Rosemary Kennedy Endowed Chair in the Philosophy of Medicine

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The Joseph and Rose Kennedy The Kennedy Institute Volume 3, Number 2 Institute for the Study Georgetown University of Human Reproduction Washington, D.C. 20057 and Bioethics Quarterly Report Summer 1977

New Chair Established He is co-organizer of the Symposia on Philosophy and Medicine. This series of Symposia is designed to produce litera Rosemary Kennedy ture in a field which up to this point Endowed Chair in has had a dearth of published material. The proceedings of each symposium is the Philosophy of being published, and together they are Medicine being called the Philosophy of Medicine Series. At this time 3 volumes have H. Tristram Engelhardt, Jr., M.D., been published of at least an 11 volume series. Those volumes now in print are Ph.D ., has been appointed to the first Evaluation and Explanation in the Bio Rosemary Kennedy Endowed Chair in medical Sciences; Philosophical Dimen the Philosophy of Medicine. This professorship sions of the Neuro-Medical Sciences; is being jointly funded by a and Philosophical Medical Ethics: Its grant from the Joseph P. Kennedy, Jr. Nature and Significance. A fourth Foundation and the University. Dr. volume, Mental Health: Philosophical Engelhardt will hold a joint appointment Perspectives, will be out in print in as a professor in the Departments October 1977. of Philosophy and Community Medicine , and as a Senior Research Scholar Dr. H. Tristram Engelhardt Within Georgetown’s Medical Center. of the Joseph and Rose Kennedy Institute Dr. Engelhardt will be working with the for the Study of Human Reproduction This fall Dr. Engelhardt will be directing and Bioethics at Georgetown a seminar sponsored by the National resident staff and the medical students University. Endowment for the Humanities for in the field of pediatric mental health medical practitioners, titled, “The through the University Affiliated Facil Dr. Engelhardt has been a frequent Delivery of Health Care: Physicians’, ity. He is very interested in the concept visitor and contributor to the activities Patients’, and Society’s Rights.” In the of “levels of capacity” for the mentally of the Kennedy Institute for several spring of 1978, he will be teaching a handicapped in the sense that mental years. He is a contributing author and course for graduate and medical students handicaps are generally uneven. That i an associate editor of the Encyclopedia on “Historical and Philosophical a person may be handicapped yet still of Bioethics. Concepts of Disease” in the University. have many areas in which he can develop and flourish as an individual. Within the In his new position here Dr. Engelhardt Dr. Engelhardt is in the process of writing U.A.F. program, Dr. Engelhardt will be working with staff, students and families will be involved in integrating the efforts several books. He anticipates that of a primarily research Institute his textbook of Medical Ethics will be , concentrating on the ethical issue and an ongoing medical school program. finished by the end of the academic arising in the prevention, diagnosis and Teaching, writing and research will all year. He is also involved in writing a treatment of mental retardation. His im portant. book on John Hughling Jackson and interest in mental health has led him t the development of the concept of devote two volumes in the Philosophy cerebral localization in the 19th Century of Medicine Series to the subject of , and is in the process of gathering Mental Health. an anthology of readings on the history Copyright © The Kennedy Institute of the concept of disease. Summer 1977 Dr. Beth Soldo

Dr. Beth Soldo Dr. Soldo is also developing a proposal individual differences. The elderly for a cross-cultural comparative study population today is neither a social, Gerontology: The of behavioral aspects of aging. She and economic or demographic monolith. George Myers will again collaborate on It’s a very heterogeneous population. Study of Aging this study, which will not involve a Distinguishing between groups of individuals survey, but will analyze secondary annual simply on the basis of their data sources from the United chronological age negates very fundamental Beth J. Soldo, Ph.D., joined the Institute States and several countries of Western differences between individuals in February as a Research Associate Europe. not simply at the latter end of the life with the Center for Population Re- cycle, but throughout it. search. She received her Ph.D. in Sociology Dr. Soldo has presented papers at meetings from Duke University this year, of the Population Association of Q: What else accounts for the gerontol and her main area of concern is the relationship America and the Gerontological Society ogist’s uneasiness with chronological between gerontology and demography . age? in meeting the needs of the aged. A: Chronological age also masks intra- individual differences. Aging, as a social Dr. Soldo has taught at Duke University concept, refers to both the rate of development , including courses in Urban Sociology and the stage of development and Social Demography. She is Interview with Dr. Beth Soldo along multiple dimensions. There’s teaching “Social and Demographic Q: Gerontology is the study o f aging. the dimension of health status, functional Aspects of Aging” at Georgetown capacity, cognitive acuteness, integration during the summer session. Although Exactly what does aging mean to a of roles, and so on. All these she has no teaching plans for the winter gerontologist? fit into a complex of dimensions that term, she will continue her research at we in society tie up into a neat bundle the Center in a number of ways. A: Aging, fundamentally, is a process, one that is both unidirectional and irreversible and label “age.” And yet an individual can look very old in the sense that all Dr. Soldo, along with George Myers of . Chronological age is used as an of the visual cues are present gray hair, the Duke University Center for Demo- indicator of a developmental stage in wrinkled skin — and yet this same person graphic Studies, is at the midpoint in a that process. Because of its utility, can kill you at tennis. To some extent two-year research project funded by chronological age has widespread administrative the multiple dimensions of aging are the Administration on Aging. This use. interdependent, but they’re not perfectly study is entitled “Changing Household correlated. So somebody could Patterns among the Elderly,” and will Despite its administrative appeal, chronological be very old along a social status dimension examine variations and changes in patterns age is beset with conceptual , and yet relatively young along a of household arrangements over problems. The first, and perhaps most health status dimension. the period 1969-1976. The project is obvious, is its failure to capture inter- also intended to assess determinants of Q: Why then does society continue temporal variations in age-related behavior make so many assumptions about p eo , and to examine the impact of p le based on age? changing economic conditions and program intervention strategies on changing A: Primarily for its convenience. If I patterns. simply know your age, I don’t need to "The elderly population today is neither a social, economic or demographic monolith."

