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Bioethics as a field is relatively new, emerging only in the late 1960s, though many of the questions it addresses are as old as medicine itself. When Hippocrates wrote his now famous dictum Primum non nocere (First, do no harm), he was grappling with one of the core issues still facing human medicine, namely, the role and duty of the physician. With the advent of late-twentieth-century science, an academic field emerged to reflect not only on the important and age-old issues raised by the practice of medicine, but also on the ethical problems generated by rapid progress in technology and science. Forty years after the emergence of this field, bioethics now reflects the profound changes in medicine and the life sciences.
Nature and Scope of Bioethics
Against the backdrop of advances in the life sciences, the field of bioethics has a threefold mission: (1) to raise important questions about the general practice of medicine and the institutions of health care in the United States and other economically advanced nations, (2) to wrestle with the novel bioethical dilemmas constantly being generated by new biomedical technologies, and (3) to challenge the presumptions of international and population-based efforts in public health and the delivery of health care in economically underdeveloped parts of the globe. While attention to the ethical dilemmas accompanying the appearance of new technologies such as stem cell research or nanotechnology can command much of the popular attention devoted to the field, the other missions are of equal importance.
At the core of bioethics are questions about medical professionalism, such as: What are the obligations of physicians to their patients? and What are the virtues of the "good doctor"? Bioethics explores critical issues in clinical and research medicine, including truth telling, informed consent, confidentiality, end-of-life care, conflict of interest, nonabandonment, euthanasia, substituted judgment, rationing of and access to health care, and the withdrawal and withholding of care. Only minimally affected by advances in technology and science, these core bioethical concerns remain the so-called bread-and-butter issues of the field.
The second mission of bioethics is to enable ethical reflection to keep pace with scientific and medical breakthroughs. With each new technology or medical breakthrough, the public finds itself in uncharted ethical terrain it does not know how to navigate. In the twenty-first century—what is very likely to be the "century of biology"—there will be a constant stream of moral quandaries as scientific reach exceeds ethical grasp. As a response to these monumental strides in science and technology, the scope of bioethics has expanded to include the ethical questions raised by the Human Genome Project, stem cell research, artificial reproductive technologies, the genetic engineering of plants and animals, the synthesis of new life-forms, the possibility of successful reproductive cloning, preimplantation genetic diagnosis, nanotechnology, and xenotransplantation—to name only some of the key advances.
Bioethics has also begun to engage with the challenges posed by delivering care in underdeveloped nations. Whose moral standards should govern the conduct of research to find therapies or preventive vaccines useful against malaria, HIV, or Ebola—local standards or Western principles? And to what extent is manipulation or even coercion justified in pursuing such goals as the reduction of risks to health care in children or the advancement of national security? This population-based focus raises new sorts of ethical challenges both for health care providers who seek to improve overall health indicators in populations and for researchers who are trying to conduct research against fatal diseases that are at epidemic levels in some parts of the world.
As no realm of academic or public life remains untouched by pressing bioethical issues, the field of bioethics has broadened to include representation from scholars in disciplines as diverse as philosophy, religion, medicine, law, social science, public policy, disability studies, nursing, and literature.
History of Bioethics
Bioethics as a distinct field of academic study has existed only since the early 1960s, and its history can be traced back to a cluster of scientific and cultural developments in the United States during that decade. The catalysts for the creation of this interdisciplinary field were the extraordinary advances in American medicine during this period coupled simultaneously with radical cultural changes. Organ transplantation, kidney dialysis, respirators, and intensive care units (ICUs) made possible a level of medical care never before attainable, but these breakthroughs also raised daunting ethical dilemmas the public had never previously been forced to face, such as when to initiate admission to an ICU or when treatments such as dialysis could be withdrawn. The advent of the contraceptive pill and safe techniques for performing abortions added to the ethical quandaries of the "new medicine." At the same time, cultural changes placed a new emphasis on individual autonomy and rights, setting the stage for greater public involvement and control over medical care and treatment. Public debates about abortion, contraceptive freedom, and patient rights were gaining momentum. In response, academics began to write about these thorny issues, and scholars were beginning to view these "applied ethics" questions as the purview of philosophy and theology. "Bioethics"—or, at the time, "medical ethics"—had become a legitimate area of scholarly attention.
In its early years, the study of bioethical questions was undertaken by a handful of scholars whose academic home was traditional university departments of religion or philosophy. These scholars wrote about the problems generated by the new medicine and technologies of the time, but they were not part of a discourse community that could be called an academic field or subject area. Individual scholars, working in isolation, began to legitimize bioethical issues as questions deserving rigorous academic study. But bioethics solidified itself as a field only when it became housed in institutions dedicated to the study of these questions. Academic bioethics was born with the creation of the first "bioethics center."
Ironically, academic bioethics came into existence through the creation of an institution that was not part of the traditional academy. The first institution devoted to the study of bioethical questions was a freestanding bioethics center, purposely removed from the academy with its rigid demarcations of academic study. The institution was the Hastings Center, originally called The Institute of Society, Ethics and the Life Sciences, which opened its doors in September 1970. Its founder, Daniel Callahan, along with the psychiatrist Willard Gaylin, M.D., created the center to be an interdisciplinary institute solely dedicated to the serious study of bioethical questions. Callahan, a recently graduated Ph.D. in philosophy, had been one of the isolated scholars working on an issue in applied ethics, and he had found himself mired in complex questions that took him far afield from the traditional boundaries of philosophy. His topic, abortion, required engagement with the disciplines of law, medicine, and social science, which he felt himself unprepared to navigate. With academic departments functioning as islands within a university, it seemed that truly interdisciplinary work was impossible. The Hastings Center was founded to create an intellectual space for the study of these important questions from multiple perspectives and academic areas.
The second institution that helped solidify the field of bioethics was the Kennedy Institute of Ethics, which opened at Georgetown University in 1971. The founders had similar goals to those of Hastings, though they placed their center inside the traditional academy. While housed outside of any particular academic departments, the Kennedy Institute came to look more like a traditional department, offering degree programs and establishing faculty appointments along a university model.
From these modest beginnings, the field of bioethics exploded, with dozens of universities following suit, creating institutions whose sole function was the study of bioethical issues. Its growth was fueled by the appearance both of new technologies such as the artificial heart and in vitro fertilization and new challenges such as HIV. Bioethics was now permanently on the academic map and central to public discourse.
Institutions of Bioethics
Since the early 1970s, as bioethics has gained legitimacy, there has been an increasing trend of bioethics centers becoming academic departments. Originally modeled on the structure of an independent "think tank," the bioethics centers of the early twenty-first century are often housed within either a medical school or school of arts and sciences, indistinguishable in structure from any other departments in those schools. The professionalization of bioethics has taken it from the academic margins to the center, and with this development has come all of the trappings of traditional academics, such as tenure, degree programs, professional conferences, and academic journals.
Beginning in the 1980s, medical schools began housing bioethics institutes either as departments of medical ethics or departments of medical humanities. Located within an undergraduate medical school, the duties of these departments include the ethics education of the M.D. students. Whereas the original bioethics centers had as their primary focus the production of scholarly research, departments of bioethics have pedagogical obligations and are viewed as institutions designed to serve the narrower educational mission of the school. Bio-ethics institutions that are instead housed within a school of arts and sciences have the same type of pedagogical obligations, though perhaps serving a different student population, namely, university undergraduates or graduate students. Departments of bioethics, depending on their configuration, offer traditional undergraduate or graduate courses, undergraduate majors or concentrations, graduate degrees (usually master's degrees), undergraduate medical school ethics training, and/or residency ethics training. By the early twenty-first century, there were more than sixty master of bioethics programs in the United States, attracting a diverse student population including recent undergraduates; students pursuing joint J.D., M.D., and Ph.D. degrees; and midcareer professionals from the fields of law, medicine, and public policy whose work requires specialty training in the field of bioethics.
