“Acceptability research” is a term first coined to describe inquiries into individuals’ responses to family planning and contraceptive technology. As defined by WHO, “acceptability” is a “quality which makes an object, person, event, or idea attractive, satisfactory, pleasing or welcome.” In fact, the word “acceptable” in English is distinct from other issues that are also encompassed within “acceptability research.” “Acceptable,” to many, connotes faint praise. It may mean that something is tolerable only to the point of not being protested. On the other hand, the attributes “desirable” and “preferable” are more positive. In fact, all of these qualities are examined within the meaning of “acceptability research” as currently used by the Population Council.

Acceptability of a product or a medical procedure is most commonly studied in terms of patients or clients. Do those who will undergo the procedure or be the subjects of the technology find its use acceptable? But, in fact, acceptability can also be tested in relation to the providers of the technologies (i.e., the medical professionals), to the program managers or to policymakers.

In recent years, the competency of patients to refuse life-sustaining treatment has been widely discussed. Generally, competence has been recognized to be a legal concept, holding that the patient is presumed competent unless a court declares the person incompetent and designates a guardian. It has been noted, however, that clinical medical practice often diverges markedly from this standard. Some authors have suggested that in many cases the implicit medical presumption may be that many persons, particularly the aged, are presumed incompetent to refuse treatment until they demonstrate to their physician's satisfaction that they are competent. This gap between legal theory and medical practice presents numerous difficulties to both legal and medical professionals seeking to accommodate the competing values of patient self-determination and best interests.

This paper will present and discuss a case exemplifying a particular problem that can arise in the competency evaluation process.

Active shooter incidents (ASI) have unfortunately become a common occurrence the world over. There is no country, city, or venue that is safe from these tragedies, and healthcare institutions are no exception. Healthcare facilities have been the targets of active shooters over the last several decades, with increasing incidents occurring over the last decade. People who work in healthcare have a professional and moral obligation to help patients. As concerns about the possibility of such incidents increase, how should healthcare institutions and healthcare professionals understand their responsibilities in preparation for and during ASI?

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver.

In approximately the last 20 years, the self-protection capacity of many American Indian tribes has significantly increased to include the review of research requests by a tribally based IRB. While these tribal IRBs are trained using a curriculum derived from the Belmont Report, there is need to recognize the cultural specificity of the Belmont Report and its potential for conflict or inappropriateness when applied to populations with deep differences in cultural constructs compared to the majority population. However, recognition of the sometimes paradigmatically different culture of American Indian tribes compared to the U.S. culture at large seldom occurs. Moreover, significant and subtle factors of researchers' professional, organizational, and personal cultures that relate to the research enterprise are essentially never addressed by themselves or the tribal IRB. Nonetheless, tribal IRBs continue and serve as a procedural guide for investigators intending to conduct respectful research with American Indian populations.

Despite spending more on health care than every other industrialized country, the U.S. ranks 37th in health outcomes. These differences cannot be explained away with differences in age and income, or even with quality of care. And, the rate of growth in health care spending in the U.S. continues to increase. The share of the Gross Domestic Product (GDP) attributable to health care grew from 9% in 1980 to more than 17% in 2011. Health care costs are projected to account for more than one-fifth of our economy by 2021. Despite spending more and more, the U.S. does not have better health outcomes than other countries. Worse, our increasing spending is largely attributable to preventable conditions. More than 85 cents of every dollar spent on health in the U.S. are spent on the treatment and management of chronic diseases, such as those caused by preventable conditions related to obesity and tobacco use.

The legalization of physician-assisted suicide (PAS) remains a hotly debated issue throughout the United States, and continues to capture the attention of government officials at both the state and federal levels. While the practice is currently legal in Oregon, some federal lawmakers and officials from the U.S. Department of Justice have attempted to outlaw that state's practice through legislation (e.g., the Pain Relief Promotion Act of 1999), or through a strained interpretation of the federal Controlled Substances Act. And while several citizen groups throughout the United States have attempted but failed to legalize PAS through popular initiative, several state lawmakers have succeeded in specifically outlawing the practice. Yet even though physician-assisted suicide (PAS) remains unlawful in every state except Oregon, there is ample evidence that American physicians throughout the United States have participated in PAS by providing their terminally ill patients with lethal prescriptions.

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect issues of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists.

A living will is a directive from a competent, seriously ill individual to medical personnel and family members regarding the treatment he wishes to receive when he becomes incompetent to make decisions for himself. It is important to remember that a living will is not necessary when an adult is competent and chooses to refuse treatment since it is clear that generally, an adult, whether critically ill or not, may refuse any treatment for any reason. A living will is applicable only when a previously competent patient is seriously ill and incompetent.

Recent concern about new medical technologies which can prolong the dying process without improving the quality of life has sparked interest in rhe living will. More than five million copies of sample living wills have been distributed throughout the country, often by churches and senior citizens groups. State governments have also responded to this interest; the first Natural Death Act was signed into law in California in 1976. Since then, thirteen states and the District of Columbia have passed similar legislation, sometimes referred to as right-to-die statutes (see table accompanying this column).

The subject of screening stands at the intersection of medicine and public health and the law. Medicine is concerned about the care of the individual patient; public health focuses on maintaining and improving the health of entire populations. The law is concerned with the balance of rights and responsibilities, protecting society from errant individuals and protecting the individual from undue constraints of society.

In looking specifically at the questions of screening or testing for the Human Immunodeficiency Virus (HIV) it is useful to consider the meaning of the words “tests” and “screening” because many different terms are applied to these concepts — diagnostic testing, case finding, screening, surveillance, and so on. In all cases, medical tests have a common purpose: to provide information that sheds light on the probability that the disease of interest actually is present in the patient being tested.

At the end of 1987, the insurance industry could breathe a sigh of relief. By a combination of good luck, astute planning, and nerve, life and health insurers had managed to impose HIV-testing requirements on insurance applicants while making few concessions to the gay community or insurance regulators. To a greater degree than almost anyone had thought possible, the insurers had deflected most of the expected health costs from the AIDS epidemic onto the nation’s taxpayers, and had taken steps to deny life or health insurance to anyone they considered to be at risk of AIDS.

The use of blood tests to determine if an individual is infected with the human immunodeficiency virus (HIV) that causes AIDS has been a matter of considerable controversy. Yet to date only a handful of states have restricted the use of HIV testing by companies offering life or health insurance.

States have implemented a variety of legal and policy approaches to address the overdose epidemic. Some approaches, like increasing access to naloxone and connecting overdose survivors with evidence-based treatment, have a strong public health foundation and a compelling evidence base. Others, like increasing reliance on punitive criminal justice approaches, have neither. This article examines law and policy changes that are likely to be effective in reducing overdose-related harm as well as those that are likely to increase it.

In financial disputes involving research, the parties are traditionally individual researchers and their institutions, biotech and pharmaceutical companies, and other entities engaged in the commercial development of biomedical research. Occasionally, research subjects claim that researchers have misled them or misappropriated their biological materials to derive financial gain. The best known example is the case of Moore v. Regents of the University of California, decided in 1990.

With new developments in genomics, large-scale repositories of tissue and other biological specimens are increasingly important. Biobanks have been established by various researchers, commercial entities, health-care institutions, and even entire countries. Individuals who contribute specimens almost always retain no commercial interest in any resulting research and language to that effect is now customarily included in informed consent documents signed at the time the specimen is given. Suppose, however, that the research subjects actually collect the specimens themselves, recruit the researcher, and provide financial support for the research.

As we enter the new century, humanity wields increasing power to understand, alter, and control the world in which we live. The mysteries of our genetic code provide remarkable new insights into our unique human characteristics. Rapid developments in information technology provide instant access to limitless data. The information age has taken hold, and the genetic revolution is in full swing. With apologies to Aldous Huxley, we stand at the precipice of a brave new world.

It has been just 50 years since James Watson and Francis Crick's groundbreaking discovery of the double helix. Since then, profound developments in the science of genetics have been staggering. More staggering still are the potential benefits, the boundless horizons, the promised and unimagined applications of their work, and the work of the many scientists involved in the sequencing of the human genome. There can be no doubt that a firm and unwavering commitment to the betterment of humankind has fueled this tireless effort.

It has been 40 years since the seminal papers on pharmacy’s status as a profession sparked debate about the pharmacist’s role in health care, yet the questions they raised are just as poignant today as they were then. The issue of pharmacy’s status as a profession and its role in health care has again been brought into question, albeit in a roundabout manner, through discussions over the pharmacist’s right to refrain from dispensing emergency contraception. The key to understanding the contemporary pharmacist’s role as part of the health care team, as well as the pharmacist’s alleged right to refrain from dispensing emergency contraception, is to examine a situation that almost every contemporary pharmacist experiences.

Health care insurance schemes, whether private or public, are notoriously unaccommodating to individuals with disabilities. While most nonelderly nondisabled persons in the U.S. are insured through private sources, coverage sources for nonelderly persons with disabilities have traditionally been a mix of private and public coverage. For all age groups, the employment-to-population ratio is much lower for persons with a disability than for those with no disability. Moreover, employed persons with a disability were more likely to be self-employed than those with no disability. As a group, therefore, nonelderly people with disabilities have not been as well positioned as others to obtain private health care insurance because in the U.S., acquiring such coverage usually is employer based.

In 1995, Dennis Thompson, the founding director of Harvard’s program in Ethics and the Professions, authored a book entitled Ethics in Congress. That subject, in and of itself, seemingly was not new. And it undoubtedly inspired a few irreverent snickers. Consider that a Goggle search of “Ethics in Congress oxymoron” recently produced 5.79 million results in just over a tenth of a second.

But it was the subtitle of the book — From Individual to Institutional Corruption — that revealed how Thompson’s tome signaled an abrupt departure from the standard paradigms for measuring political corruption.

The acquired immunodeficiency syndrome (AIDS) has raised perplexing ethical and public policy dilemmas. Early in the epidemic, closing of bathhouses, testing blood donors for human immunodeficiency virus (HIV) infection, and notifying seropositive blood donors evoked passionate controversies. Current dilemmas include testing and using promising new treatments, notifying partners of seropositive persons, and, most recently, restricting the clinical activities of seropositive health,care workers who perform invasive procedures.

These dilemmas about HIV infection involve scientific judgments, cultural norms, and social values. In the HIV epidemic, public rhetoric and political pressure have been prominent. On the one hand, some persons have launched moralistic crusades against homosexuals and injection drug users. For these persons, AIDS symbolizes the breakdown of traditional family values and the social order. On the other hand, some advocates for persons with HIV infection have used confrontational tactics such as sit-ins and disruptive demonstrations.