elicit all kinds of detailed information accumulated life history as much as to Q: What can we do to increase their about you. In social interactions, age current circumstances. chances for a good life? serves as a convenient proxy or surrogate variable. I know a lawyer who insists Q: Do you think the post-war “baby A: I would say our primary concern before he goes into the courtroom boom” has aggravated the difficulties should be to give them options, along that he know the age of the opposing of the older generation? every dimension which is of social concern attorney. He’s found this to be a short- to us. But a flexible retirement age hand way of getting a grasp on what A: The baby boom created both problems will generate other problems in other kind of approach the opposing attorney and help for those who are currently places in the life cycle for the population will take, the kind of argument he’ll elderly; problems, for example, as a whole. So when you propose make, how fast you can throw things at in the sense that given a fixed or limited any kind of intervention, you must be where his weaknesses may very amount of societal resources, and given careful that while it may be good for well be. In other words, if he’s a young the large baby boom cohort knocking the elderly, it may also generate a problem attorney, he may be up on book knowledge on the door of the labor force and demanding for the young. , but very inexperienced in terms entry, one of society’s ways of of courtroom maneuvers or staging coping with the problem is to ask (in I think that probably the most vivid techniques, as opposed to an older one fact, provide incentives) for the elderly concern of the elderly is their health who may be very apt at the theatrical to leave the labor force. This can happen care. This is an area where the United aspects of courtroom presentations but 10 years before there’s any health- States can learn a lot from the countries may not be as knowledgeable about the related reason for them to retire, or any of Western Europe who, demographi nuances of legalities as a younger one desire on their part to do so. On the cally speaking, are much older populations may be. And everyone, not just an attorney other hand, I think the baby boom is . The countries of France, Sweden , uses this type of shorthand. responsible for much of the attention and Norway have substantially higher we are currently focusing on the elderly. proportions of their population in the Q: Why then is gerontology defined Because the baby boom has considerably elderly years than we do. above as the “study o f aging?” A ren’t taxed every social structure it has all o f us aging, every day ? touched, much of our concern for the Q: Is that due, not only to better elderly today is based on the fear of health care, but because of a lower A: In a certain sense, aging begins the what will happen when these young birth rate? moment you’re born. From that adults reach the older ages. moment on, an individual accumulates A: More the birth rate than anything time and age-related changes occur. I Q: Do you think that our elderly to- else. From a demographic standpoint, think it’s much more meaningful to day differ very much from the elderly populations age because of a decline in talk about gerontology as the study of in past generations ? fertility. I’m sure that most people change along the dimensions that are expect that the increase in proportions associated with age. That also immediately A: Our elderly are probably the most of elderly can be directly related focuses attention on the fact that adaptable cohorts ever to pass through to improvements in survivorship and re age does not exist in a life cycle. our system. They were bom into a time duction in mortality rates. Since the There’s nothing magical that of no electricity, minimal indoor plumbing 1900’s certainly the mortality rate has happens to individuals when they , no cars or airplanes, and they’ve declined, but most of that progress has cross the threshold into chronologically-defined had to adjust and even master all these “old age.” In fact, an individual innovations. By no means should we at 70 is responding to his or her sell them short on their ability to adapt. Dr. Matthew F. McNulty, Chancellor of the Medical Center; Dr. Warren T. Reich, Associate Professor, Department of Community Medicine; Dr. John Utz, Dean o f the Medical School, (left to right)

been made in conquering the childhood diseases. So what follows from medical Dr. Warren Reich Appointed to intervention is, (1) individuals survive their infancy, and (2) higher proportions Department of Community Medicine of each cohort survive to the point where they themselves have children . Today approximately 95 per cent The Georgetown University Medical Dr. Matthew McNulty, Chancellor of of any cohort survives to age 30, so any Center has announced the appointment the Medical Center, emphasized that, further reductions in mortality will of Dr. Warren T. Reich as Associate Professor and Head of a new Division probably have to be in terms of the “ The physician, the dentist, the nurse, and chronic diseases. of Health and Humanities in the Department the other health scientists o f the future will of Community Medicine. be called upon for increasing and broader Q: Can y o u make any predictions service to society. “ To provide that service, a knowledge and about the elderly up to the year 2000? In making the announcement, Dr. Robert R. Huntley, Chairman of the understanding o f basic bioethical, moral, social and economic issues is important to A: The problem with trying to predict Department of Community Medicine, complement an ever increasing body of the proportion of elderly is that it’s said, “This is the beginning of a major scientific knowledge. Georgetown University highly dependent on the birth rate. The new program in bioethics and health- Medical Center intends to maintain scientific excellence but also to provide a birth rate has been declining since the related humanities for the entire Medical Center, based on the work of a University-wide curriculum that is both interdisciplinary early sixties, and we’re about at re- and interprofessional for the scientist/ placement levels now. But there is one planning committee.” scholar of the future.” hypothesis that the women of the baby boom are postponing their fertility, and Dr. Reich who, since 1971, has been we may see a flood of babies born within Senior Research Scholar at the University's The new program will draw on resources a certain year when these women Kennedy Institute, will develop in other parts of the University, such as reach their 30’s and face their last the new program for the Schools of the College of Arts and Sciences, the chance to have children. We can predict Medicine, Dentistry, and Nursing. In Graduate School, the Kennedy Institute, to the relationship between mortality addition to Bioethics, which will be at and the Law School. and fertility, and what it means for the the core of the curriculum, the three age structure of the population around Schools intend to develop a curriculum Dr. Reich will retain a joint appointment 1990 or 2000, but beyond that the accuracy that will include Literature, Philosophy, in the Kennedy Institute’s Center of our projections is dependent Theology, Art, History, Sociology, and for Bioethics, where he is completing on how closely we can predict the Law. work as Editor-in-Chief of the Encyclopedia course of fertility. And fertility, of all of Bioethics. the demographic processes, is the most The purpose of the program will be to subject to “guesstimate” error. provide a stimulus for the identification of value issues in health care and the Dr. Beth Soldo and biomedical sciences, and to develop Ms. Erla Zwingle intellectual skills for understanding and resolving the increasing ethical dilemmas raised by the contemporary life sciences , health sciences, and health care. Dr. Dorothy Swaine Thomas.

