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Ethics of Ambiguity: A Buddhist Reflection on the Japanese Organ Transplant Law

Ronald Y. Nakasone

David E. Guinn (ed.)

in Handbook of Bioethics and Religion

This chapter examines the structure and role of ambiguity in the Japanese Organ Transplant Law by looking at the Chinese Huayen Buddhist doctrine of dharmadhatu-pratityasamutpada (fajie yuanqi shuo) ... More

This chapter examines the structure and role of ambiguity in the Japanese Organ Transplant Law by looking at the Chinese Huayen Buddhist doctrine of dharmadhatu-pratityasamutpada (fajie yuanqi shuo) or universal dependent “coarising”, a major interpretation of the Buddha's pratityasamutpada, dependent-coarising or interdependence. Specifically, it will examine the nature of ambiguity through the zhuban yuanming jude men or “the attribute of the complete accommodation of principal and secondary dharmas” that Fazang (643-712) formulated. The interdependent and evolving Buddhist vision of reality causes ambiguity in decision making and action.Less

THE SOUNDPROOF STUDY: Victorian Professional Identity and Urban Noise

John M. Picker

in Victorian Soundscapes

This chapter argues that later 19th-century Londoners' deliberations over street music serve as a gauge of that urban community's explicit demands and entrenched biases. It shows how fights for ... More

This chapter argues that later 19th-century Londoners' deliberations over street music serve as a gauge of that urban community's explicit demands and entrenched biases. It shows how fights for silence repeatedly emerged as regional struggles against street music, insofar as they attempted not only to protect literal neighborhoods and city blocks from intrusive noises but also to defend more abstract regions of identity, those critical domains of nationality, professionalism, and the body. These ongoing battles over sound were concretely as well as conceptually territorial. Even as those opposed proclaimed as their principal goal the removal of music from the streets throughout the City and West London, including Belgravia, Kensington, and Chelsea, they endeavored to maintain clear boundaries in three main interrelated and at times overlapping areas: first, defending the purity of English national identity and culture against the taint of foreign infiltration; second, upholding economic and social divisions between the lower classes and middle-class professionals; and third, protecting the frail, afflicted bodies of (English, middle-class) invalids from the invasive, debilitating effects of (foreign, lower-class) street music. The chapter considers the verbal and visual responses of large numbers of Londoners, including Thomas Carlyle, Charles Dickens, and John Leech, to the strains of a powerful threat.Less

Acquisition of Organs

F. M. Kamm

in Morality, Mortality Volume I: Death and Whom to Save From It

Deals with the problem of the acquisition and distribution of organs for transplantation and allows the application of the foregoing theoretical discussion of saving lives and relevant/irrelevant ... More

Deals with the problem of the acquisition and distribution of organs for transplantation and allows the application of the foregoing theoretical discussion of saving lives and relevant/irrelevant utilities. As an aid to dealing with categories that are of current concern to the medical community, Ch. 11 starts with a summary of the recommendations of the US Task Force on Organ Transplantation on acquisition and distribution of organs, and discusses and criticizes the total‐brain‐death criterion for death. The next section of the chapter discusses the role of informed consent of the original organ owner and his family in relation to the State in the task of acquiring organs, as well as the moral possibility of sale, trading, and taking of organs. The last section of the chapter considers the morality of more controversial proposals for acquiring organs: ‘donation’ from foetuses, donation from live donors where there is significant risk to the donor, and (the most radical) killing some persons for the sake of acquiring organs for others.Less

Commentary: Local and Global Contexts of the Praxis of Bioethics: ‘Transplant Tourism’ and ‘Altruistic’ Medicine

Yosuke Shimazono

in The Future of Bioethics: International Dialogues

In this chapter, Chin criticizes the global ban on ‘transplant tourism’ and argues that promotion of this practice could be reconciled with transplant medicine, which is presumably based on the value ... More

In this chapter, Chin criticizes the global ban on ‘transplant tourism’ and argues that promotion of this practice could be reconciled with transplant medicine, which is presumably based on the value of altruism. However, due to globalization and diversification of the practice of transplant medicine, an international consensus on an ethical issue has become increasingly difficult to obtain. Chin’s argument does not focus enough on the fact that, in this context of global bioethics, ‘transplant tourism’ has emerged as an area where a certain degree of harmonization between jurisdictions is an achievable goal. It is also suggested that altruism is too thin a term that fails to capture complexity of social lives. To localize bioethics, it is necessary to question not only the role of altruism, as Chin does, but also the concept of ‘altruism.’Less

