I begin with a confession, and I know that isn't a good way to start. But here goes. Nearly ten years ago, I retired as director of the Ethical Culture Fieldston School in New York City and also as dean of The Humanist Institute. But I quickly found out that retirement need not be -- ought not be -- abdication. So I now serve as ethics consultant and ethics committee chair at a small local hospital (less than 100 beds). I also teach a course or two each year in medical ethics at one of the smaller branches of my state university. Of course, I try to keep up with the thinking of my colleagues by reading the literature, by attending conferences and seminars, and by using the Internet. Nevertheless, things move very quickly in biomedical ethics, and the news does not always reach this corner of South Carolina in timely fashion. So I am often surprised. That, I suppose, helps to keep me interested. It also warns me against hasty conclusions.
What follows in the chapters below, then, is a reflection "from the trenches," as it were. I have tried to say as clearly and as completely as I can what I have observed over the years in the classroom as a teacher and administrator, and in the clinic as an ethicist (although I'm not sure I like the pretensions of that title). Without, I hope, indulging in mock humility or in Socratic irony, I have a deep sense of what I do not know. In fact, the more time I spend in the field, the less satisfied I am.
To be sure, as a philosopher, I am tempted by the conceptual side of issues like confidentiality, organ transplant, managed care, physicianassisted suicide, and the rest of the biomedical ethics agenda. I enjoy