material for a further study until compulsory retirement at Penn Dorothy Swaine on this general topic when her brought her to the newly formed Thomas physical disability prevented further Kennedy Institute at Georgetown. work o f this type. Her doctoral dissertation Together with Simon Kuznets, a The Kennedy Institute announces from the London School of former fellow student, she started a with sadness the death of Dr. Dorothy Economics, under the title, Social major project on population redistribution Swaine Thomas in May of this year, Aspects of the Business Cycle, re- and economic growth. In after a long illness. Dr. Thomas joined mains a landmark in the field some this project Dr. Thomas saw a the Kennedy Institute’s Center for fifty years later. dem onstration of linkage of economic Population Research in 1972, and and demographic change “by a she was im portant to the early organizing continuous chain of interdependent Upon returning to the United States of the Center’s teaching and variables,” a complete change from in 1924, Dr. Thomas experienced larch program. the economic determinism which she great difficulties in obtaining a position thought she had found in her earlier on the faculty of a first-rate university Born in the last quarter of the nineteenth research. century, she was educated as . The Federal Reserve Bank a social research scientist in a time did want her and she became involved While her work in migration research when there were few such professionals with time series analyses. A post-doctoral fellowship led her into probably gave her the most professional , and among them only a handful more training in the behavioral sciences fame, she is remembered by of women. She demonstrated . Together with W.I. Thomas, her students for her gracious hospitality that a professional woman could she used psychometric and socio- while she wholeheartedly make it on her own long before the metric techniques on an investigation taught and defended academic current discussions over women’s of child development which resulted freedom. rights or ERA became matters of in The Child in America. Further re- everyday concern. search on children was done at Columbia, and later at Yale. In college she decided to concentrate on Economics and Sociology rather than the English and Latin It was at the University of California that she had studied for years, and at Berkeley in 1940, where Dr. began to work under the tutelage of Dorothy Thomas reached a major William Fielding Ogburn. Her work career goal—to become a full professor with him resulted in a joint publication with tenure at a first-rate university , “Are Inventions Inevitable?” . Being on the West Coast led her which was published when she was to study the Japanese after Pearl only 21. Her second paper with Harbor and the evacuation of American Ogburn was “The Influence of the Japanese. The evacuation and B u siness Cycle on Certain Social Con- ultimate resettlement was reported ions.” She maintained her interest in two books, with co-authors from in economic and social cycles among the re-locatees, The Spoilage throughout her life, and she was colllecting and The Salvage.

In 1948 she joined the University of Pennsylvania where she remained Jam ie Ferrara (M. A. Oxon)

The material for this article was gathered in an Elective offered by Georgetown University’s Department o f Community Medicine and International Health in cooperation with the Great Oaks Center, Maryland and the University Affiliated Program, Department of Pediatrics.

victories of vertical medicine are now “ w ater” ) is prevented from accumulating Medicine so Pyrrhic that many are questioning within the brain, minimizing the very foundations of the medical damage to the nervous system and and Mental enterprise. The clash between vertical often allowing a child to lead a perfectly and horizontal is thus echoing through- normal life. Pharmacologic advances Retardation out our health care system, but nowhere have helped control the seizures are the difficulties thrown into which may accompany severe brain sharper relief than in the case of mental damage, and a drug such as thioridazin The explosion of scientific knowledge retardation. can be effective in containing hyper- during this century has fostered a specialization activity. However, large dosages of this and consequent division of The medical student who begins to agent may produce permanent eye labor in our medical services to an unprecedented study seriously the causes and consequences damage and may even lead to a loss, degree. Indeed, ours is an of mental retardation soon vision. In certain cases it produces age of “vertical” medicine: doctors encounters both the strengths and paradoxical effect and can actually construct towers of medical knowledge weaknesses of our scientific progress. increase a child’s restlessness and un- and expertise over extremely narrow From a diagnostic perspective, the controllability. “Hyperactivity” itself areas of interest. The successes of such genetic nature of Down’s Syndrome is is a misleading label, a phenomenon vertical medicine have been impressive, now clear, and we understand how certain largely in the eye of the beholder: the especially in the elimination and containment abnormalities of enzyme metabolism availability of parents, their attitude of infectious diseases. As a may lead to severe diseases, such and understanding, the patience and consequence, we find ourselves as a as phenylketonuria. But numerous enthusiasm of a schoolteacher are all nation increasingly prone to chronic cases of mental retardation are of powerful determinants of alleged cases ailments whose medications and “etiology unknown”, often apparently of hyperactivity. A quick medical therapies leave us lingering with drastically the result of poor nourishment in solution for such agitation is the prescription restricted activities and altered utero and inadequate perinatal care. of an antianxiety agent or lifestyles. The modification of lifestyle Many deficiencies are not manifest tranquilizer. Yet the causes of a child’s is also central to the prevention of until several years after birth. In fact, difficult behavior are more often familial such chronic illnesses, e.g. lung “mental retardation” may become a and social than organic in nature. cancer and heart disease. Our health misleading term, so varied and numerous Titrating a young person into placidity concerns have thus become “hori- are the developmental disabilities through sedatives may be the easiest zontal”: medical problems and their to which it refers. Learning handicaps route for parent, teacher or physician, solutions are now more than likely to can no more rigidly be labelled than but the genuine needs of the child may have broad, long-lasting effects on us, strictly physical handicaps; yet the be camouflaged; his problems may touching almost every phase of our labels persist, often merely blurring the actually be growing worse but may go lives. precise nature of a particular problem, unnoticed by those concerned primarily and obscuring the distinctive needs and with his social conformability. Unfortunately, the remedies of “verti potentials of an individual child. cal” medicine can no longer meet the The categories and solutions offered needs of “horizontal” health care. our vertical medicine may thus ignore Some would contend that such inadequacies Scientific progress from a therapeutic or even disguise the unique needs of a are the tem porary inconveniences standpoint tells much the same story. child. Even where some specific medical of scientific progress; but the Hydrocephalus, once thought incurable, assistance is appropriate and avail- can now effectively be treated by the use of a shunt: cerebrospinal fluid (the " . . . the establishment of University Af f liated Programs for Child development in the past decade has taken a great step forward in . . . fusing the vertical and horizontal components of health care."

