL 44: 453-7.
A review of P.M. McNeill, The Ethics and Politics of Human Experimentation (Cambridge University Press 1993, 315pp., US$60) is in Lancet 342: 794-5. The UK MRC guidance on human experimentation from Nov. 1992 is in IDHL 44: 516-7. A charter on patient rights and duties of San Marino is in IDHL 44: 457-8.

Scientific Ethics A related topic to my July editorial on ethical bioethicists is a comment the editor of the Bulletin of Medical Ethics, Dr R. Nicholson, made about the morality of Israel and the World Congress of Medical Law to be held next Sept. there. Following his criticism of Israel's human rights record, many Zionist letters were received, BME (Sept 1993), 2. Let us hope the Palestinian-Israel recognition brings peace to the region and more general recognition of human rights by all involved. The issue of hypocrisy is difficult to address, and many countries and organizations who have problems in "practical ethics" hold ethics conferences.
Book reviews on the issue of scientific fraud are in American Scientist 81: 380-2; BMJ 307: 572, see also JAMA 270: 1286; Science 261: 1661. The US case of alleged fraud in the AIDS vaccine trial by the US Army has resulted in a "innocent" decision by the committee, Science 261: 824-5. The activities of the American Association for the Advancement of Science in social issues are in Science 261: 1190-1. Fraud in medical cost claims is also quite common, Lancet 342: 670; NEJM 329: 892-4. On whistle-blowing see BMJ 307: 667-70.
A few US universities have set up misconduct investigation procedures which seem to work, and they encourage others to join them, Science 261: 1108-1111. A review of the Dingell hearings on misconduct by B. Healy is in NEJM 329: 725-8, see also p.732-4. Authorship is discussed in J.Z. Segal, "Strategies of influence in medical authorship", SSM 37: 521-30. The responsibilities of reviewers are mentioned in O&G 82: 464. Intellectual property is discussed in Nature 365: 384.

Conferences (updated from last list): For those with Email contact: Russell L. McIntyre, Th.D., UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway, NJ 08854, USA. Tel. (908) 235-4549. Fax: (908) 235-4549; EMail rmcintyr@umdnj.edu; issues a conference list which is updated every 2 weeks.

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