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Lawyers are trained to think in terms of power exercised by a sovereign-an institution authorized to enforce a procedurally appropriate decision with coercive force.' Generally, lawyers have a broad notion of what constitutes a sovereign. In the United States, for example, this notion includes the federal government, state governments, most tribal units, traditional territorial governments and their agencies-e.g., school boards, local public park districts, water run-off management districts, and flea abatement boards-and a host of other institutions. As a result, it is difficult for lawyers to recognize that policy also may emanate from other institutions that possess only persuasive authority, not coercive power.

Together, the four Articles in this Symposium demonstrate the strength of bioethics institutions that do not grow out of sovereign governments. Perhaps we have entered an era where the value of engaging nonsovereign institutions in policy making is seen as valuable across disciplinary lines. These authors, for example, apply their theories to the market for pharmaceuticals, the International Health Regulations, and the collection of genetic information. The challenge for the bioethics community is to take the principles developed here and to apply them to other pressing issues, including physician-assisted death, female genital surgery, the request for futile medical care, designing proper regulation for a managed care system, and, perhaps, providing a just and equitable distribution of health care resources in this country and around the world.

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Houston Law Review





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