Jamie Ferrara, M.A., Oxon.

able, shuttling between various subspecialists strains and problems of their own lives; vertical and horizontal components of may compound a child’s problems consequently they become less and less health care. The programs of the facilities . Confusing and conflicting therapeutic able to deal with great demands of an are essentially interdisciplinary: regimens often leave parents atypical youngster. Guidance and counseling neurology, orthopedics, speech pathology bewildered as to the meaning of a may be essential to the health of , occupational therapy, psychiatric particular diagnosis and the relative importance the family, and should not exclude the and other hospital resources are all of any single medication. As consideration of such alternative pro- available for investigation and evaluation a result, these interpreters of medical grams such as care in a residential facility . Each service consulted during a directives may not be able to distinguish , which may afford at least temporary case comes together in a joint, interdisciplinary a significant abnormality in their relief. Parents themselves are often staffing, where the various re- child’s appearance or behavior from reluctant to consider such an option ports are made and the recommendations which is not. The success of medical due to the understaffing and inadequate compiled. The staffings not only intervention is often totally dependent supervision of many institutions. allow the member of the subspecialties on the parent’s precise under- At this point the family physician may to hear what the other disciplines are standing and cooperation in maintaining be in the best position to offer guidance proposing in relation to a patient, but a strict diet or detecting early certain with his previous experience of an they must agree on a consistent set of signs and symptoms. The well institution, his knowledge of the child’s therapeutic priorities: this reduces the being of a severely atypical child is history and needs and his insight into potential conflicts among many narrow factually determined by the education the total family situation. His concern vertical perspectives. Finally, educational and adjustment of his parents as well as is for the health of the entire group, and social service members of the by his own. and he may be the first to notice when team then present the broad horizontal the unrelenting demands of any one dimensions of the child’s situation and Effective parental cooperation requires member have become genuinely destructive examine how feasible a proposed thera far more, however, than a coordination of the familial fabric. Painful pressures peutic regimen may be in the particular of medical subspecialties. A severely often prove corrosive even in the circumstances. Such staffings are invaluable retarded child can generate enormous most loving of families; should the learning experiences for health pressures within a family structure. Siblings marriage dissolve no one is well served, care professionals. Not only does the are often jealous of the enormous least of all the developmentally disabled primacy of the team reduce possible time and effort required on behalf of child. conflicts among the subspecialties by their brother or sister; children’s feelings forging a common set of priorities, but of shame or uneasiness may be a reflection In order to be effective therapeutic the particular familial and social facto of parental attitudes as well, especially allies, it is imperative that physicians which are the essential context of any if there is anxiety about a retarded understand the horizontal details of the intervention are explored and evaluated individual’s social behavior. Suppression personal and familial dynamics surrounding All the problems, solutions, obstacles of guilt at having caused the a mentally retarded child. and potentials of health care find a problem and the fear of having another Traditional medical education is notoriously common forum and single focus in the handicapped baby may also weigh lacking in developing such complementary staffing. Here, at last, vertical and hori heavily on parents. The lives of the perspectives, but the establishment zontal squarely intersect. en tire family can come to be defined of University Affiliated Pro- by the requirements of a retarded child, grams for Child Development in the Medicine has made great strides from which usually makes everyone less effective past decade has taken a great step forward the time when a doctor could only say at dealing with the continual in this area toward fusing the “Your child is retarded, there is nothing we can do for him. Take him home and Kennedy Institute Hosts love him as best you can.” The love is still essential, but we can now do a Third Annual Intensive great deal to help him reach toward in- dependence and self-sufficiency with Bioethics Course our increased knowledge and expertise. The challenge here, as in so many other For the third year the Kennedy Foundation lectures and discussion groups using areas of medicine, is to resist being so , in collaboration with the Kennedy case studies. Attention was devoted to dazzled by our successes that any in- Institute and the Harvard Inter- specific topics such as the relationship ability to provide an immediate and faculty Program on Medical Ethics, presented between law and ethics, the allocation total solution is considered a failure its annual week-long Intensive of scarce medical resources, the risk and a professional embarrassment. Bioethics Course in early June. The of patients, and the care of the mental Diagnoses still remain frustratingly course is designed for leaders in medical ly retarded. These discussions were undifferentiated, medication is sometimes and nursing education and health administration built upon a more general grounding in only empirically successful and who are in key positions in normative, utilitarian, and deontological often there may be no cure: for the policy formation and decision making theories of ethics. large majority of developmental disabilities in their respective institutions. The invited our vast armamentarium still participants come from district The idea was stressed that as advances offers no technologic “ fix”. The continuing and national institutions across the in medical technology increase, there problems of mental retardation country, the course providing a forum must be an increase in society’s awareness in education, medication, growth and for exchange of common concerns and of the ethical implications of both development are sobering reminders of ideas at all levels. the risks and benefits that such a technology our professional limitations and common may entail solutions to health human frailty. But health care care problems must have the input of Two of the participants, working here does not cease simply because there is both science and ethics. in Washington, were Dr. Joseph S. no cure; indeed the more difficult challenge Drage, Chief of the Developmental to physician and health care team Lynn Taylor Neurology Branch of the National Institutes is to help these children reach their of Health, and Dr. William Blan own potentials, however limited. In pied, the EHVIST Program Director of accepting that challenge we may even the National Science Foundation. Both find our own human potential mirrored Dr. Drage and Dr. Blanpied are re- in theirs: not in what little they will sponsible for deciding nationally which come to do for themselves, but in the research projects will be approved and great deal they may do for others. funded by their institutions.

The course in theoretical and applied ethics was presented to the 50 participants through selected readings, formal Dr. Sid Z. Leiman

Towards a National Dr. LeRoy Walters, Ph.D., Director of Jewish Ethicist Immunization Policy the Center for Bioethics, The Kennedy Institute, was named the Chairman of Appointed Visiting Immunization and the National Immunization Work Research Scholar Group on Consent. The Consent Work Informed Consent Group recommended that a National Dr. Sid Z. Leiman, Associate Professor Immunization Policy Council be established in the Department of Religious Studies Last year’s threat of a swine flu epidemic which should include persons at Yale University, has been appointed precipitated an enormous from a variety of professional disciplines to a twelve month stay as a Visiting Re am ount of concern with mass immunizations related to imm unization as well as representatives search Scholar in the Center for Bio- in the United States. This fear of the public who are not involved ethics during academic year 1977-78. m epidemic brought to a head the in the production of vaccines or t that many children are not being the conduct of immunization programs. Dr. Leiman is a specialist in Biblical immunized against such infectious diseases studies and ancient Middle Eastern languages as poliomyelitis, measles, diphtheria ; he has studied in both the The Consent Work Group emphasized and other potentially debilitating, United States and Israel. Since receiving in its Report that there be such a council if not fatal, diseases. As of 1975, only his Ph.D. at the University of Pennsylvania with full powers of review to insure 65.5% of children between the ages of in 1970, he has published numerous that safe standards of immunization 1-4 were adequately immunized against articles on ethics in both Hebrew programs are met. The Consent Work measles, 64.8% immunized against and English language journals, as well Group expressed concern that special polio, and 75.2% against diphtheria. as lecturing on Jewish law and ethics at informed consent procedures and safe- The potential exists for many of these various universities in the United States. guarding mechanisms be developed for diseases to be completely eradicated in At Yale University Dr. Leiman has children, who comprise 70% of those the United States. However, the number taught graduate and undergraduate immunized, as well as others whose of reported cases of measles, in particular courses in Jewish medical ethics, Jewish capacity to understand the consequences , has continued to climb since 1973 ethical literature, and Jewish legal text of their actions, for example, when there were 26,690 cases reported, (for example, Maimonides’ Code). the mentally retarded and the elderly to 39,585 reported cases in 1976. senile. The Work Group also emphasized that informed consent to immunization As a scholar of the Jewish ethical tradi Responding to public concern over contagious should not be viewed as merely tion, Dr. Leiman will be working at the diseases that can be controlled the signing of a written document; Kennedy Institute on a research project by mass immunization programs, the rather, it should be understood as an concerning the concept of triage the Office of the Assistant Secretary for ongoing process involving public participation allocation of scarce medical resources Health (OASH) convened a National in immunization, policy decisions within the Jewish ethical tradition. Immunization Conference in Washington , and the presentation of balanced Additionally, his presence here will in- , D.C. in November 1976. OASH, information about immunization sure that the Jewish ethical perspective through a contractor, then created six through mass-media health education will continue to be represented in the work groups this spring to develop programs. discussions and academic teaching pro commendations which would provide grams sponsored by the Kennedy Insti essential inputs towards formulating a tute, as well as in national and interna national immunization policy. tional consultation on many of the critical ethical issues we face today. 10