On Selling Organs

Patrick Shade and John Lachs

in Freedom and Limits

Lachs argues that liberty is a relevant idea in addressing technological advances concerning organ transplant. Arguing that the poor have a right to make use of their bodies in securing wealth, he ... More

Lachs argues that liberty is a relevant idea in addressing technological advances concerning organ transplant. Arguing that the poor have a right to make use of their bodies in securing wealth, he contends that the government has no right to interfere with the sale of skills and bodies, so long as this activity does not harm others.Less

Reification of the Human: Global Organ Harvesting and Kazuo Ishiguro’s Never Let Me Go

J. Paul Narkunas

in Reified Life: Speculative Capital and the Ahuman Condition

Kazuo Ishiguro’s 2005 novel Never Let Me Go follows a group of genetic clones who are created as wards of the British health service because they serve a utilitarian function: They are manufactured ... More

Kazuo Ishiguro’s 2005 novel Never Let Me Go follows a group of genetic clones who are created as wards of the British health service because they serve a utilitarian function: They are manufactured for the purpose of having their vital organs harvested until their death. The world he envisions of a grouping of humans reproduced to be a living warehouse of organs while certainly dreadful is nowhere near as horrific as when organ transplantation and global uneven development intersect in our neoliberal present. Ishiguro shows how humans who view their humanity instrumentally expedite a world that is ready to slice them into shares, monetizing all the parts along the way. Through Ishiguro’s text, I diagnose the reification of the body as an aggregation of fungible body parts. Human reification challenges bioethicists and cultural critics alike to reflect on how human dignity and bodily integrity no longer serve as barriers for marking the species-limit due to new advances in biotechnology.Less

All Things Twice, First Tragedy Then Farce: Lessons from a Transplant Error

Charles L. Bosk

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

This chapter examines the transplant error in the Jesica Santillan's case and the main actors in the story (from Duke University Medical Center to Carolina Donor Services, from the United Network for ... More

This chapter examines the transplant error in the Jesica Santillan's case and the main actors in the story (from Duke University Medical Center to Carolina Donor Services, from the United Network for Organ Sharing (UNOS) to the surgeon Jim Jaggers) in order to frame our understanding of medical mistakes as individual, institutional, and system-wide phenomena. Jesica's story illustrates how stakeholders transform celebrated cases to provoke discussions in public arenas and use as dramatic examples of formulating policies to prevent and/or reduce medical errors and achieve patient safety. Focusing on the theoretical understandings of systems error, the chapter analyzes how this mistake was understood at the time and examines the steps taken by the Organ Procurement Organizations (OPOs) and Duke to reassure the public that the causes of this error had been discovered and fixed.Less

The Organ as Scrying Glass: Images From the Organ Reform Movement

Kerala J. Snyder

in The Organ as A Mirror of Its Time

In the first half of the 20th century the organ functioned almost as a scrying glass: a traditional northern European instrument of divination. A brief outline of organ reform movement is given here ... More

In the first half of the 20th century the organ functioned almost as a scrying glass: a traditional northern European instrument of divination. A brief outline of organ reform movement is given here which includes Albert Schweitzer's criticism of “factory-built organs” and his advocacy of the Alsatian Silbermann organ as the ideal resource for the music of Bach. In a parallel development, a new interest in the baroque organ type began in the 1920s with the restoration of the Schnitger organ in Hamburg's St. Jacobi Church and the influential but highly compromised Praetorius Organ built by Walcker in Freiburg, based only on the description of model organ dispositions given in Praetorius's Syntagma Musicum.Less

Human Organ Transplant Ordinance: Facilitating Adult Live Donor Transplants?

Athena Liu

in Law and Medicine: Current Legal Issues Volume 3

Organ transplant raises difficult legal and ethical issues. Organs may come from a live or dead donor, and a donor may be an adult or a minor. This chapter deals with only live adult (over eighteen) ... More