Another result of the professionalization of bioethics was the pressure to publish in traditional scholarly venues, such as academic journals. But the formation of a new academic field of study necessitated the creation of academic journals in which to publish these novel scholarly works. Journals emerged that were designed solely for works in the field of bioethics, including the Hastings Center Report, the Kennedy Institute of Ethics Journal, the American Journal of Bioethics, and Bioethics. But the mainstreaming of bioethics into the academy also opened up space within traditional medical and scientific journals for scholarly works in bioethics. Research in bioethics is now routinely published in the likes of the Journal of the American Medical Association, the New England Journal of Medicine, Science, and Nature.
Perhaps the institution most effectively used within the field of bioethics is the Internet. All major bioethics institutes, centers, and departments (and some journals) have elaborate Web sites, not only offering information about the specific institution, faculty, and degree programs, but also undertaking an educational mission to raise the level of public debate about current bioethical issues. These Web sites offer substantive information for individuals seeking to become better informed about these issues. One of the most developed Web sites is the companion site to the American Journal of Bioethics (www.bioethics.net). This Web site not only offers actual scholarly works in the field but also includes a high school bioethics project, job placement information, a "Bioethics for Beginners" section, and a collection of bioethics news stories from the popular press, updated daily, with direct links to the original news articles.
The Methods of Bioethics
The founders of the field of bioethics and its first leaders were largely theologians or philosophers. Reflecting the scholarly conventions of their home disciplines, the first works in bioethics centered on a normative analysis of bioethical issues, arguing for or against the moral permissibility of a particular technology, practice, or policy. Starting in the 1970s, these philosophers and theologians were joined by physicians and lawyers, who too made normative claims about bioethical problems. But by the mid-1990s, bioethics was attracting populations of scholars who had not previously been well represented in the field, namely, social scientists and empirically trained clinicians, both physicians and nurses. With the entry of these new groups of scholars, the "methods" of bioethics began to shift, mirroring the methodologies of the new disciplines becoming central to the field. With this change, bioethics included not only normative analysis but also the empirical study of bioethical questions, what Arthur Caplan has called "empiricized bioethics."
Empiricized bioethics takes one of two forms: either it seeks to collect empirical data needed to shed light on a bioethical problem, or it attempts to stand outside the discipline in order to study the field itself. Projects taking the first form use either qualitative or quantitative social science methodology to collect data needed to make persuasive bioethical arguments. These empirical studies might explore, for example, patient comprehension of medical information, patient and family experience with medical care, the ability of children or incompetent adults to give consent for research participation, or the frequency with which practitioners face particular ethical dilemmas.
Projects taking the second form explore the way in which the field of bioethics is evolving, the influence it has had on policy formation, the methods and strategies it employs, the field's understanding of itself, and its place in public life and contemporary academia. One very prominent contemporary method employing this strategy is narrative bioethics, or what might be called "deconstructionist bioethics." Using the insights of literary criticism, these bioethicists examine the discourse of the field to reveal its biases, conventions, and assumptions, making the field more self-reflective about its motives and goals. Along the same line, the field has seen the development of feminist bioethics and disability bioethics, both of which focus on issues of inclusion and exclusion, voice, and their confluence on particular substantive issues. Altogether, the empirical methods of bioethics have been so well received in the field that by the early twenty-first century, all bioethics centers and departments had representation from the social sciences or clinical medicine, and in many cases the empiricists constituted the majority of center or department membership.
One final methodology that has had a significant presence in medical humanities departments is literary analysis, in which literary texts are used as a vehicle for the ethics education of clinicians in training. These medical humanists use first-person illness narratives or first-person testimonies from clinicians, as well as important works in fiction, to teach health care professionals about the ethical issues involved in being both patient and practitioner.
Current Issues in the Field: Bioethics
in the Early Twenty-First Century
The bioethical issues being addressed by the field are too numerous to count, but the flavor of bioethics in the early twenty-first century can be conveyed by an exploration of the bioethical implications of genetic research, health care access reform, and stem cell research, arguably the most pressing issue in the field to date.
Advances in the science of genetics, including the Human Genome Project and the ability to find genetic markers for particular diseases, have raised difficult ethical dilemmas. Two of the most pressing issues are preimplantation genetic diagnosis and the genetic testing of adults. With the technology to identify inherited diseases in the early embryo comes questions about which embryos ought to be implanted, which diseases constitute a legitimate moral reason to discard an embryo or become the criterion for embryo selection, which traits ought parents be allowed to select or test for, and who ought to have access to this technology and on what grounds. For example, while there might be widespread support for testing embryos that might carry the trait for Tay-Sachs disease or cystic fibrosis, there are troubling questions about selecting embryos on the basis of sex, nonlethal trisomes (such as Down's syndrome), or aesthetic or character traits that technology may someday be able to screen for. In adult medicine, genetic tests already exist to detect mutations leading to some forms of inherited breast cancer and to Huntington's disease. Here, questions arise about privacy of health care information, psychological impact, stigmatization, lack of informed consent, health insurance access, and familial disclosure. With the advent of commercial genetic testing centers, patients will soon have easy access to genetic tests independent of the practice of clinical medicine, without the benefit of genetic counseling services, professional psychological support, or adequate, and possibly accurate, clinical information. The Internet, for example, will likely bring universal access to any genetic test as it becomes available.
Emerging Issues for the Future
As the twenty-first century unfolds, new and expanding areas of research will require increasing attention to their related ethical aspects.
Knowledge about the human brain holds much promise and offers much needed hope to those who suffer from disorders of the brain and mind. The relative accessibility of the brain through biochemical, electrical, and magnetic stimulation, as well as surgery, makes neurological interventions tempting as knowledge of brain structure, wiring, and chemistry grows. Nevertheless, there has been little systematic analysis of the ethical implications of the revolution in the brain sciences. This revolution raises numerous ethical questions and issues:
- The "essence" of personhood and identity
- The relation between physiological structures and higher functioning ("mind" or "self")
- The ways in which abnormalities in the brain might account for atypical or antisocial human behavior
- The acceptability of using pharmaceuticals, implants, or other interventions to enhance innate traits such as memory, attention span, or musical ability
- The legitimacy of intervening to alter aspects of personality, mood, or emotion; to assess the effectiveness of treatments or incarceration in modifying criminal behavior; or to detect predispositions to both desirable and undesirable behavior in persons who cannot themselves consent
New knowledge of the brain will soon have an enormous impact on the legal and penal systems. How to integrate knowledge of the brain into the practice of forensics, the prosecution of persons accused of crime, and the screening of those seeking parole are all issues likely to become pressing in the not-too-distant future. Equally controversial will be the use of new knowledge about the brain in the detection and prevention of the onset of undesirable behavior in adolescents and children and in trying to improve or enhance their capabilities and skills.
While there has been much attention in bioethics to the mapping of the human genome and to the nuclear transfer techniques used to clone Dolly the sheep and other animals, the most provocative genetics-related issue facing society during the first half of the twenty-first century is likely to be to what extent ought humans design their children. Rudimentary steps toward making eugenics a reality are all around us.