Rose Fitzgerald Kennedy Lecture Series

The Rose Fitzgerald Kennedy Lecture Series was established in 1976 as a forum for eminent scholars to present series of discourses and meetings to encourage discussion, study, reflection and action on problems of ethics and contemporary life, with special attention to the poor, the powerless, and the forgotten, the mentally retarded, children and families.

Five guest lecturers have been invited to Georgetown University’s campus in 1977, and two European Cardinals have been invited to the 1978 Lecture Series, under the auspices of The Joseph P. Kennedy, Jr. Foundation, The Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, and Georgetown University. The Rev. Prof. Dr. Hans Kung, professor of dogmatic and ecumenical theology , is D irector of the Institute of Ecumenical Research at the University of Tubingen, Germany. He opened the lecture Series in February 1977, when he delivered three lectures on “Why Be a Christian?”

The debate has been long-standing whether there is such a specific entity as Christian Ethics which can actually be differentiated from General Ethics. Father Kung’s three lectures upon what and who is peculiarly Christian has been a part of that discussion. His book, Christ Sein (To Be a Christian) was a German bestseller, surpassed only by the Gulag Archipelago. The book, in English, has become a Washington bestseller, largely as a result of his provocative lectures at Georgetown.

Mrs. Walter Mondale, Mrs. Sargent Shriver, Dr. Hans Kung (left to right) Dr. Jerome Lejeune, the renowned French geneticist, will deliver a lecture in the Rose Fitzgerald Kennedy Lecture series in September 1977.

In 1956 scientists discovered the correct chromosome number in man (46). Only three years later Dr. Lejeune and his co-workers discovered the first chromosome variance in man, known as Mongolism or Down’s Syndrome (usually 47 chromosomes). Since 1959, when Dr. Lejeune make his momentous discovery, the study of chromosomal variations in man has rapidly increased Dr. Coles into a science of its own.

Robert Coles, M.D., noted Harvard psychiatrist In September Dr. Lejeune will present who has done extensive work his paper, “The Congruence Code; an and research with children and families, Essay on Mutual Recognition Between spoke on the topic “Children and D.N.A. and Proteins.” Dr. Lejeune gave Ethics” in April 1977. an earlier version of this paper before Dr. Vanier the French Academy of Science. His Dr. Coles has written nearly 400 articles lecture at Georgetown will be the first Jean Vanier, Ph.D. Many American and 25 books. In 1973 he was opportunity for Americans to learn of mentally handicapped adults are given awarded the Pulitzer Prize for nonfiction his most recent D.N.A. research. care within uncaring institutions. Rejected for the second and third volumes by society, they lead dull, meaningless of Children o f Crisis. The first volume , marginal lives with little hope of Children o f Crisis was published in or idea of something better. 1967, and resulted in his earning three awards: the Phi Beta Kappa Ralph Jean Vanier, the founder and director Waldo Emerson Award, the Four Freedoms of “L’Arche” (the ark), in his own Award and the Wolf-Anisfield search for a meaningful life, has sought Award. The fourth and fifth volumes of to bring together into a single community the series will be published later this both the mentally handicapped year. and those who assist them.

His two lectures at Georgetown were an The beginning of his great effort was outgrowth of his current research in quite humble when he bought a small which he has begun to study children in dilapidated house in France and moved different kinds of families around the in with two mentally retarded friends world. He has been especially interested in 1964. The son of the 19th Governor in how these children form ethical General of Canada, Jean Vanier had received ideals and political values. his doctorate in Philosophy from Dr. Lejeune 1

the Institute Catholique in 1964 and Laurence H. Tribe, J.D., of the Harvard Institute has increasingly delved into had a commission in the Royal Canadian University Law School, will be the these issues, there has been a simultaneous Navy. Coming out of this favored fifth 1977 Guest Lecturer in the Rose expansion in the field of law con background, he chose to live with the Fitzgerald Kennedy Lecture Series. He cerning individual liberty and state in unfavored and neglected. will present a series of four lectures on terests as they affect decisions of life “Constitutional Theory and the Life and death such as the living will legis In Jean Vanier’s own words we are Sciences” in October, at Gaston Hall, lation in California, the Karen Anne given a glimpse of just what the message Georgetown University. Quinlan court case, and the Supreme of L’Arche is all about: C ourt’s decision on the rights of individuals Professor Tribe is the author of Channeling to obtain abortions. More and more the world seems to be Technology Through Law and is dividing itself into two. On the one hand there are those motivated by the accumulation the co-author of Environmental Protection It is Professor Tribe’s hypothesis that o f riches, by the need to possess, and and When Values Conflict, a recent the development of Constitutional by the need to dominate and be above book of essays on environmental technology theory can be used to influence the di others. On the other hand there are those . He has also written several articles rection that biomedical science and who live in involuntary poverty and misery on environmental law, technology technology takes today, and he is especially and who are in some way marginal to assessment, and policy science for such sensitive to the important role society (the aged, the handicapped o f all kinds, the alcoholics, the mentally ill, and journals as The Southern California that law can play in shaping the earlier so forth, and those who live in misery in Law Review, Philosophy and Public Affairs stages in biomedical scientific and tech the developing countries). Is not the great , and the Harvard Law Review. nological advance. By planning sound challenge o f the day to create communities legal parameters, the Life Sciences m. which by their joy and simplicity of life continue to enhance rather than de draw the “rich” towards a life of greater The Kennedy Institute has long been simplicity and self-gift, and that draw the involved in a wide range of questions stroy the life and dignity of man. Dr. miserable towards a new hope? . . . Do we that concern bioethicists as well as the Tribe has been a frequent visitor to the not need communities of those who choose courts and lawyers. As the Kennedy Institute in the past year. poverty, happy to share their lives with the rejected in order to create a bridge between the two worlds?

