View Full PDF

Contents

• Letter from the Editor Bo Peng
• Interview: Dr. Renée C. Fox (University of Pennsylvania)

Articles

• The Effects of Society on the Development and Categorization of Mental Illness by Melinda Yang, Swarthmore College Read Abstract

  Mental illnesses affect a significant portion of the population, from children with attention deficit hyperactivity disorder to adults suffering from depression. There are mental illnesses with definite biochemical origins, but they will not be discussed in the following paper. The process of labeling a mental state an illness is unclear, however, which leads to problems in diagnosis and treatment. The standard used for comparison is a vague concept of normality, which often depends on the values of society. The Diagnostic and Statistical Manual of Mental Disorders is the accepted standard, but even this is revised every few years. Even in use, doctors often cannot concretely diagnose a patient. Society greatly influences the categorization of mental illnesses in this manual, and while this may provide some function for the wider society, it can often be detrimental to the individual’s autonomy. The degree of influence society has on the diagnosis and treatment of various mental illnesses will not be discussed here. We must understand how mental illnesses are categorized and diagnosed in order to address the potential harm to the individual’s health and autonomy and to find a compromise in cross cultural conflicts. The influence of society on perceptions of mental illness is a significant aspect that we, as a society, as the medical community, and as individuals, must be more aware of to better treat mentally ill patients.

• The Moral Permissibility of Abortion by Gina Babinec, Dalhousie University Read Abstract

  While the legal permissibility of abortion is firmly established in most countries, the moral permissibility of the act is an issue that still remains a topic of consistent debate. This paper addresses the moral permissibility of abortion by outlining conditions under which it is the most morally just. Focusing first on the elements of the ethical perspectives most commonly considered in the debate, conservative and liberal, I explore the overall similarities and differences between the two, highlighting their flaws in providing sufficient moral guidance as ethical theories. Then, I compare the principles of these two perspectives to those of the feminist position. I propose that the principles of the liberal and conservative perspectives, respectively, are less morally just than those offered by the feminist perspective. Thus, abortion is always morally permissible if carried out under the principles of the feminist perspective.

• Gradualism and the Fetus by Phil Galligan, Stanford University Read Abstract

  Warren Quinn’s “gradualism” purports to defend the moral status of the fetus on the basis that it is a “partly existent” human being, and therefore deserving of moral consideration in proportion to its degree of existence. My counterargument is in the form of a dilemma: On one horn, if a fetus is properly thought of as a partly existent human being because of its potential to develop into a human being, Quinn has to solve the problem faced by all views that ascribe actual rights on the basis of potential properties; it seems absurd to treat an entity as though it already is an X just because it will become an X sometime in the future. On the other horn, if Quinn’s argument relies only on attributes currently possessed by the fetus, he must specify what these morally relevant attributes are.

• The Need for Patient Preference Research: A Case Study in the Rationing of Limited Resources for Treating HIV/AIDS Patients by Michelle Parilo, Harvard University with Ames Dhai and Mark Brady Read Abstract

  Despite the ever-increasing international focus on the HIV/AIDS epidemic, most HIV infected patients needing antiretroviral drugs are still not receiving them. One important reason is severely restrained resources. Decisions need to be made about how to distribute these resources as countries like South Africa work towards the goal of universal HIV treatment access (Bachmann, 2006, p. 109-120). The pressing questions are 1) how to distribute these life-saving, but limited, resources and 2) who should decide. This paper explores the different ways of approaching the question of distribution, but its main focus is patient participation in the decision making process. It is concluded that those who are most affected by the decision should have a say in deciding how the limited resources are allocated to ensure patient autonomy and allow policies to be driven by the consumer. In doing a HIV patient preference pilot study over the summer in Johannesburg, South Africa, the writers of this paper discovered that it is possible (and necessary) to ask HIV-positive patients their preferences.

• The Search for an HIV Vaccine: Ethical Issues of Phase III Clinical Trials by Jessica Ho, University of Pennsylvania Read Abstract

  The devastating impact of the HIV/AIDS impact is well known: the epidemic has killed and orphaned millions, reversed gains in life expectancy, negatively impacted national economies, and shows few signs of abating in particularly stricken countries. Given the recent developments in the biomedical sciences, the fact that we have not yet developed an HIV vaccine seems unfathomable. A survey of the vast body of literature available on the topic provides an overview of the constellation of factors which are delaying the development of the vaccine. A comprehensive summary of the logistical and ethical issues involved in testing candidate vaccines and in particular, holding Phase III clinical trials, follows. It highlights the intense and controversial debate over the clinical tests of HIV vaccines which is occurring both at the local level and in the international arena.

• Recent Development Focus: Failure of the Merck HIV Vaccine by Kavita Vinekar, University of Pennsylvania

For information on obtaining a hard copy of Penn Bioethics Journal Vol IV Issue i, please see our Subscription section.