The finalization of a crude map of the human genome and other animal and plant genomes means that medicine will soon have at its disposal a huge amount of information about the contribution genetics makes to a wide variety of traits, behaviors, and phenotypic properties. In addition primitive efforts to introduce genes into the cells of the human body through gene therapy will be refined to the point at which genetic surgeons should be able to introduce targeted genes with specific functions into both somatic cells (cells in a person's body) and germ-line cells such as the stem cells in the testicles that create sperm in a man's body. And the ability to analyze the genetic makeup of sperm, eggs, and embryos has already led to some infertility clinics offering genetic testing for diseases as a part of their standard care for their clients. This means that parents of tomorrow, both infertile and fertile, will increasingly look to medicine to diagnose potential problems and risks before babies and children are created. The issue will not be whether humans should design their children but to what extent and with what if any limits on how far one may go to improve, enhance, and optimize them.
When should a person die?
Another fascinating emerging ethical issue is whether humanity should seek to control the time of death. It is one thing to agree that individuals who are dying have the right to withdraw or not initiate medical treatments. It is quite a different matter to say that someone who is not terminally ill but is suffering from a terribly disabling chronic condition, a severely diminished quality of life, or the prospect of decades of life in a state of dementia or extreme frailty should have the right to medical or technological assistance in dying as is already the case in the Netherlands, the state of Oregon, and Colombia. The focus of these debates, however, has been almost exclusively the terminally ill. As the population of the world ages over the course of the twenty-first century, more and more persons may begin to ask or demand the right to control the timing of their death, whether they are deemed terminally ill or not.
See also Biology ; Death ; Eugenics ; Life ; Medicine: Europe and the United States .
Callahan, Daniel. "Bioethics as a Discipline." Hastings Center Studies 1, no. 1 (1973): 66–73.
Caplan, Arthur L. Am I My Brother's Keeper? The Ethical Frontiers of Biomedicine. Bloomington: Indiana University Press, 1997.
Jonsen, Albert R. The Birth of Bioethics. New York: Oxford University Press, 1998.
Reich, Warren T. "The Word 'Bioethics': Its Birth and the Legacies of Those Who Shaped Its Meaning." Kennedy Institute of Ethics Journal 4, no. 4 (1994): 319–336.
Rothman, David J. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. 2nd ed. New York: Aldine de Gruyter, 2003.
Stevens, M. L. Tina. Bioethics in America: Origins and Cultural Politics. Baltimore: Johns Hopkins University Press, 2000.
Arthur Caplan
Autumn Fiester
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The term "bioethics" is derived from the Greek words bios, meaning life, and the Greek word ethos, meaning character. The meaning is essentially "life character." Today, ethics might be better described as applied morals or the philosophy of being moral, with bioethics being the discussion or application of morals within the diverse fields of the life sciences.
The quest for better health has guided scientists and researchers to develop many tools for analysis including organic chemical synthesis and improved genetic engineering. A significant aspect of contemporary medical research is the use of animals as test subjects. Many advances in personal care products, pharmaceutical drugs, and life-saving medical treatments have come about through the use of animals for testing and research. However, this practice is controversial.
Many people feel that animals are abused and mistreated for unnecessary research. The use of animals to test the safety of household or personal care products angers those who feel that humans are unfairly abusing animals for commercial gain. In contrast, scientists point out that animals are the most reliable indicators of potential human response to certain diseases and treatments, and that many successful, life-saving treatments and medical breakthroughs have emerged only because it is possible to test treatment options using animals, rather than human beings.
Unfortunately, some of these discoveries have come at the cost of the natural or induced death of test animals. So the ethical situation arises: Does the benefit of the new data outweigh the risk to the organism, or is the risk greater than the benefits? What may be considered unacceptable to one person may be an acceptable trade-off to another. To address this dilemma, bioethicists attempt to set reasonable restrictions and limits on experimentation so as to maintain a balance between the suffering of experimental animals and the research benefits that may be derived from animal experimentation.
Ethics itself has long been coupled to philosophy and religion. Each person's moral viewpoint is constructed from a host of factors, including education, family background, religion, personal experiences, social level, economic standing, and profession. So if every researcher and every consumer can, hypothetically, hold different views about the relationship between risk and benefit, who is responsible for setting guidelines? And what is the foundation for such guidelines?
Bioethics and Research Institutions
A first step toward establishing ethical guidelines for animal testing has been taken by institutions in the United States that fund research, such as the National Institute for Health, the Food and Drug Administration, and the Agriculture Department. Their policies are primarily set by the public in the form of political action initiated by their elected representatives. The directors and boards of these institutions consider the opinions of their constituents when deciding what types of research to support.
Private institutions such as the Howard Hughes Foundation and Rockefeller Foundations set their policies through committee discussion groups and professional panels that make recommendations to the directors of the respective foundations. Their opinions are reflected in the programs the foundations choose to fund.
Finally, private businesses and corporations that fund this type of research generally use a board or panel approach and approve of experiments within the guidelines set forth in both state and federal law, with an eye to accommodating the general will of the public.
In each of these three cases, an advisory committee is usually composed of senior researchers of a particular discipline—for example, biotechnologists to examine biotechnology questions—plus a philosopher to provide some historical depth and background, and members of interest groups or other public representatives. These panels make their recommendations based upon consideration of current circumstances as well as the potential future impact of the relative costs and benefits of the proposed research.
What sorts of issues does a panel consider when looking at a given experiment? With regards to animal testing for a new pharmaceutical, the dialog generally contains several crucial elements. The first step is to identify an experimental need. For example, a company may wish to test a new drug that would destroy fatty deposits in coronary (heart) arteries. The pharmaceutical company needs to conduct experiments to ensure drug safety and identify any possible side-effects for humans. Since federal law requires that any drug be thoroughly tested with an accurate experimental model to understand its effects before it is approved, one of the first questions to consider is how this may be best accomplished.
A variety of systems are available to model a drug's behavior. These include microbial models (not suitable in this case); tissue models (the heart tissue model might provide very good information with no apparent negative effects); computer modeling (not always appropriate for finding actual data); and finally, animal models—which have the potential to provide the most accurate information about the drug's likely effect on human beings.
The question of ethics arises during this process. In contemporary American culture, we tend to value human life above the lives of animals. Supporting this view are such culturally accepted practices as the consumption of certain animals as food, the production of drugs such as insulin from animals, and the pursuit of the longstanding hobbies of hunting and fishing for recreation and relaxation. Not everyone agrees that all of these practices are acceptable, however.
Animal Rights vs. Human Lifestyle
The widespread use of animal life to maintain human life or lifestyle is a growing point of controversy . An increasing number of consumers are voicing the opinion that the use of animals in the development of products for human use should be restricted. This is especially true in regard to the cosmetics industry where products are used for appearance rather than health purposes. For example, many consumers, investors, and animal rights activists are offended by the ways in which a product like mascara may be tested on animals before it can be approved for human usage.
There are those who believe that animal testing may be acceptable if used to develop new drugs that may save human lives. The necessary data regarding performance and safety cannot be gathered any other way. But the practice of killing an animal every time a shampoo changes its color is disturbing to many of these same people. While this may seem extreme, this happens under current law because every time something is added to an existing formula the new combination must be retested for safety and effectiveness, and animals do not always survive such testing.