Little more than a decade after he began his first home with his friends, Jean Vanier has seen his dream expand as others have joined him around the world in creating little village communities where all its members are helped to develop to their fullest potential as human beings. He will give the fourth Rose F. Kennedy Lecture on is subject in October.

Professor Laurence H. Tribe. 14

Kennedy Institute Invites Two Mrs. Rose Fitzgerald Kennedy to Be European Cardinals to 1978 Awarded Degree

Rose F. Kennedy Lectures On Saturday morning, October 1, 1977 Georgetown University will confer the Cardinal Franz König of Vienna, and led him into Oriental studies as well as degree of Doctor of Humane Letters Cardinal Jan Willebrands of Utrecht inquiry into two of the great “isms” of upon Mrs. Rose F. Kennedy. Mrs. have been invited to lecture in the 1978 our times—Communism and Atheism. Kennedy is being honored in particular Rose Fitzgerald Kennedy Lecture Series Since Vatican II he has sought to find a for her many philanthropies, particu . Both Cardinals are known and respected “basis for accom m odation” with Communists larly in the field of Mental Retardation for their diligent promotion of and Atheists. An account of the Ceremonies will be ecumenism. During the sessions of contained in the next issue of the Vatican II they sought to bring into Modern science and natural history Quarterly Report. dialogue people of diverse backgrounds have questioned long accepted “truths,” and beliefs. some of which were integral parts of the Old and New Testaments. Cardinal As Secretary of the Secretariat for Promoting König has emphasized that changing Christian Unity, Cardinal Wille science has in no way interfered with brands helped make it possible for either divine inspiration or inerrancy. leaders of the Roman Catholic and In his book, The Hour Is Now (translated Russian Orthodox faiths to meet together by Herbert W. Richardson, Harper for the first time in centuries. He 8c Row, 1975, from the original Die has also promoted constructive ex- Stunde Der Welt, 1971), he wrote: changes between Christians and Jews.

The natural sciences have, for several centuries The Cardinal was formerly a Professor , also developed new methods o f gaining of Philosophy and while little of his knowledge. Technological man lives in work has been translated into English, terms o f his experimentally gained knowledge he has written extensively in French, . Contemporary man has quite different German and Italian on the topics of expectations in the religious realm than did the people who lived quietly on religious liberty and ecumenism. farms during past ages. Science brings many new questions. If we don’t deal with Cardinal König is the author of a three- these questions and expectations, then we volume work on comparative religion as ourselves will be guilty if technologically well as a number of other books and oriented people don’t find their way to God and the Church, but are lost in con- articles. His intellectual researches have fusion.” 15

has been a member of the faculty in the which will assist him in expanding his Visiting Institute’s Total Immersion Course. teaching program at Fairfield University . Research Dr. Fletcher spent a year as a Fulbright scholar at the University of Heidelberg Scholars and went on to serve for seven years in Joan Sieber, Ph.D. is Professor of Psychology Episcopal parishes in Alabama and Virginia at the State University of Calif . He then entered the Union Theological ornia. She is an expert in cognitive development Patricia King, J.D., Associate Professor and related socialization Seminary in New York and was of Law at Georgetown University Law processes, especially in children. Dr. awarded his Th.D. in 1969. His dissertation School, has been appointed as a Visit-Research Sieber has accepted an appointment as , “A Study of the Ethics of Medical Scholar for the fall academic a Senior Visiting Research Scholar at Research,” reflected an early interest in term. She is a member of the the Institute. She will also do extensive ethics and medicine. His teaching and Joint Commission on Prescription Drug consulting work for the National Science writing continue to be focused on these Use, and a Commissioner of the National Foundation. Dr. Sieber, who is a issues, and he has done novel work with Commission for the Protection former Associate Editor for the Journal human subjects involving informed of Human Subjects in Biomedical and of Applied Social Psychology is editing consent and amniocentesis. Several recent Behavioral Research. a forthcoming issue of the Journal of articles of Dr. Fletcher have been Social Issues on “The Ethics of Re- concerned with critical choices in the Professor King will be concentrating on search on Social Issues.” She is also care of defective newborns. research and writing on the interface working on the ethics of behavioral between bioethics and the law during research and hopes to complete a Dr. Fletcher will work part time at the her time at the Kennedy Institute. In manuscript on the subject while at the Clinical Center of the N.I.H. to help addition to her research and writing, Institute. think through ethical questions relating she will continue her full time teaching to the work in that facility. His extensive at the Law Center. One seminar, entitled experience in clinical, theoretical, “Decisions in Human Experimentation and pastoral work in medical ethics will and Treatm ent,” will give Georgetown be a great asset to N.I.H. and the Kennedy law students an opportunity to Institute. explore current issues in an area of bioethics in which she is well qualified to teach. Vincent Burns, S.T.D., S.J., Professor of Moral Theology, has received a one- year appointment as a Visiting Research John C. Fletcher, Th.D., will be a Visiting Scholar at the Center for Bioethics. He Research Scholar at the Center for comes to us from Fairfield University, Bioethics beginning Fall 1977. Dr. the Jesuit College in Connecticut, Fletcher is a prominent Episcopalian where he teaches bioethics in the School ethicist who was formerly the Head of of Nursing. 11NTERMET (the Washington Metropolitan Area Interfaith Seminary). He During his stay at the Kennedy Institute he will be doing research and writing 16

