In past decades, biomedical technology has created such advances that many health care professionals and consumers are overwhelmed by the apparently unlimited choices in treatment decisions. Problems in human reproduction, preservation of life, research on human subjects, and allocation of scarce resources are just a few of the categories of concerns that we now face. These dilemmas are complex both from conceptual and ethical perspectives. Thus, it becomes more and more difficult to define such important concepts as “human life” or ‘extraordinary treatment,” and to apply these concepts to clinical situations. It has become almost impossible to objectively interpret and apply ethical principles which should guide actions of health care providers.

A number of indications suggest that we may be on the verge of another massive shift in the orientation of our system for the civil commitment of the mentally ill. After nearly one and one-half centuries during which commitment criteria were based on the mentally ill person's need for care and treatment, the late 1960s and 1970s saw a rejection of this standard in favor of criteria based solely on the individual's dangerousness to self or others. Now, in the 1980s, we are witnessing an outcry against dangerousness-oriented standards and the beginnings of a return to a need-for-treatment model.

Several incidents involving the withdrawal of treatment and/or the ordering of supportive care for nursing home residents came to public attention in the spring and summer of 1981, raising serious concerns among advocates, attorneys, and health care professionals about the use of supportive care orders. It appeared that there was little consistency or consensus with respect to the meaning or application of the Supportive care concept.

In response to such concerns, a task force of interested individuals long term care staff and administrators, consumer advocates, medical, legal and social service professionals, and government agency officials was convened to identify and discuss issues raised by the use of supportive care. The task set by the group was to make recommendations and propose a set of guidelines for the provision of supportive care in long term care settings.

Surrogate motherhood has captured the attention of both the media and the legal profession in the past several years. Courts faced with litigation on surrogate motherhood have uniformly taken the position that these arrangements are contrary to public policy, and have refused to compel the specific performance of these contracts? It is my position that these rulings have been correct, and that if surrogate motherhood is to be considered legally acceptable in this country (which I think it should not be ) then state legislatures must act to legalize the contracts drawn up for these arrangements.

The procedure for surrogate motherhood is usually initiated by either a married couple, of whom the wife is infertile, or by a single man. In either case, a contract is made with a fertile woman; the woman is to be artificially inseminated with the man's sperm. Generally, this is done in exchange for a large sum of money. At the time that the baby is born, the surrogate mother surrenders the child for adoption by the wife (in the case of a married couple) and presumably by the father to regularize his relationship with the child.

The hospital emergency department- those who receive care there and those who provide it-has changed rapidly in recent years. The number of patients going to emergency departments is steadily increasing, and the care which they seek is not confined to traditional emergency care. More and more patients utilize the hospital emergency department for routine health problems, either as substitutes for personal health care providers or as replacements when their own providers are unavailable.

Physicians, nurses, and other health care providers in the hospital emergency department have changed from generalists to emergency care specialists. The rotating, on-call staff physician serving in a department with low priority is being replaced by the emergency medicine practitioner. Since 1980, the American Board of Emergency Medicine has been certifying physicians qualified in this new specialty, and the Emergency Department Nurses’ Association has been administering an examination for certification in emergency nursing.