At first, one might question why it is necessary to go to such lengths to test a nonmedical product. But what if a shampoo's new color proved to harmful to human skin? Or caused hair to fall out? Most consumers agree that it is not acceptable to have less stringent safety standards for such products, and yet there is disagreement about what this means in regard to the ethics of animal testing. It is impossible to set absolute moral guidelines, since each case is unique, but for a variety of reasons, current law is set to err on the side of physical human safety.
Questions in Bioethics
Bioethics requires the asking of questions that go beyond current legal requirements. Are there ways to guarantee safe cosmetics and personal care products that do not involve the use of animals? If animal testing is the only sure way to guarantee product safety, are there ways to keep from harming animals in the process? One option gaining in popularity is to restrict animal testing to the most humane and painless tests possible. Restricting the use of animals to the final stages of testing is another way researchers are trying to balance human safety with animal comfort.
Another issue confronting bioethicists has to do with the removal of animals from the wild for research purposes. In particular, the use of wild chimpanzees and other primates is under scrutiny. The dilemma arises because the public does not appear to support continued harvesting of primates from wild habitats for research purposes, yet the chimpanzee, for example, is the animal most closely related to humans, and thus most desirable for testing potential medicines.
There is little disagreement that creative minds are needed to explore alternative methods of assessing the effects of chemicals on human beings. Increasing knowledge about the human genome, and the promise of genetic treatments for human disease, suggest that animals will continue to have a role in medical research. Those involved in the field of bioethics will constantly be challenged to assess how and when to use animals for this research.
The field of bioethics addresses more than just the question of how to manage conflicting priorities and approaches to animal testing. Now that geneticists have created clones of nonhuman species of vertebrates, there are increasing questions regarding the ethical use of human genetic material. Should researchers be allowed to try to clone human organs for life-saving transplants? Should human embryonic tissue be made available for stem-cell research? Should doctors be allowed to test gene therapy on human patients who have exhausted all other treatment options?
Scientists search for ways to apply a growing body of knowledge to the betterment of human life. Philosophers and others pose ethical questions concerning scientific advancement. Sellers of goods and services depend on the advancements of science to create and fill market needs. Bioethics is the field where life science, philosophy, and commerce meet, where practitioners negotiate boundaries, wrestle with guidelines, and seek balance within the natural world in the quest to improve the quality and quantity of human life.
see also Animal Rights; Animal Testing.
Brook Ellen Hall
Kuhse, Helga, and Peter Singer, ed. Bioethics: An Anthology. Malden, MA: Blackwell Publishers, 1999.
Shannon, Thomas A. Bioethics: Basic Writings on the Key Ethical Questions that Surround the Major, Modern Biological Possibilities and Problems. Mahwah, NJ: Paulist Press, 1994.
Veatch, Robert M. The Basics of Bioethics. Upper Saddle River, NJ: Prentice Hall, 1999.
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Bioethics refers to the systematic study of the moral aspects of health care and the life sciences. Physicians have always made decisions with significant moral components in the context of medical practice guided by the Hippocratic obligation to help patients without causing harm. This traditional medical morality nonetheless became insufficient to address the ethical issues that arose as medical practice changed over the course of the twentieth century to include more care by medical specialists, extensive use of complex medical technologies, and a trend toward dying in the hospital rather than at home. A series of controversies involving research with human subjects and the allocation of scarce new technologies (e.g., kidney dialysis and organ transplantation) made clear that the wisdom of physicians and researchers was inadequate to ensure the appropriate treatment of patients and research subjects. In universities and hospitals, this widespread patients' rights movement galvanized the attention of a growing contingent of theologians, philosophers, and lawyers who came to identify themselves as medical ethicists or bioethicists.
A central task of bioethics has been the articulation of approaches to guide the moral aspects of medical decision making. Here, a core commitment has been to the empowerment of patients' meaningful participation in their own health care, which is typified by the now common practice of obtaining informed consent (the process in which a clinician gives a patient understandable information about a proposed procedure or intervention, including its risks, benefits, and alternatives, and then the patient makes a voluntary decision about whether to proceed with it). The ethical principle of "respect for autonomy" underpinning this approach distinguishes bioethics most sharply from earlier systems of medical ethics. Three other principles that are also influential include beneficence (doing good for the patient), nonmaleficence (not harming), and justice. These core principles lead to a set of rules such as those regarding truth-telling and confidentiality. Together, these principles and rules comprise a secular means of approaching ethical issues in medicine that is designed to be relevant in a pluralistic society. In practicality the great question in many situations is which principle takes precedence. This conflict is readily apparent in the two prominent bioethical discourses surrounding death and dying: withdrawal of support in the terminally ill and physician-assisted suicide.
Withdrawal of Support in the Terminally Ill
The rise of mechanical ventilation and intensive care technology may be likened to a double-edged sword. While rescuing countless patients from acute illness, it has also made possible the preservation of bodily functions of patients following severe brain injury. The 1981 report of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death, confirmed the appropriateness of the existing practice that allows withdrawal of life support from patients with absent brainstem functions as defined by the 1968 Harvard brain death criteria. Far more controversial have been those patients in irreversible coma who nonetheless still preserve brainstem reflexes, a condition designated as persistent vegetative state (PVS) that may continue many years with technological assistance. Perhaps the most famous such case was that of Karen Ann Quinlan, in which the New Jersey Supreme Court in 1976 recognized the right of the parents of a twenty-one-year-old woman with irreversible coma to discontinue her ventilator support over the objections of her physicians. The widely publicized decision opened the door for withdrawing such support legally, but still left open many ethical and practical questions.
Here the bioethicists stepped in. On one level, the Quinlan case confirmed their emerging role in the health care setting. Given the difficulty of ascertaining the patient's own wishes based upon the recollections of family and loved ones, the New Jersey Supreme Court recommended that hospitals develop ethics committees to guide such decisions when family and physicians are at odds. Ethicists thus gained a foothold in many hospitals. On a second level, discussions of discontinuing life support underlined the need for a more substantial framework to guide decision making. Many ethicists evoked the principle of autonomy to advocate advance directive—declarations such as living wills or the appointment of a durable power of attorney for health care—to minimize uncertainty regarding the patients' wishes should an event consign them to dependence upon invasive technology, making it impossible for them to participate in decision making about whether to continue the use of such technologies. Yet, less than 10 percent of Americans have completed such wills.
Following a series of legal cases the right to refuse life-sustaining therapies, including ventilator and feeding tube support from patients with irreversible coma, has been established. Nevertheless, in certain jurisdictions the process of refusing therapy may require clear evidence that this would indeed be in concert with the wishes of the patient.
Physician-Assisted Suicide
In many ways, the movement in some parts of the United States and in the Netherlands promoting the legalization of physician-assisted suicide (PAS) carries the autonomy argument to its logical conclusion. Here, the patient with a terminal illness proceeds to take complete control of the dying process by choosing to end life before losing independence and dignity. During the 1990s, PAS gained widespread notoriety in the popular media thanks to the crusade of the Michigan pathologist Jack Kevorkian, who has openly participated in the suicides of over a hundred patients. Oregon legalized the practice in its 1997 Death with Dignity Act. Meanwhile, the Netherlands has legalized the practice of euthanasia (distinguished from PAS in that the physician directly administers the agent ending life) in 2000.
