On February 26, 1997, the Fordham University School of Law hosted the Sixth Annual Stein Center Symposium on Contemporary Urban Challenges, entitled  Urban Bioethics: A Symposium on Health Care, Poverty, and Autonomy.   The Foreword introduces Articles in this Symposium issue and discusses two central themes of the various Articles: socioeconomic framing of bioethical and healthcare issues, and the challenge of the moral consensus

Cooper, Elizabeth B.

Zipursky, Benjamin C.

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Foreword: Urban Bioethics

Fordham University School of Law

Fordham Urban Law JournalVolume 24 | Number 4 Article 11997Foreword: Urban BioethicsElizabeth B. CooperAssociate Professor of Law, Fordham University School of Law. B.A. 1983, University of Pennsylvania; J.D. 1988, New YorkUniversity.Benjamin C. ZipurskyAssociate Professor of Law, Fordham University School of Law. B.A. 1982, Swarthmore College; Ph.D. (Philosophy) 1987,University of Pittsburgh; J.D. 1991, New York University.Follow this and additional works at: https://ir.lawnet.fordham.edu/uljPart of the Health Law and Policy CommonsThis Article is brought to you for free and open access by FLASH: The Fordham Law Archive of Scholarship and History. It has been accepted forinclusion in Fordham Urban Law Journal by an authorized editor of FLASH: The Fordham Law Archive of Scholarship and History. For moreinformation, please contact tmelnick@law.fordham.edu.Recommended CitationElizabeth B. Cooper and Benjamin C. Zipursky, Foreword: Urban Bioethics, 24 Fordham Urb. L.J. 663 (1997).Available at: https://ir.lawnet.fordham.edu/ulj/vol24/iss4/1FOREWORDURBAN BIOETHICSElizabeth B. Cooper*Benjamin C. Zipursky**On February 26, 1997, the Fordham University School of Lawhosted the Sixth Annual Stein Center Symposium on Contempo-rary Urban Challenges, entitled "Urban Bioethics: A Symposiumon Health Care, Poverty, and Autonomy." The all-day symposium,which was sponsored jointly by the Stein Center for Ethics andPublic Interest Law and the Fordham Urban Law Journal, broughttogether nationally recognized scholars in bioethics and healthcarepolicy with leaders from government, civil rights organizations,medicine, law, public health, economics, and anthropology.This Symposium issue collects the Articles that grew out of thatconference. The Articles are presented in three groups, corre-sponding to three panels at the conference: The Allocation ofHealth Care Resources and its Effect on the Poor; Mandatory Test-ing of Pregnant Women and Newborns: HIV, Drug Use, and Wel-fare Policy; and Physician-Assisted Suicide: Rights and Risks toVulnerable Communities. "Urban Bioethics"-the title of our sym-posium-signifies an attempt to merge two (or perhaps three) dif-ferent fields: bioethics and healthcare policy, on the one hand, andthe critical study of the legal rights of urban and disadvantagedpopulations, on the other. This merger, while entirely natural, isunder-explored, and it is to the credit of the Fordham law studentswho organized this Symposium, Elena Paraskevas-Thadani andKate Weinstein, to have recognized this topic and brought togethersuch a fine set of contributors to discuss it.Many themes wind through the different Articles in this sympo-sium, but two particularly merit attention: first, what might becalled the socioeconomic framing of bioethical and healthcare is-sues, and second, the challenge of moral consensus. The firsttheme is both compelling and timely. Those who address the con-* Associate Professor, Fordham University School of Law. B.A. 1983, Univer-sity of Pennsylvania; J.D. 1988, New York University.** Associate Professor, Fordham University School of Law. B.A. 1982,Swarthmore College; Ph.D. (Philosophy) 1987, University of Pittsburgh; J.D. 1991,New York University.664 FORDHAM URBAN LAW JOURNAL [Vol. XXIVfluence of health care, poverty, and autonomy are faced with thefact that there is not a legal right to health care in this country.While this Symposium is not about whether such a legal rightshould exist-a delicate question meriting separate attention-itdoes require us to recognize the reality of the socioeconomic con-text framing the issues of how to allocate resources in healthcarepolicy, who should be entitled to make which healthcare decisionsfor whom, and what sorts of laws, regulations, and ethical normsought to govern the diverse questions of biomedical law and ethics.What is this reality? In urban settings, in contrast to the nationas a whole, the majority of people reliant on public assistance areracial minorities. Unemployment and underemployment dispro-portionately affect African-American and Latino communities.For a person striving to make ends meet, this reality too oftenmeans piecing together low-paying part-time jobs that do not pro-vide benefits. Ironically, while this person (more often than not, awoman) may be able to avoid public assistance, she is also leastlikely to be able to obtain benefits-from an employer or from thegovernment-and rarely able to afford private health insurance.At the same time, existing government support for people inneed is shrinking at unprecedented rates. Medicare is about tochange in a way that will surely hurt the elderly. The Medicaidprogram leaves ever larger gaps in the healthcare needs of thepoor. Public hospitals in New York City face the threat of extinc-tion, and even while they remain, they must deal with staggeringbudgetary pressures. Managed care, in both the public and privatesectors, is rapidly becoming the dominant healthcare paradigm,and it is entirely unclear how much space this form of care, evolvedout of the very idea of cost-cutting, will leave for the poor.Our contributors, focusing on allocation of resources, mandatoryHIV testing, and physician-assisted suicide, recognize that these is-sues are especially difficult framed within this context of wide-spread poverty, a difficulty that is only amplified by the enormousdiversity of race, gender, class, age, and disability within urbancommunities. By combining ethicists and legal scholars with phy-sicians, public health experts, politicians, and civil rights advocates,we hope to indicate our awareness that conceptual questions of, forexample, the proper scope of autonomy and confidentiality in theHIV context, are, in many ways, a short distance from the questionof how women, men, and children, in certain disadvantaged set-tings are to be treated by certain social institutions. Conversely,the overtly political nature of the consequences of many bioethicalFOREWORDand healthcare decisions must affect, but need not exhaust, theanalysis of the ethical, legal, and constitutional questions that con-front us in this area.A second theme running through these issues is the plurality inmoral, religious, and cultural approaches that our society-andparticularly our urban centers-bring to fundamental questions ofvalue, for example the importance of health vis-a-vis other socialgoods, the duties owed by a parent to a child and the right of thestate to monitor those duties, and the proper attitude toward dying.The liberal strains in our culture and our law push us to leave eachto make her own decisions in such matters insofar as that is possi-ble. This bald liberal idea, however, does not provide sufficientguidance, for there are obviously many questions that we must de-cide collectively.What many political thinkers, liberal and communitarian alike,have come to recognize is that there is no possibility of functioningas a healthy and legitimate community unless we are at least ableto deliberate together about these problems, to find some overlap-ping consensus on how to deal with these problems. The issues atthe core of our three panels raise questions ranging from the fair-ness of wealth disparities, to the normative structure of families,and the meaning of death. These issues of bioethics, as much asany that our populace faces, indicate the difficulty and importanceof finding common ground in order to resolve outstanding issues ofconcern. It is therefore with pride that we present this series ofArticles, written from a wide range of points of view, but togetherdisplaying a commendable aim to reach answers together on thesedifficult questions.1997] 665666 FORDHAM URBAN LAW JOURNAL [Vol. XXIV

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