Dr. Mokrohisky Dr. Mokrohisky firmly believes that Dr. Kadlec there is an increasing need for ethical expertise in the training of nurses and Pediatrics and doctors, and he feels that teachers with Immunologist to experience in clinical medicine and in Bioethics the handling of difficult ethical situa Study Bioethics tions are more likely to win respect for formal ethics education in the medical Dr. Stefan T. Mokrohisky will be joining and nursing school setting. Josef Kadlec M.D., Ph.D., S.J., will be a the Kennedy Institute this fall as a Ph.D. candidate in Bioethics at Georgetown degree candidate in Bioethics with a His medical training in pediatrics has University this fall, arriving from unique set of credentials. He is a Nor given him a particular interest in the the University of London where he has bertine Monk who has just completed process of development in terms of just completed his Bachelor of Divinity his residency in Pediatrics at the University human potential. “Regardless of the degree and been ordained a priest into of Colorado Medical Center in starting point,” he noted, “the right to the Jesuit community of the U.K. Denver. During 1976-1977 he served as be involved in that process must be preserved an Instructor in the Dept, of Pediatrics for all persons, including the Father Kadlec’s background is truly re- as well as being Chief Resident of the mentally retarded.” markable. Born in Prague, he studied Colorado General Hospital Pediatrics medicine and became a physician in program. In addition to his studies here, he will 1953. He then specialized in medical be available to the U.A.F. where he will microbiology and immunology and In addition to fulfilling all of his clinical continue his clinical work with the from 1953-1965 he held a number of duties, Dr. Mokrohisky also played mentally retarded. positions in research, teaching, and an important role in the Colorado practice in immunology, allergy, and infectious Medical Center in stimulating interest disease control in Czechoslovakia in bioethical problems. He established . By 1967 he had received a Ph.D. within the Pediatrics Dept, a monthly in Microbiology and had become a ethics conference which he chaired, Consultant with the Pan-American where problem cases were reviewed Health Organization-World Health and discussed. This was well attended Organization, operating out of Caracas by medical students, housestaff and , Venezuela and working on the control faculty. He has not been afraid to face of infectious diseases in the whole very tough and difficult issues for medical Caribbean area. centers, including an open dialogue with Denver newspapers and their re- Defecting from Czechoslovakia, he became porters regarding the bounds of their a Venezuelan citizen, joined the coverage of patients with special problems Society of Jesus in 1971, and returned . to Europe to study philosophy and the ology, this time in London. 17

In addition to studying bioethics, The Rev. Bruno Schuller, S.T.D., S.J. Father Kadlec will also be studying the of the Westfälische Wilhelms-Universita latest advances in immunology and at Münster, Germany, will be a Senior microbiology at the Georgetown Medical Research Scholar at the Kennedy Institute Center. . He is a world expert on moral German Theologian principles and the relationship of other It is planned that Fr. Kadlec will return Appointed Senior disciplines, particularly the natural to England to assume a leadership position sciences, to these moral principles. in bioethics. With doctorates in Research Scholar Known as a theologian’s theologian, Clinical Medicine, Basic Science and Father Schüller is an extremely well respected Bioethics he will be uniquely qualified critic. When theologians are for the task. breaking new ground, they often seek the comments of Father Schüller. If their work can withstand his critical inquiry, then it is likely to stand up to any other review to which it may be subjected.

Father Schüller has been appointed to a permanent position at the Kennedy Institute and he will spend two months at the Institute in the fall and two more in the spring during which he will devote himself to research and writing. In the months he is away from the Kennedy Institute he will continue his work in Münster where he holds the Chair in Moral Theology. His presence at the Kennedy Institute will contribute to the ecumenical international spirit that the Kennedy Institute fosters by bringing noted European theologians to the United States. Rev. Bruno Schuller 18

Recent Publications of Kennedy Institute Scholars

The following is a listing of book length publications by Senior Research Scholars and Visiting Scholars since the latter half of 1975. Several of these books were released after the departure of a Visiting Scholar yet are listed below since they were based on work done at the Institute.

Over 150 articles were also published by the Kennedy Institute Scholars during this period, in such journals as the American Philosophical Quarterly, The Monist, the Journal of the American Statistical Association, the Journal o f the American Medical Association, Industrial Gerontology, the Journal o f Comparative Family Studies, The New England Journal of Medicine, Judaism, Hospital Progress, Quaker Religious Thought, Pediatric News, and many, many others. Connery, John R. Shryock, Henry S., Siegel, Jacob S., and We are certain that significant bioethics Abortion: The Development of the Roman Associates. Catholic Perspective. The Methods and Materials o f Demography. articles by our Scholars will continue Chicago: Loyola University Press, 1977. Condensed Edition by Edward G. Stockwell, to be well represented in the important New York: Academic Press, 1976. journals. A full list of articles published Haring, Bernard. by Institute Scholars since its inception The Ethics o f Manipulation: Issues in Siegel, Seymour. Conservative Judaism and Jewish Law. in 1971 can be obtained from the Institute Medicine, Behavior Control and Genetics. New York: Ktav Publishing Co., 1977. at cost. New York: Seabury Press, 1975. Published in England under title: Manipulation; Ethical Boundaries o f Medical, Veatch, Robert M., and Branson, Roy, eds. Ethics and Health Policy. Beauchamp, Tom L., ed. Behavioral & Genetic Manipulation. Cambridge, Mass.: Ballinger Publishing Co., Ethics and Public Policy. Slough, England: St. Paul Publications, 1975. 1976. Englewood Cliffs, N.J.: Prentice-Hall, 1975. Perlin, Seymour, ed. Walters, LeR oy, ed. Beauchamp, Tom L., and Barker, Stephen F., A Handbook for the Study o f Suicide. eds. New York: Oxford University Press, 1975. Bibliography o f Bioethics. V ol. II. Thomas Reid: Critical Interpretations. Paperback, 1976. (Reprinted 1977). Detroit: Gale Research Co., 1976. Philadelphia: Philosophical Monographs, University Published in Swedish-language edition. City Science Center, 1976. Stockholm, Sweden: Natur och Kultur, 1977. Walters, L eR oy, ed. Bibliography o f Bioethics. V ol. III. Detroit: Gale Research Co., 1977. 1£

Demography The Kennedy Institute Scholars ANDRE E. HELLEGERS, M.D Director o f the Institute Library WILLIAM P. KELLY. JR.. M.A. Associate Director of the Institute

A visitor to the Kennedy Institute’s LE ROY WALTERS. PH.D. Center for Population Research Library Director o f the Center for Bioethics on the third floor of the D.C. Transit TOM L. BEAUCHAMP. PH.D Building at 3520 Prospect Street would ROY BRANSON. PH.D. find several rooms of books, reference VINCENT BURNS. S.J.. S.T.D. materials, reprints, and all the major JAMES F. CHILDRESS. PH.D. H. TRISTRAM ENGELHARDT. JR.. M.D.. journals currently being written in the PHD English language on demography and JOHN C. FLETCHER. TH.D. population studies. Librarian Joan Helde JOHN C. HARVEY, M.D.. TH.M. PATRICIA A. KING, J.D. says, “The prime reason for this library’s SID Z. LEIMAN. PH.D. existence is to support the M.A. in RICHARD A. McCORMICK. S.J.. S.T.D. Demography Program of Georgetown SEYMOUR PERLIN. M.D. WARREN T. REICH. S.T.D. University and the research activities of BRUNO SCHULLER. S.J., S.T.D. the staff here at the Center.” JOAN SIEBER. PH.D.