Bioethicists have generally condemned the approach to PAS represented by Kevorkian, but have been divided in opposing the practice under any circumstances. For many observers, Kevorkian's willingness to assist patients on demand devoid of any long-term doctor-patient relationship raises troubling questions about his patients' true prognoses, their other options, and the contribution of depression to their suffering. The physician Timothy Quill's decision to assist in the suicide of a forty-five-year-old woman described in an influential 1991 article has attracted much less condemnation. The woman "Diane" had been Quill's patient for eight years, and he wrote eloquently of how he had come to understand how her need for independence and control led her to refuse a cancer therapy with only a 25 percent success rate. For many ethicists the crucial question is whether PAS could be legalized yet regulated to assure the kinds of basic safeguards demonstrated by Quill's example, without placing vulnerable members of society at risk. In contrast, some ethicists have backed away from condoning any legalization of PAS as creating more potential for harm to the elderly than good—or perhaps marking a fateful step on a slippery slope leading to involuntary euthanasia.
However these issues are resolved, there is increasing recognition that a single-minded commitment to autonomy to the neglect of the other foundational principles of bioethics distorts how death and dying take place in reality. Whether they would allow PAS only rarely or not at all, most bioethicists would argue that a great challenge facing the care of the dying is the provision of palliative (or comfort) care for the terminally ill.
See also: Anthropological Perspective; Black Stork; Informed Consent; Psychology; Suicide Types: Physician-Assisted Suicide
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics, 4th edition. New York: Oxford University Press, 1994.
Buchanan, Allen E., and Dan W. Brock. Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge: Cambridge University Press, 1990.
Filene, Peter G. In the Arms of Others: A Cultural History of the Right-to-Die in America. Chicago: Ivan R. Dee, 1998.
Fletcher, John C., et al., eds. Introduction to Clinical Ethics, 2nd edition. Frederick, MD: University Publishing Group, 1995.
Jonsen, Albert R. The Birth of Bioethics. New York: Oxford University Press, 1998.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: A Report on the Medical, Legal and Ethical Issues in the Determination of Death. Washington, DC: Author, 1981.
Quill T. E. "Death and Dignity: A Case of Individualized Decision Making." New England Journal of Medicine 324 (1991):691–694.
Rothman, David J. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York: Basic Books, 1991.
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BIOETHICS addresses the moral and ethical issues arising from clinical practice, medical and biological re-search, resource allocation, and access to biomedical technology. Van Rensselaer Potter at the University of Wisconsin and Andre Hellegers at the Kennedy Institute of Ethics independently coined the term "bioethics" in the early 1970s to describe different concepts, and its exact definition remains contested today. However, it is nonetheless possible to discern the growth of a professional bioethics industry and discipline intimately tied to cultural mores and new advances in biomedical technology and techniques. Indeed, the field of bioethics underwent explosive growth and institutionalization in the 1970s as challenging issues such as euthanasia, in vitro fertilization, organ transplantation, and genetic engineering attracted the public's attention and concern. Because questions over appropriate science and social policies exist at the crossroads of legal, political, and moral disputes, the history of American bioethics is one of contentious debate, government regulation, and continuing growth.
The history of medical ethics dates to antiquity, and the Hippocratic Oath to "do no harm" remains at the core of modern medical ethics. The American Medical Association (AMA) established a code of ethics in 1846 to regulate medical practice; a hundred years later, revelations about Nazi medical experimentation led to the Nuremberg Code, requiring "informed consent" from human subjects involved in research. In the 1960s the introduction of dialysis machines, and the resulting "God committees" to decide who would receive the life-saving treatments, strained the medical community's ethical consensus. At the same time, a cultural emphasis on individual rights merged with growing concerns over medical and biological advances to require government intervention. For example, the definition of "brain death," the ethics of organ transplantation, and the potential for prenatal genetic discrimination led to the first Senate hearings on bioethics in 1968. These issues also led to the establishment of the Institute of Society, Ethics, and the Life Sciences (also known as the Hastings Center) in 1969; the National Science Foundation's Ethics and Human Values Implications of Science and Technology (EHVIST) program in 1971; and the Joseph and Rose Kennedy Center for the Study of Human Reproduction and Bioethics (later the Kennedy Institute of Ethics) in 1971.
Throughout the 1970s a professional bioethics industry developed in response to numerous ethical and medical dilemmas. The wide assortment of issues attracted attention from diverse groups. Many religious communities felt genetic screening might increase abortions of "defective" babies, while the Roe v. Wade decision and questions regarding fetal research ensured the active participation of women's groups. The disclosure of improper medical conduct and a lack of informed consent in the Tuskegee, Alabama, syphilis study heightened awareness about the regulation and control of research, as the public questioned whether researchers could be trusted with ethical responsibilities. These questions resurfaced in disputes over the morality of "gene splicing" throughout the decade, while the Karen Ann Quinlan case thrust the "right to die" movement into the spotlight. The birth of Louise Brown, the first "test-tube" baby, also ignited public interest, as the government and the public struggled to address the plethora of issues. By 1980, many medical schools had established programs and journals to discuss the challenging new issues and prepare students for their future careers; the first Encyclopedia of Bioethics appeared in 1978.
In 1974 the United States Congress, led by Massachusetts Senator Edward Kennedy, established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The commission released a series of reports over the next four years that provided the "official" positions necessary to create uniformity in American policies on the various complex legal and ethical issues. Given the religiously pluralistic fabric of American society, the committee's primary position, as outlined in The Belmont Report, relied on the three principles of beneficence, justice, and autonomy as acceptable, and secular, bioethical guidelines. Early treatises on medical ethics, such as Joseph Fletcher's Morals and Medicine (1954) or Paul Ramsey's The Patient as Person (1970), had often combined Christian theology with a liberal philosophy to help reconsider the doctor-patient relationship in light of the latest medical developments. Indeed, some observers credit the rise of bioethics with revitalizing philosophical ethics, as the new challenges demanded a fresh approach and a resolution.
However, the guidelines failed to quell public uneasiness and led many groups to question the official principles throughout the 1970s and 1980s. Christian fundamentalists and Christian Scientists were especially vocal and litigious in challenging the emphasis on individual autonomy. Critics often charged that the Belmont Report's principles downplayed the importance of community and family and argued against the autonomy of children and mentally handicapped patients in making decisions regarding abortion, euthanasia, or life-saving medical treatments. Similar disagreement followed the 1982 release of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Re-search (est. 1980) report Splicing Life because it advocated the patenting of genetically-altered organisms and stated that future debates on biological research could rely on professional bioethicists, rather than theologians, for moral and ethical perspectives.
By the early 2000s bioethics was internationally recognized and interdisciplinary, drawing participants and perspectives from philosophy, medicine, biology, theology, and history. By 1990, over 100 organizations and institutions dedicated to bioethics had been established, many of them in the United States, an acknowledged leader in the field. Indeed, responding to ethical concerns over human gene therapy and experimentation with human subjects, President Bill Clinton established the National Bioethics Advisory Commission in 1996. Chaired by Harold Shapiro, former president of Princeton University, the commission produced the influential report Cloning Human Beings, which outlined the ethical issues related to the emerging technology. The commission's charter expired in October 2001, leaving empty that critical nexus where specialists in medical, clinical, or research ethics could address the latest bioethical developments, from reproductive techniques and access to artificial organs to cloning, stem cell research, and genetic privacy and discrimination. As the sophistication of medical technology and biological research increases, the field of bioethics continues to grow, preparing to meet the unforeseen challenges of the twenty-first century.
