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ABSTRACT A rich literature in public health has demonstrated that health is strongly influenced by a host of environmental factors that can vary according to social, economic, geographic, cultural or physical contexts. Bioethicists should, we argue, recognize this and - where appropriate - work to integrate environmental concerns into their field of study and their ethical deliberations. In this article, we present an argument grounded in scientific research at the molecular level that will be familiar to - and so hopefully more persuasive for - the biomedically-inclined in the bioethics community. Specifically, we argue that the relatively new field of molecular epigenetics provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns. We begin by presenting two distinct visions of bioethics: the individualistic and rights-oriented and the communitarian and responsibility-oriented. We follow with a description of biochemical characteristics distinguishing epigenetics from genetics, in order to emphasize the very close relationship that exists between the environment and gene expression. This then leads to a discussion of the importance of the environment in determining individual and population health, which, we argue, should shift bioethics towards a Potterian view that promotes a communitarian-based sense of responsibility for the environment, in order to fully account for justice considerations and improve public health. [ABSTRACT FROM AUTHOR]

The author offers insights on the framework for unrestricted prenatal whole-genome sequencing. Topics covered include the need for prenatal genetic testing to focus on promoting reproductive autonomy, the measurement of the effectiveness of prenatal testing and the justification of public funding of noninvasive prenatal whole-genome sequencing (NIPW). Also mentioned is the reliance of the framework on a process requiring prospective parents' extended engagement.

While many experts and organizations have recognized infertility as a public health issue, most governments have not yet adopted a public health approach to infertility. This article argues in favor of such an approach by discussing the various implications of infertility for public health. We use a conceptual framework that focuses on the dual meaning of the term ‘public’ in this context: the health of the public, as opposed to that of individuals, and the public/collective nature of the required interventions. This analysis highlights the need for a comprehensive public health approach toward infertility, points to some initiatives that are already in place and demonstrates that prevention is currently a neglected—yet much needed——element. We move on to discuss the sensitive nature of prevention initiatives as a probable explanation for their scarcity. We illustrate the complexity of prevention through an analysis of an infertility prevention campaign previously conducted in the United States, which provoked significant controversy. We use a public health communication ethics framework to expose the strengths and the shortcomings of this campaign, and conclude that prevention initiatives targeting infertility can indeed be conducted in a sensible way that promotes autonomy while improving public health. [ABSTRACT FROM AUTHOR]

In this article the author presents his views on an article which discussed few ethical and legal assumptions that are currently accepted as basic principles in Western medicine and bioethics, particularly on patient autonomy and the right to refuse medical interventions. This commentary will highlight the significant cultural gap between the point of departure for expanding the scope of patients' rights and the end of life, and the recent Israeli experience in the same field.

Focuses on laws in Israel regarding the withdrawal of medical treatment at the end of life, for those who do not wish to be kept alive by ventilators. Comments on Israeli laws and how they differ from those in the Western world; Comparison between withholding treatment at the end of life to withdrawing treatment already started to keep one alive; Description of end of life care in Israel; Way that the laws prohibit the termination of continuous medical care, such as being on a mechanical ventilator, but permits the termination of discrete medical care; Use of timers on ventilators in order to transform ventilators from continuous to discrete medical care, and thus allow for termination; Bioethical analysis of Israeli laws.

The author discusses the ethical and cultural considerations of incentives for postmortem organ donation in China. He stresses that the concept of incentives for postmortem organ donation was introduced to increase donation rates. He highlights the issues concerning the compensation for the deceased donor.

Looks at how doctors should respond to patients who have the capacity to make their own medical decisions yet refuse treatment that is in their interest. Question regarding whether or not societies should support the right of patients to make their own medical decisions; Discussion of how many countries allow patients who have decisional capacity to refuse treatment; Analysis of the Israeli Patients Rights Act, which allows clinicians, under specified conditions, to force treatment on patients who have decisional capacity; View that clinicians need not appeal to ethicists or courts to determine treatment but should appeal to an appropriate surrogate.

A letter to the editor is presented in response to the article "An offer you can't refuse? Ethical implications of non-invasive prenatal diagnosis," by Schmitz and colleagues in the 2009 issue.