This is an historic account of the development of total hip replacement as it took place in the author's laboratories and surgical clinics from about 1954 to the present time. The study covers five phases: basic research into the lubrication of normal animal joints; the trial of polytef as a low-friction plastic for the hip socket; bonding of implants to living bone by quick-setting acrylic cement; introduction of high-density polyethylene as a successful plastics material for the hip socket; and the attempt to identify a cause of late failure, when the probable alternatives were chemical rejection or bacterial infection, by eliminating airborne infection. (JAMA230:1025-1028, 1974)

Physicians' efforts on behalf of patients often involve the use of resources that, because of naturally limited supply or economic constraints, are not readily available to all who need them. The dilemma in such cases is how physicians may fulfill their ethical duties to do all that [they] can for the benefit of the individual patient 1 when the care that they can provide is constrained by the scarcity of needed resources.

BACKGROUND The question of physician participation in capital punishment has a long history. 1 Physicians have helped develop execution methods that were more humane than conventional methods. The most famous example is that of Dr Joseph Guillotin, who developed a mechanism for execution that he believed to be far more humane and civilized than other contemporary methods. 2 However, other physicians have disagreed with any physician participation in the death penalty. 1 The Oath of Hippocrates has historically been interpreted as prohibiting physician participation in executions. The Oath states in part: I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anyone when asked to do so nor will I suggest such a course. 1 During the 1970s, states began to consider use of lethal injection when executing condemned prisoners.

This report analyzes the ethical issues raised by requirements that parents be involved when minors seek an abortion. Parents are generally supportive and understanding and can provide helpful guidance to their children. In some cases, however, parents may respond abusively to the knowledge that their minor child is pregnant or is considering an abortion. In addition, privacy in matters of health care is a profound need of minors as well as adults. Accordingly, the Council concludes that, while minors should be encouraged to discuss their pregnancy with their parents and other adults, minors should not be required to involve their parents before deciding whether to undergo an abortion.

OVER the last 50 years, people have become increasingly concerned that the dying process is too often needlessly protracted by medical technology and is consequently marked by incapacitation, intolerable pain, and indignity. In one public opinion poll, 68% of respondents believed that "people dying of an incurable painful disease should be allowed to end their lives before the disease runs its course."1A number of comparable surveys indicate similar public sentiment.2 Since the turn of the century, there has been a dramatic shift in the places where people die. Sixty years ago, the vast majority of deaths occurred at home. Now most people die in hospitals or long-term care facilities. Approximately 75% of all deaths in 1987 occurred in hospitals and long-term care institutions,3up from 50% in 1949,61% in 1958, and 70% in 1977.4This transition from the privacy of the home to medical institutions

The medical profession has long recognized the need to maintain the confidentiality of a patient's medical condition, particularly when stigmatizing conditions, like human immunodeficiency virus infections, are involved. The obligation to maintain confidentiality continues after the death of the patient. At the same time, there may be public health concerns that justify limited disclosure of a deceased person's human immunodeficiency virus status. This report provides guidelines that balance the need for confidentiality with public health concerns when a deceased person infected with the human immunodeficiency virus undergoes an autopsy.

The American Medical Association's Council on Ethical and Judicial Affairs recently reviewed the ethical implications of sexual or romantic relationships between physicians and patients. The Council has concluded that (1) sexual contact or a romantic relationship concurrent with the physician-patient relationship ship is unethical; (2) sexual contact or a romantic relationship with a former patient may be unethical under certain circumstances; (3) education on the ethical issues involved in sexual misconduct should be included throughout all levels of medical training; and (4) in the case of sexual misconduct, reporting offending colleagues is especially important.

It is our purpose in reporting this case to call attention to an extremely uncommon tumor of the broad ligament. The tumor in our case proved very confusing as to identity until it was found to be metastatic from a small inconspicuous primary lesion of the rectum. The adnexae and parametria have been the site of many unusual tumors. Many of these tumors have been difficult to identify as evidenced by the numerous suggested classifications of ovarian tumors. The development of these structures gives rise to innumerable possibilities for different types of tumors and for their appearance in unusual locations. Reports of carcinoids in this region, however, are rare. Stewart and Taylor1described a patient with primary carcinoid of the appendix with two metastatic nodules implanted on the pelvic peritoneum; the patient was well 10 years after the removal of the appendix and the two nodules from the cul