Engelhardt, H. T. The Foundations of Bioethics. Oxford: Oxford University Press, 1986.
Jonsen, Albert R. The Birth of Bioethics. New York: Oxford University Press, 1998.
Reich, Warren, ed. The Encyclopedia of Bioethics. New York: Simon and Schuster, 1995.
Stevens, M. L. Bioethics in America: Origins and Cultural Politics. Baltimore, Md.: Johns Hopkins University Press, 2000.
J. G.Whitesides
See alsoClinical Research ; Euthanasia ; Medical Research .
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The field of bioethics, as distinct from medical ethics, has existed since the 1960s. Unlike medical ethics, which for centuries has examined the duties and responsibilities of physicians to their patients and to other doctors, the development of bioethics can be traced to the rapid progress in technology and science experienced in the United States in the 1960s. Organ transplantation, chemotherapy, kidney dialysis, respirators, the contraceptive pill, genetic screening, and intensive care units were extraordinary medical breakthroughs that were seen as highly beneficial but also costly and sometimes harmful. This explosion of technological success brought in its wake a set of daunting ethical dilemmas that medicine, academics, legislators, and the public had never previously been forced to face.
In the wake of these developments, issues of healthcare access and rationing, withdrawal and withholding of lifesaving care, dignity in dying, and how to define death and manage the high cost of medical care now loomed large as urgent ethical quandaries. At the same time, societal changes placed greater emphasis on individual autonomy and rights, which prompted the public to press the field of medicine for more patient involvement and control over medical treatment. The ethical dilemmas generated by these advances in science and medicine required interdisciplinary study and reflection that traditional academic disciplines were ill-equipped to handle. In response to these pressing ethical problems, scholars began to venture outside of their traditional subject matter to discuss, debate, and write about these new dilemmas, and bioethics became a new area of academic attention.
Some of the original dilemmas are still at the core of bioethics today. The field now focuses ethical problems in clinical, preventive, and research medicine that involve truth telling, informed consent, confidentiality, end-of-life care, conflicts of interest, nonabandonment, euthanasia, and substituted judgment for incompetent persons. Bioethics has established both the right to informed consent and the right to control one's medical treatment as key tenets of American law and ethics. With each new technological breakthrough, the field of bioethics expands its scope to address new ethical dilemmas, most recently those involving the human genome project, stem cell research, artificial reproductive technologies, the genetic engineering of plants and animals, the prospect of human reproductive cloning, preimplantation genetic diagnosis of embryos, nanotechnology, and xeno-transplantation. Bioethics has also more recently begun to reflect on the health-care challenges faced in developing nations, such as whether national or local standards should govern the conduct of medical research or the problems of rationing access to innovative treatments in nations besieged by devastating epidemics such as malaria or AIDS.
Since the 1960s, the field of bioethics has gained legitimacy as an independent academic discipline, and that new status has brought significant changes in the structure and institutions of the field. Originally, the institutions of bioethics were independent think tanks. Today, the trend is the creation of academic bioethics departments, either within a medical school or school of arts and sciences. The professionalization of bioethics has taken it from the academic margins to an accepted place within universities, hospitals, regulatory bodies, the media, and industry.
SEE ALSO Medicine
Callahan, Daniel. 1973. Bioethics as a Discipline. Hastings Center Studies 1 (1): 66–73.
Fox, Daniel. 1985. Who Are We: The Political Origins of the Medical Humanities. Theoretical Medicine 6: 327–341.
Jonsen, Albert. 1998. The Birth of Bioethics. New York: Oxford University Press.
Potter, Van Rensselaer. 1971. Bioethics: Bridge to the Future Englewood Cliffs, NJ: Prentice Hall.
Reich, Warren, ed. 1978. Encyclopedia of Bioethics. New York: Free Press. 3rd ed., 2004. Ed. Stephen G. Post. New York: Macmillan.
Reich, Warren. 1994. The Word "Bioethics": Its Birth and the Legacies of Those Who Shaped Its Meaning. Kennedy Institute of Ethics Journal 4: 319–336.
Arthur Caplan
Autumn Fiester
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bioethics, in philosophy, a branch of ethics concerned with issues surrounding health care and the biological sciences. These issues include the morality of abortion, euthanasia, in vitro fertilization, and organ transplants (see transplantation, medical). In the 1970s bioethics emerged as a discipline with its own experts, often professional philosophers, who developed university courses on the subject. Many hospitals now employ experts on bioethics to advise on such issues as how to treat terminally ill patients and to allocate limited resources. Advances in health care, the development of genetic testing and screening, and the new research in genetic engineering, including gene therapy, have also given rise to questions in bioethics.
See W. T. Reich, ed., Encyclopedia of Bioethics (4 vol., 1978); H. T. Engelhardt, The Foundations of Bioethics (1986); R. Macklin, Mortal Choices: Bioethics in Today's World (1987).
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text:
December 26-31
Winter Fest is Wisconsin's premier winter family event! Experience the magic of the season as the Delta Center is transformed into a Winter Wonderland of fun for the whole family!
Highlights of the event include the "Milwaukee's Got Talent" talent show, Radio Disney's New Year's Eve Celebration, Operation MOVE, carnival rides, a roller rink, an indoor zip line and much more! The festival will be held from December 26-31 at the Delta Center.
Click here for a listing of attractions during Winter Fest 2012.

subset: commoncrawl


text:
If you are heading to Somerset's premier city for a holiday or weekend break while staying in a luxury b and b in Bath, you might just like to include a day at the races with the glitz and glamour of Lady's Day at Bath racecourse? Lady's Day on September 1 is the most glamorousRead more
A trip to Bath would not be complete without a visit to the Roman Baths or the Thermae Spa for one of the therapeutic spa breaks in Bath, but if you are visiting in early September you may also like to include the 'Taste of Africa' event into your itinerary. The Taste of Africa takesRead more


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Return downtown was a hit for Dew Days
The weather was perfect, the crowds were large and by the time the final ride had been ridden Sunday afternoon the message seemed to be pretty clear: That's the Dew Days we remember.
That was the idea with this year's version of Farmington's summer celebration. For several years Dew Days bounced around town, and it seemed to lose fans and build up debt along the way. So when a new group took over for this year's event the idea from the beginning was to bring things back downtown, where the celebration had been held for most of its history. Committee chair Brian Lindquist said that, as much as anything, was the key to what he and others described as a great success this year.
"It was nothing I had to do with it. It was nothing that I went out and made it mystical and magical," said Lindquist, the city's police chief. "It wouldn't have mattered who was in charge this year. Whoever brought it back downtown (would have had success).
"It's like going to a high school reunion," he said. "You can recapture those things you're fond of."
Dew Days organizers said they heard early and often that the celebration needed to return downtown, and the change seemed to work magic on crowds. Dew Days committee member Darla Donnelly said crowds were lined up three deep for Friday night's bed races. Lindquist said all of the vendors he talked to were happy with the business they drew.
"That's what we were looking for is bringing back the old Dew Days," Donnelly said.
Donnelly was thrilled with the results. Asked how she felt about the weekend she repeated three times, "It was great."
Lindquist didn't have an accurate count of the people who showed up but he was happy with crowds throughout the weekend.
"The cruise night was full. The beer garden had a good crowd," he said. "There was a good crowd for the parade."
Several people contributed to this year's Dew Days and brought in new events like a business expo and a fishing tournament. There was also a new art fair at this year's Dew Days.