CONRAD TAEUBER, PH.D. Reference materials include U.S. Census Director o f the Center for Population Research Reports from the 1970 Census which have come out in 262 separate reports, Joan Helde, Librarian CHRISTINE BACHRACH. M.A. LEON F. BOUVIER. PH.D. as well as all Vital Statistics of the DEBORAH DAWSON. M.A. United States and other publications Library and these materials, as MURRAY GENDELL. PH.D. from various government departments well as those not urgently needed in the HAITUNG KING. PH.D. Demography Library, are being donated THOMAS W. MERRICK. PH.D. and agencies, that are basic to demo- JEFFREY S. PASSEL. PH.D. graphic research. All papers written by to Georgetown’s Lauinger Library JEANNE C. RIDLEY. PH.D. past and present scholars at the Center . HENRY S. SHRYOCK. PH.D. JACOB SIEGEL. M.A. for Population Research are on file. An BETH J. SOLDO, PH.D. acquisitions list is put out regularly for The Library maintains good relations distribution at the Center. with the Population Reference Bureau PAUL BRUNS. M.D. Director o f the Laboratories for and participates in interlibrary loans Reproductive Biology A number of Kennedy Institute Scholars with other facilities such as the Joint , such as Dr. Taeuber and Dr. Shry Bank Fund Library of the World Bank ROBERT C. BAUMILLER. S.J., PH.D. ROBERT CEFALO. M.D.. PH.D. ock have made personal contributions and the International Monetary Fund. RONALD CHEZ. M.D. of materials to the Library. This past Librarian Joan Helde has been elected DESSOUKY A. DESSOUKY. M.D. the Demography Center became Treasurer of the local Washington- PETER RAMWELL. PH.D. JOHN J. SCHRUEFER, M.D. primary recipient of the extensive Baltimore Chapter of the International JOAN SIMKOVICH. M.D.. PH.D. library collection of Dr. Dorothy Association of Population Libraries and Swaine Thomas. A number of her books Information Centers. and other materials are duplicates of Dorothy Rainey those previously acquired by the Demography The Kennedy institute Quarterly Re- port is published by the Kennedy Institute , Georgetown University, Washington , D.C. 20057

Carol Hetler, Editor Contributing Editors: Dorothy Rainey Lynn Taylor Erla Zwingle

Third class postage paid at Andre E. Hellegers, M D Washington, D.C.

student, Mr. Ray Capone4. I have dab- Encyclopedia of A Note from bled in such speculations myself5. Bioethics Project the Director What particularly strikes me is that all of us—and many others—have debated Completed the merits of disease curing or preventing The article by Mr. James Ferrara (M.A., as against maximizing an individual’s All manuscripts to be included in the Oxon) is notable for two reasons: to fitness or health; disease abolition forthcoming Encyclopedia of Bioethics, begin with, it is the first time that a versus health enhancement, if you like. the first comprehensive work of its medical student has contributed to these What becomes so clear is that Mr. Ferrara's kind in the field of bioethics, have now pages. That is as should be, for students treatm ent of the plight of the retarded been delivered to the publisher, and a are a major constituency of the Kennedy is precisely an advocacy of May 1978 publication date has been Institute. Of course, not every student talent enhancement, rather than disease set. The compilation of the Encyclopedia receives a full premedical plus a full curbing. That is what the needs of the and the editing of all the manuscripts classical education at the undergraduate mentally retarded so clearly demand at has been an on-going project at level, as Mr. Ferrara did at Xavier University this juncture. The mentally retarded are the Kennedy Institute for the past five . Neither do students usually therefore not just paradigmatic for the years under the direction of Warren T. take their junior year in philosophy at debate on ethical protection of the Reich, Editor-in-Chief. He reports that the Sorbonne. Nor do many, if indeed powerless. They are also paradigms for The Free Press, a Division of the MacMillan any, proceed to read Classical Greats at the reflection upon the duties of health Publishing Co., Inc., plans to Oxford, as Mr. Ferrara did. In fact, care systems and the great philosophical bring out the 1-1/2 million word Encyclopedia nowadays, only 100 or so students per debates on what the so-called Health in a set of four volumes for year have the wits to do Classical Professions are about. Both the article approximately $180. Greats at Oxford at all. The odds on and the author are welcome additions their winding up in medical school to the Institute. There will be a total of 309 articles in would baffle Jimmy the Greek. the Encyclopedia. Each article will con 1. Kass, Leon R. tain a comprehensive bibliography; in But the second reason for considering “Regarding the End of Medicine and the Pursuit addition, the Editors have compiled for of Health,” Public Interest No. 40: 11-42, Summer this a noteworthy event is that Mr. Ferrara each article an extensive cross-referencing deals with the subject of mental 1975. guide to the entire Encyclopedia. retardation, the primary concern of the 2. Neale, Ann. The Concept o f Health in Medicine: A Philosophical Kennedy family for whose parents this Persons wishing to be included in the Institute was named. Mr. Ferrara rightly Analysis. Ph.D. Dissertation, Georgetown University, September 1975. pre-publication notification list, should draws attention to the paradigmatic send requests to The Kennedy Institute 3. Branson, Roy. nature of the plight of the retarded. He attention, Managing Editor, Encyclopedia does it in a way which parallels other “The Secularization of American Medicine.” Hastings Center Studies 1 (2) : 17-28, 1973. of Bioethics. issues with which this Institute has grappled, most notably the issue of 4. Capone, Ray, what is health and what might be the “Conceptual Problems in Defining H ealth.” Unpublished paper, 1973. medical profession’s role in maximizing it. Dr. Leon Kass wrote on that subject 5. Charles Sumner Bacon lecture, delivered at The from this Institute1 as did Dr. Anne Abraham Lincoln School of Medicine on March 5, 1975, Obstetrics and Gynecology Annual, Neale2, Dr. Roy Branson3, and a college 1977.