Organ transplant raises difficult legal and ethical issues. Organs may come from a live or dead donor, and a donor may be an adult or a minor. This chapter deals with only live adult (over eighteen) donors and recipients. Live transplant is mainly governed by the Human Organ Transplant Ordinance (HOTO) which has two main objectives: first, to prevent organ trading, which can take two forms: commercial agencies acting as intermediaries between donors and recipients, and recipients buying organs by paying potential donors as a means of inducing a donation which would not otherwise have taken place. The other objective of the HOTO is to protect the right to self-determination of both donors and recipients. The chapter first examines the scope of the HOTO by reference to the meaning of ‘organ’ and ‘payment prohibited’. Parts II and III examine the legal structure for related and unrelated donations and the extent to which the objectives of the HOTO are achieved. Part IV examines the position of adult comatose recipients. In a recent Hong Kong case, such a patient died as a result of not being able to have a liver transplant. The chapter discusses the position of such a patient under a recent amendment to the HOTO and examines one of its implications.Less

Civil Society

Peter Baldwin

in The Narcissism of Minor Differences: How Europe and America are Alike

Quantifying The Attributes of civil society, in turn, is complicated and slippery, but let us try. Americans are oft en thought to be unusually antigovernment in their ... More

Quantifying The Attributes of civil society, in turn, is complicated and slippery, but let us try. Americans are oft en thought to be unusually antigovernment in their political ideology, practically anarchists by European standards. They are supposed to believe in individual reliance, be less inclined than Europeans to have the state help the worst-off , and more likely to regard the poor as having failed. Surveys of attitudes do not, however, uniformly bear out such polarities. Proportionately more Americans than anyone but the Spaniards claim to obey the law without exception. A higher percentage of Americans trusts their government a great deal than many Europeans, other than the Spaniards, the Swiss and the Finns (figure 159). A Pew Foundation survey in 2007 found that proportionately fewer Americans worried that the government had too much control than did Germans and Italians, with the French at the same level and the British just a percentage point lower. A higher percentage of Americans have a great deal of confidence in their civil service than any Europeans other than the Irish. Proportionately, almost five times as many Americans as Swedes say they trust their government bureaucracy (figure 160). But talk is cheap, and such findings may indicate desire as much as reality. The trust of Americans in their state apparatus can be measured more concretely by their willingness to pay taxes. Unlike many Europeans, Americans pay the taxes required of them. Only in Austria and Switzerland are the underground economies as small. In the Mediterranean, the rate of tax avoidance is much higher—over three times the American level in Greece and Italy (figure 161). The Montana survivalist—so beloved by the European media—holed up in his shack, provisioned for a siege, and determined to resist the government’s impositions, is as uncharacteristic of the average American as the Basque or Corsican separatist, ready to kill and maim for his localist aspirations, is of the average European. Less

Neurocognitive Effects of Solid Organ Transplantation

Nataliya Zelikovsky and Debra S. Lefkowitz

in Cognitive and Behavioral Abnormalities of Pediatric Diseases

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been ... More

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills. Less

Playing With Matches Without Getting Burned: Public Confidence in Organ Allocation

Jed Adam Gross

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

Following Jesica Santillan's death, the United Network for Organ Sharing (UNOS), the nonprofit organization that oversees the country's organ allocation network, reaffirmed its commitment to ensuring ... More

Following Jesica Santillan's death, the United Network for Organ Sharing (UNOS), the nonprofit organization that oversees the country's organ allocation network, reaffirmed its commitment to ensuring public confidence in the transplant system. This chapter examines the historical formation of UNOS and analyzes why public confidence is a paramount priority for transplant policymakers. It discusses the cultural-technical organization of matching, the efforts to promote organ donation, and the politics and economics of organ allocation. Overall, the chapter explores how the matching of available organs with worthy recipients has historically intersected with American debates over scarcity, abundance, fairness, equality, and public confidence.Less

Justice in Organ Allocation

Rosamond Rhodes

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

Focusing on the central ethical issue of Jesica Santillan's case, this chapter discusses the question of whether transplant organs were allocated justly. Specifically, it analyzes how notions of ... More

Focusing on the central ethical issue of Jesica Santillan's case, this chapter discusses the question of whether transplant organs were allocated justly. Specifically, it analyzes how notions of justice should, and should not influence organ matching and that organ allocation should be governed by the principles of “clinical justice”. The chapter also provides insight on the United Network for Organ Sharing (UNOS) policy and the ways in which issues of urgency, efficacy, equity, and the interests of small transplant centers are weighed in organ allocation.Less

The “Evil” of Healthcare Rationing

Philip M. Rosoff

in Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

This chapter introduces the concept of the need for organized healthcare rationing after first discussing the dysfunctions of the healthcare system in the United States: its disorder, gross ... More