A core group of about 10 people helped put everything together this year. Lindquist plans to step down as chair now that the event is done, but he believes the group that has formed is well positioned to keep the momentum from this year's event rolling next summer.
Neither Donnelly nor Lindquist identified a specific highlight from the weekend, but both were happy with the event as a whole.
"The highlight was just the overall great turnout and great support and compliments on how great it was to have Dew Days back," Donnelly said.


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DULL, Scotland, April 26 (UPI) -- Dull, a hamlet in Scotland's Perthshire, may be thousands of miles from Boring, Ore., but residents say their names constitute a bond between the two towns.
The two communities have proclaimed their sisterhood, The Daily Telegraph reported. The relationship will have to be unofficial, the newspaper said, because Dull, which has lost population and no longer supports a church or school, is considered too small to have an official relationship with Boring, an unincorporated place about 20 miles southeast of Portland with a population of about 12,000.
Dull learned of its trans-Atlantic soulmate when a Dull resident bicycled through Boring during a vacation in the United States. Elizabeth Leighton came home and told a friend, who got in touch with Steve Bates, chairman of the Boring planning association.
Neither name is a comment on its town. Dull is believed to derive from a Gaelic word for either meadow or snare, while Boring was named after one of its first residents, William Boring, a Civil War veteran who died in 1932 at the age of 91.
Peter Campbell of Dull Farm said he hopes the publicity will bring more visitors to stay in the two chalets he rents out.
"Dull is a fairly quiet place, more a hamlet than anything. Whether it could be described as being 'dull' is debatable," he said. "There are no shops or anything like that, but it's an historic place -- St Andrews University was founded here centuries ago."


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Sandra's Restaurant Remakes – Sandra Lee, known for making semi-homemade recipes and money-saving meals, hits the road visiting famous food establishments across the country to learn the tricks of their signature dishes and then recreates them the easy way. Sandra takes on the famous fare of restaurants, bakeries and bars, and then puts her unique spin on the perfected classics giving viewers tips on how to make restaurant-quality dishes at home. From her Unbelievable Meatball Burger to a Chocolate Coconut Cake Cocktail, Sandra makes the astonishing, attainable and the remarkable, relatable for all at-home cooks.
Producer: BSTV Entertainment / Trilogy
TX: 14th October 2012
Source: Food Network press release (via The Futon Critic)


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We've never had a swinging experience, but we've done FMF and BDSM (and I still can't decide if I'm sub or Domme ... sigh).
We took a break from that for a few years and have been talking lately about playing with others.
This time, I said, I am interested in having contact with another man (or even another woman; I'm game) while he plays with a lady who makes his toes curl. In the same room, of course. I quite like to watch him have fun; I prefer watching to participating in FMF with him.
What I'm working on is separating sex and love so the Crazy Slut inside may come out and play without any guilt ... and as little jealousy as possible. In the past, I've been known to be very territorial and insecure.
But that was before we were married. I'm much more confident now in the fact my husband loves me and doesn't want to go anywhere. Actually, I'm somewhat concerned HE might become the green-eyed monster now that we're married.
Any suggestions from the Old Hats would be much appreciated.
Thank you.


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June 4, 2013
Punch bowl Falls on Eagle Creek is both inspiringly beautiful and fatally dangerous. The cliff on the left above the falls tempted five friends to jump June 2, with disastrous consequences.
Stories this photo appears in:
Three men injured, one dead in jump from Punch Bowl Falls
Punch Bowl Falls, a lush, dramatic and inviting forest-encased waterfall on Eagle Creek, enticed four cliff jumpers into its cool waters on June 2 and claimed the life of one man, leaving three others injured. Five friends took the Eagle Creek trail for a late spring hiking adventure: four made it home, but Jason Endicott, 25, of Cincinnati, Ohio, did not. His remains were recovered by search teams on June 3. At about 5 p.m. Sunday, the Hood River County Sheriff's Office received a report of multiple men injured at the falls.
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text: 24 May 0 ShareShare onShareTweetShare Happy Memorial Day Jake Ricks | Lifestyle, News | No comment Remember those that have gone before you in order to make your life amazing today. quotes AUTHOR - Jake Ricks Jake Ricks is the Online Marketing Manager and chief content writer and editor for the Bullfrog Spas blog. Jake has been published in a variety of publications with topics that include the pool and spa industry, outdoors, and content marketing. Jake's passion is fly fishing and living life outside. He guides, competes in fly fishing events, designs fly patterns and is a regular contributor to outdoor blogs and periodicals.


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ZURICH -- World and European champion Spain topped the latest FIFA rankings on Wednesday, with European teams holding the first four positions as they prepare to begin qualifying for the 2014 World Cup, while the United States moved up three places to No. 33.
Spain maintains its lead over Germany and England, and Portugal moves into fourth place above South American champion Uruguay.
Portugal beat Panama in an exhibition last month, and Uruguay drew with France. Results from four years ago also dropped out of FIFA's calculations.
Italy is No. 6, followed by Argentina and the Netherlands. Croatia and Denmark complete the top 10.
World Cup host Brazil, which has dropped in the rankings while playing only exhibitions this year, climbed one spot to No. 12.
Ivory Coast leads Africa at No. 16, ahead of qualifiers for the 2013 Africa Cup of Nations this weekend.
No. 21 Mexico is the best in CONCACAF, which resumes World Cup qualifiying on Friday.
Japan leads Asia at No. 23, ahead of Australia at No. 25 and South Korea at No. 27. All three play World Cup matches next Tuesday.
European teams start on the road to Brazil with 22 matches on Friday and two on Saturday.


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I would like to plan a road trip from New Jersey to California. It has been a difficult two years for us since I am presently fighting to win my battle against cancer. I have never traveled this far and have never been in a motorhome. I live in Montreal Canada with my husband and 3 small children. My sister lives in New Jersey with her family and we would like to make this trip together. Has anyone ever done this? Any suggestions would be greatful.
I would love to see Washington, the Grand Cayon, San Francisco....
My worries are where do we leave the motorhome is it easy to park on the street or in a parking lot, if we want to make a quick visit. Also would anyone know how how it might cost and how long it would take?Money is an issue since I have not been able to work its been two years. Any suggestions on where to rent a RV would also be helpfull.
Like I said I've never done anything close to this, it may be crazy but you only live once.
Thank-you so much for any help given
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Roadtrip from NewJersey to California with an RV
I would like to plan a road trip from New Jersey to California. It has been a difficult two years for us since I am presently fighting to win my battle against cancer. I have never traveled this far and have never been in a motorhome. I live in Montreal Canada with my husband and 3 small children. My sister lives in New Jersey with her family and we would like to make this trip together. Has anyone ever done this? Any suggestions would be greatful.
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I've looked into renting an RV several times and the cost estimate has always come out significantly higher than renting a car an using hotels.
Cruiseamerica.com is one of the big rental companies.
A standard size RV that sleeps 4-5 will cost you around $900 per week, base rate. You pay extra for kitchen utensiles, pots, dishes, etc. You pay extra for bedding. You pay extra for mileage. (32c/mile). NJ to CA round trip will be over 6000 miles, or about $2000 in mileage fees.
So let' assume a 4 week trip, round trip NJ to CA and back.
base rate $3600
mileage $2000
Many people love RVs, and many people find they hate them after just a few days. You need to be prepared to fill up with potable water almost every day, and dump sewage and grey water just as often. Nobody cleans the towels or sheets for you - you need to find a laundry to do that.
