Lisa Lehmann

The success of assisted reproductive technologies (ARTs) worldwide has led to an accumulation of frozen embryos that are surplus to the reproductive needs of those for whom they were created. In these situations, couples must decide whether to discard them or donate them for scientific research or for use by other infertile couples. While legislation and regulation may limit the decisions that couples make, their decisions are often shaped by their religious beliefs. Unfortunately, health professionals, scientists and policy-makers are often unaware of the way in which faith traditions view ART and decisions concerning the ‘fate’ of surplus embryos. In this paper scholars representing six major religious traditions provide a commentary on a hypothetical case concerning the donation or destruction of excess ART embryos. These commentaries provide a rich account of religious perspectives on the status of the human embryo and an insight into the relevance of faith to health and policy decisions, particularly in reproductive medicine, ART and embryo research

Public disclosure of industry payments to physicians is one way to address financial conflicts of interest in medicine. As part of the Patient Protection and Affordable Care Act, the Physician Payment Sunshine Act requires pharmaceutical, medical device, and biologics manufacturers who have at least one product reimbursed by Medicare or Medicaid to disclose payments to physicians and teaching hospitals on a public website starting in 2014. The physician payment data will contain individual physician names, monetary values, and specific products connected to payments.According to the Final Regulations issued by the Centers for Medicare and Medicaid Services in February 2013, the law will make transparent the extent and nature of relationships between physicians, teaching hospitals, and manufacturers.

The central question of this work is how should physicians respond to patients' religious beliefs when those beliefs cause patients to act in a manner that is at odds with what most of the community regard as reasonable? I use the example of a Jehovah's Witness who refuses a life-sustaining blood transfusion as a paradigm case of a religiously grounded disagreement about medical care. In chapter 1, I explain the reasons for Jehovah's Witnesses' refusal of blood and lay out three responses to the question of how physicians should respond. The options of coercing a transfusion, respecting patients' right to self-determination, and respectfully but critically tolerating patients' medical decisions are considered throughout this work. In chapter 2, I contrast four readings of the Kantian demand for respect and argue that respect for persons as engagement can best guide physicians' interactions with patients where there is intractable disagreement. In chapter 3, I develop the idea of respectful toleration as the preferred response to patients whose religious beliefs are the foundation of a medical decision that is at odds with our initial standards of reasonableness. This response to patients is characterized by tempered beneficence that leads to engagement and persuasion, but stops short of coercion. In chapter 4, I suggest that the reluctance to engage patients in a critical discussion of their religious reasons is based on a misguided understanding of a physician's role and the process of change within religion. In chapter 5, I consider the question how a physician should respond to patients who, despite attempts at engagement, affirm their religious commitment to refuse life-sustaining treatment. I argue that physicians should respond to dying patients with whom they disagree with empathy and sympathy. ;My thesis is that religious reasons in medical decision-making should not be accorded a privileged status. They should be subject to critical scrutiny while we try to understand religious tradition's attempt to establish deeper meaning in human life. There should not be a wall between physicians and patients that prevents physicians from talking, reasoning about, and engaging patients in a discussion of their religious beliefs and reasons.