This chapter introduces the concept of the need for organized healthcare rationing after first discussing the dysfunctions of the healthcare system in the United States: its disorder, gross inefficiency, inequities, failure to offer insurance to vast numbers of Americans, and enormous (and escalating) costs. It introduces the topic of established open and overt rationing systems in the US, such as that for solid organ transplantation, and suggests that they are accepted – even embraced – by most of the public. If rationing is believed to be anathema, why is this so? It begins an argument that there may be features of the transplant (and other rationing schemes) that contribute to their acceptability, despite the fact that people who fail to receive an organ almost inevitably die.Less

Existing Rationing Systems: Organ Transplantation, Scarce Drugs, and Oregon

Philip M. Rosoff

in Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

This chapter initiates the main argument by describing in detail three systems of open, formal rationing in American healthcare: solid organ transplantation, scarce drug allocation, and the Oregon ... More

This chapter initiates the main argument by describing in detail three systems of open, formal rationing in American healthcare: solid organ transplantation, scarce drug allocation, and the Oregon Health Plan (created in the late 1980s to improve and expand medical care for poor residents of the state). While there are clear differences between the three approaches, as well as dissimilar goals and aims, they bear striking similarities in several crucial domains. Remarkably, all three systems have been accepted not only by the people immediately affected (patients), but also by the public in general, indicating that rationing per se may not be as intolerable as suspected.Less

Fairness

Philip M. Rosoff

in Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

In this chapter the essential issue of fairness is discussed as it is (and should be) a cardinal feature of existing and any future rationing method. The central characteristics of fairness, as it is ... More

In this chapter the essential issue of fairness is discussed as it is (and should be) a cardinal feature of existing and any future rationing method. The central characteristics of fairness, as it is functionally defined here, are described as are examples of failures in allocation fairness in both organ transplantation and in the Oregon Health Plan. It notes that while the consequences of not receiving an organ or a scarce drug may be death or serious injury, the allocation methods are generally accepted (even though there are desperate patients involved), because they are fundamentally judged as fair. There is a detailed description of the author’s adaptation and expansion of Norman Daniels’s and James Sabin’s “accountability for reasonableness” approach to deciding how to allocate scarce resources. The discussion is illustrated with actual case examples.Less

Does Submission to God's Will Preclude Biotechnological Intervention?: Lessons from Muslim Dialysis Patients in Contemporary Egypt

Sherine F. Hamdy

in Deus in Machina: Religion, Technology, and the Things in Between

This chapter offers a critique of the (Orientalist-derived) notion of Islamic fatalism through an ethnographic study of devout Muslims in contemporary Egypt and their flexible attitudes concerning ... More

This chapter offers a critique of the (Orientalist-derived) notion of Islamic fatalism through an ethnographic study of devout Muslims in contemporary Egypt and their flexible attitudes concerning the will of God and the legitimacy of technological intervention in matters of medical therapy and health care. Focussing on several patients receiving regular kidney dialysis treatment in a hospital in Tanta, Egypt, the author documents the ambivalent ways devout Muslims respond to opportunities for organ transplantation, negotiating between their endorsement of official pronouncements made by leading Islamic scholars, their own interpretations of religious source texts, and the shifting material circumstances that make organ transplantation more or less available to them. The chapter concludes by arguing that the term “fatalism” obscures the subtlety and complexity of these negotiations, in so far as it (quite wrongly) presumes that divine will entails passivity or inaction on the part of religious devotees, rendering them incapable of redressing their medical ailments through biotechnological intervention, or of assessing such interventions through a calculated cost-benefit analysis.Less

Welfare reform and drug policy: coalition, continuity and change

Mark Monaghan

in Social policies and social control: New perspectives on the ‘not-so-big society’

This chapter explores two public health programmes implemented in the UK under the 2010 Coalition Government, to illustrate how individualistic behavioural ideologies are embedded in them. Discussion ... More

This chapter explores two public health programmes implemented in the UK under the 2010 Coalition Government, to illustrate how individualistic behavioural ideologies are embedded in them. Discussion notes how programmes may indirectly reinforce health inequalities, and indicates the importance of social contexts when appraising policies built around 'nudge' ideas. The two programmes involve the institution of health responsibility in the National Health Service (NHS) Constitution and the application of nudges. For the second, we focus on a distinctive example: organ donation. Although parts of the literature containing criticisms of behaviourist theories refer to obvious examples such as obesity, smoking and drinking alcohol, organ donation initiatives based on behaviourist approaches may have the potential to perpetuate health inequalities for already disadvantaged groups.Less