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sorry - hit enter too fast.
So let' assume a 4 week trip, round trip NJ to CA and back.
base rate $3600
mileage $2000
gas 10mpg, $3.50/gal, $2000
extras (linens, dishes, etc) $500
and those are just the costs you'll pay cruiseamerica. Add on RV lot rentals at $20-40 per night and you see the costs add up very quickly.
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If you lived in the US I would first direct you to CruiseAmerica.com, which has rental outlets all over the US; whether they or someone similar operates in Canada I cannot say. Go to their website anyway to see some FAQs that apply to RV rentals in general. Or use a search engine for RV rentals.
RVs get miserable gas mileage, and the cost of fuel is increasing in the US...your proposed trip will be very expensive, over and above the cost of rental.
Parking is always a problem. You will see many RVs with one or more bicycles hanging on the back...there is a reason for this. You will also see RVs with cars in tow. The take-away message is that you will be parked away from city centers and will have to use alternate modes of transportation if you want to explore.
My suggestion is to rent a van or something similar, large enough to hold everyone plus baggage, and stay at motels overnight. You will be able to park in cities and have easy access to tourist venues.
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You will have more fun (IMO) and save a lot of $$$ if you either rent a van or two cars and stay in hotels/motels. Many have kitchens/kitchenettes so you can still meet any special dietary requirements and you have tons more space every night than in a motor home.
If you already owned one -- that is entirely different.
Also maybe consider driving one way and flying home. There will be drop off fees but that would let you stop for longer at some places and not have to rush back across the country.
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also consider flying into a region, say Denver for the Rockies, renting an RV for a week and return it,then fly on to, say Seattle, and repeat the process. Give you the RV experience without as much expense or driving time.
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If you are talking 4 adults plus your 3 kids plus any kids your sister has - you are talking a big RV. This will not be easy to park in any city. And I would practice driving one that big to see if you are comfortable and safe doing so.
Interesting that you mention wanting to see things on each coast, plus Grand Canyon. Lots to see between - but also lost of boring miles to travel. Consider that.
But this sounds like something you want to do, especially with your cancer diagnosis. So there are also experience and lifestyle considerations - I think you are starating out right considering these plus cost before you make a decision. Good luck.
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It will be hard to park on the street.
If you go during the school vacation season, you will be competing for good camping spots with everybody and his brother.
Motorhomes require a good deal of practice, to park in such a way that the appliances all work, and they are not at all flexible.
Janisj's suggestion of two cars is a great idea if you really want to drive all the way across the country. You can divide the travelers differently every day or even at lunch every day, so that everyone gets to travel with everyone else. If one group has seen all the gardens that they ever want to see and the other group can't wait for more, you can split up and meet later. Costs of cars and lodging will be cheaper than a motorhome, and you can still make lunch a picnic everyday for better nutrition and to save money. We have done this with friends in France and Italy, and it has worked really well.
Of course if you already have a car and your sister has a car, you don't need to rent. But the idea of driving one way and returning by plane or train (Canadian Rockies?) is a good one. If you have been fighting serious illness, a round trip could be very tiring.
But you know what? Don't give up on the idea of a big trip with those you love!
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Another money-saving and perhaps fun wrinkle would be the 2 car/camping equipment approach. Tent-camping is not all that much fun relative to the work involved for one-night stays. But you could stay in cheaper hotels while on the road and then mix it up with some tent camping at places you will stay at longer than 1 night. If you ask around you probably could borrow a lot of the stuff you need - and even if you had to buy a tent, it would be cheaper than an RV. But even if camping is not your thing, agree that cheaper hotels can work well.
As far as hotels, once you have the sleeping bags, etc you can save a lot of money and by "camping" in hotels. You could get adjoining rooms or even larger 2-bedroom suites (and suite hotels usually have breakfast included) - most of which also have at least m/w and refrig. Depending on max occupancy of hotels, kids could camp out on the floor in sleeping bags - "camping" inside and likely have a great time while the adults would get real beds. Bring a cooler for lunches - and you would save lots of money and have a similar experience in some ways.
When our kids were younger, we would often stay in less expensive hotels - as long as there was a pool we were thrilled. Dinner could be picking up a rotisserie chicken, a big salad, loaf of bread - that sort of thing. Saved money, time - and the prospect of cramming kids into a restaurant after they were trapped in a car all day.
While an RV may increase your options in some ways, it can also decrease it in others - in some parts of the country there are cheap places where you can just park it, in others it requires far more planning for input and output of water, waste and utilities - than just checking into a hotel when you have had enough driving or stop longer to see something.
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Since you want to try the RV experience, I would fly from NJ to a city with a cruiseamerica location near a National Park with campground and rent for no more than 3 days. Return to the same location to avoid dropoff fees.
Where they are available, I like staying in HI hostels. The other hostels are sometimes lacking in quality.
MY DW and I enjoyed a week stay in a cheap motel in Green River, Utah and saw several great National Parks from there.
There are several HI Hostels in San Francisco and one inside the Muir Woods National Monument which you would enjoy.
Another option to consider is a USA RailPass on Amtrak.
They are hidden under Deals on Amtrak.com
Every day/night you spend on the train is another you are not piloting a big RV and spending lots of money on gas.
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Thank you so much for all your help.
With your help you've made me realize that I would be getting myself into something very expensive and although I wanted to do something different I don't want to end up hating the trip.
And have everyone around me saying when is this going to end.
I will have to think about another adventure, if anyone has any ideas I welcome your experiences. Like I mentioned I have 3 small children from 2-8yrs old. I was planning a budget from $2-3k if possible. Thank-you so much once again for taking the time to answer my questions.
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Perhaps this year you could do a smaller trip with your group, say head down to Cape May NJ from your sister's house, take the ferry to Lewes, DE then go down to Assateague National Seashore, MD. You could try the RV thing or use 2 cars and a tent, or rent a cottage either there or just over the VA border at Chincoteague. Or head for Skyline Drive in VA or up to the Pocano Mts or have them go north while you go south and meet in Vermont at one of the ski areas that do summer activities.
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text: Hi All, As the title states can you input or tell me which air freshener do you use in your A3. Ive been using magic tree black ice in my cars for last 1 & half years. Was browsing through couple of website and found the usual Poppy Coral Air Freshener the only decent choice but I'm not sure about the smell as it only comes with Lemon Zest fragnance. Does lemon zest smells good/nice in your car ? Thanks


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CHIHULY! Richmond A RIOT of color and form in the seabed display room
48 pieces
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This is a probably 4ft. wide by 4ft. tall piece in the seafloor display-the one that was like 100ft long and 15ft wide. It really is a riot of color and organic form. Its easy to miss the beautiful 24" sphere in front of it. The light blue pieces on each side of it appeared to be hand blown glass rock or sea bed formations that were spread throughout the display. Some of them were 4ft. across. It would be easy to spend an hour in this room. If you look closely at the top of the photo, you can see two people in the blue lit room with the neon tumbleweed in it, that I put on here a few days ago. I came to this Chihuly show about a month age with my son, a glass artist himself, and again just about a week ago with my daughter, and I can say for sure, going through this show affected my perception, and sense of well being, and appreciation of form and color both times. It left me with a little inkling of the expanded space where Chihuly dances from and I feel honored to have experienced that.