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Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. Design and participants: Cross-sectional postal survey of doctors in Victoria. Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia . Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised.

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed.

Harris argues that if QALYs are used only 50% of the population will be eligible for survival, whereas if random methods of allocation are used 100% will be eligible. We argue that this involves an equivocation in the use of "eligible", and provides no support for the random method. There is no advantage in having a 100% chance of being "eligible" for survival behind a veil of ignorance if you still only have a 50% chance of survival once the veil is lifted. A 100% chance of a 50% chance is still only a 50% chance. We also argue that Harris provides no plausible way of dealing with the criticism that his random method of allocation may result in the squandering of resources.

We examine the view that all human life is of equal worth or sanctity. We find that this view is a legacy of the Judeo- Christian tradition, and cannot be justified in non - religious terms. We therefore argue that it should be rejected, and that we should openly acknowledge that some Jives are of less worth than others. We then consider a common objection: that this will lead us down a slippery slope to Nazi- style atrocities. We give our reasons for finding this objection unpersuasive. We explain why no-one has any grounds for feeling threatened by our proposal. Finally we discuss who should make the decision involved in selecting whether a person should come into existence, and how that decision should be carried out.

Perkin and Resnik advocate the use of muscle relaxants to prevent the "agony of agonal respiration" arguing that this is compatible with the principle of double effect. The proposed regime will kill patients as certainly as smothering them would. This may lead some people to reject the argument as an abuse of the principle of double effect. I take a different view. In the absence of an adequate theory of intention, the principle of double effect cannot distinguish between the intentional and merely foreseen termination of life, and cannot rule out end-of-life decisions that are often regarded as impermissible. What Perkin and Resnik are in effect saying is that there are times when physicians have good reasons to end a patient's life--deliberately and intentionally--for the patient's (and the family's) sake. Why not say so--instead of going through the agony of trying to match sanctity of life and patient-centred medical care?

Giubilini and Minerva present a clear argument for the view that, other things being equal, reasons that justify abortion also hold for early infanticide.1 A reasoned argument deserves a reasoned response. Instead, many responses following the electronic publication of the article were mere outpourings of outrage and abuse to the authors and the editor of the Journal of Medical Ethics .2 The principal arguments put by Giubilini and Minerva date back some 40 years, when Michael Tooley presented a strong case for the moral equivalence of abortion and infanticide. According to Tooley, only ‘continuing selves’ are ‘persons’, and only persons can be ascribed a ‘right to life’. …

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient.

According to a contemporary school of thought there is a specific female approach to ethics which is based not on abstract “male” ethical principles or rules, but on “care”. Nurses have taken a keen interest in these female approaches to ethics. Drawing on the views expounded by Carol Gilligan and Nel Noddings, nurses claim that a female “ethics of care” better captures their moral experiences than a traditional male “ethics of justice”. This paper argues that “care” is best understood in a dispositional sense, that is, as sensitivity and responsiveness to the particularities of a situation and the needs of “concrete” others. While “care”, in this sense, is necessary for ethics, it is not sufficient. Ethics needs “justice” as well as “care”. If women and nurses excessively devalue principles and norms, they will be left without the theoretical tools to condemn some actions or practices, and to defend others. They will, like generations of nurses before them, be condemned to silence.

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data.

[T]here had been theories that homosexuality might have a genetic basis. In June this year, these theories received a somewhat firmer basis. Researchers at the United States National Cancer Institute reported new evidence which suggests that some gay men may have a genetic predisposition to homosexuality. The research team led by molecular biologist Dean Hamer tested 40 pairs of homosexual brothers and found that 33 of the pairs shared genetic markers on a particular area of the X chromosome (called Xq28), indicating a link between homosexuality and a gene in that area. If followed-up research were to confirm the findings, then, it has been claimed, this would be the first example of a behavioral trait that has been found to have a genetic basis. The study does, however, leave some central questions unanswered. Some revolve around the link between genetics and the nature of sexuality itself. The others concern the ethical and social implications of the research....

In earlier publications, we had argued that Paul Ramsey is inconsistent because he simultaneously asserts that (i) 'all our days and years are of equal worth' and (ii) 'that it is permissible to refrain from prolonging the lives of some dying patients'. Thomas Long has suggested that we have not shown that Paul Ramsey is inconsistent. Ramsey and we, he holds, start from incommensurable metaphysical views: for Ramsey, the dying process has religious significance--God is calling his servant home. While it is normally a good thing to keep a patient alive, it would, for Ramsey, show deafness to God's call to keep a dying patient alive. It is true we do not share Paul Ramsey's religious views. It is, however, not necessary to rely on any particular metaphysical views to refute Ramsey's position. For Ramsey's view to be internally consistent, Ramsey would have to be able to distinguish between dying and non-dying patients. We examine some of Ramsey's examples and show that his practical judgements do not allow us to draw this distinction. This means that, contra Long, we hold fast to our charge that Ramsey's view is inconsistent.

Kuhse and Singer, the editors of this special issue of Bioethics, introduce seven articles on conflicting concepts, public policies, and standards for the determination of cardiorespiratory and brain death and the relationship of brain death to the beginning of "brain life" and to organ donation, especially from anencephalic infants. The articles are "Consciousness, the brain and what matters," by Grant Gillett; "Brain death and the anencephalic newborn," by Robert D. Truog and John C. Fletcher; "Brain death and brain life: rethinking the connection," by Jocelyn Downie; "A plea for the heart," by Martyn Evans; "The importance of knowledge and trust in the definition of death," by Bo Andreassen Rix; "Death, democracy and public ethical choice," by Reid Cushman and Soren Holm; and "Misunderstanding death on a respirator," by Tom Tomlinson.

Victoria, Australia's Infertility (Medical Procedures) Act 1984, the first legislation to regulate reproductive technologies, permits research on surplus embryos fertilized in vitro but prohibits the creation of embryos for research purposes. The failure to define when an embryo has come into existence or when fertilization has occurred has prevented the continuation of potentially valuable research directed at overcoming infertility. The Standing Review and Advisory Committee on Infertility must now consider the debate over when fertilization occurs, an event that is no longer regarded as a discrete or instantaneous act but as a process revealing no clear point at which a human individual begins to exist. Because the law requires a clear line of demarcation, any legislation in this area will face the problem of defining this point. Interpretation of a 1987 amendment to the 1984 Act may allow the fertilization of ova for purposes other than implantation.

Thomas Long has argued that there is an irreconcilable metaphysical difference between the views of those who, like ourselves, believe that on quality-of-life grounds it is sometimes justifiable to end the life of a severely handicapped infant, and those who, like Paul Ramsey, reject this view. Because of this metaphysical difference, Long considers it impossible for our arguments to refute Ramsey's position. We disagree.

considered jointly have no special moral status'. That is to say, an egg and a sperm in separate test-tubes in the same rack have no greater moral status than the egg alone or the sperm alone. But this is irrelevant. For from it we can derive no conclusions about the moral status of the embryo unless we can rely on (A). But (A) is false. Contrary to what Singer and Kuhse suppose, I am not eager to find elementary fallacies in their work. None the less those fallacies are there and the authors have done nothing to eliminate them.

Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down's syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down's syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex issues involved. This volume--by two authorities on medical ethics--presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic.