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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

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

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

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

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

May God Protect This Beautiful Organ

Andrew Talle

in Beyond Bach: Music and Everyday Life in the Eighteenth Century

In chapter nine, Gottfried Silbermann’s construction of a new organ in the small town of Rötha serves as a case study of such projects, which were undertaken frequently in Bach’s Germany. Its ... More

In chapter nine, Gottfried Silbermann’s construction of a new organ in the small town of Rötha serves as a case study of such projects, which were undertaken frequently in Bach’s Germany. Its unveiling in 1721 was celebrated with a performance led by Johann Kuhnau, Bach’s predecessor as Cantor of St. Thomas. Impressive organs like the one built in Rötha were spectacular feats of engineering and artistry. Such instruments were among the most complicated pieces of technology in existence and there was something promethean about the work of Silbermann and other organ builders: their work came as close as human beings ever did to fabricating fellow living creatures. As a result, organs often figured in the analogies of philosophers of the era, particularly those who sought to preserve a distinction between the physical (organ) and metaphysical (organist).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

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

The Inexcusable and the Unforgivable

Aaron T. Looney

in Vladimir Jankélévitch: The Time of Forgiveness

Chapter Five adopts and deepens the distinction between the excuse and forgiveness addressed in Chapter Two. What can be excused is not the object of forgiveness because the excuse follows the order ... More

Chapter Five adopts and deepens the distinction between the excuse and forgiveness addressed in Chapter Two. What can be excused is not the object of forgiveness because the excuse follows the order of reasons and understanding, whereas forgiveness transcends understanding both in its object and as an event. According to Jankélévitch, the inexcusable constitutes the true object of forgiveness. By contrasting Jankélévitch’s conception of wickedness to the predominant Western theories that evil is rooted in either ignorance or a privatio boni, it seeks to clarify the relation between freedom and evil, the correlation between punishment and forgiveness, and the struggle between love and evil. Evil constitutes what Jankélévitch calls the organ-obstacle of forgiveness. It is sometimes organ and sometimes obstacle—a tension that elicits an oscillation in discursive thought between evil and love. The chapter concludes with a meditation on the omnipotence of love and the impotence of love based on Jankélévitch's interpretation of verse 8:6 from The Song of Songs: If love is as strong as evil, he suggests, then evil is stronger than love, and love is stronger than evil. The discussion closes by situating the question of the unforgivable in the context of this unremitting dynamic.Less

Reanimation: The Logic of Transfer in Measure for Measure

Philip Lorenz

in The Tears of Sovereignty: Perspectives of Power in Renaissance Drama

The chapter considers a first paradigm of sovereignty, focusing on the metaphor-logic of substitution that reanimates the body-of-power in Shakespeare's Measure for Measure. Shakespeare's only play ... More

The chapter considers a first paradigm of sovereignty, focusing on the metaphor-logic of substitution that reanimates the body-of-power in Shakespeare's Measure for Measure. Shakespeare's only play with a religious title, Measure for Measure (1604), a foundational text for scholars working on political theology, asks us to think about the status, structure and above all staging of the law at an acute moment of national and international crisis. Viewing Measure in relation to the Act and writ of habeas corpus, the chapter shows how the “organ transplant” logic of representation staged in Measure for Measure effectively restores the law and satisfies sovereignty's desire to have the body.Less

Primary Topic Article: Trafficking and Markets in Kidneys: Two Poor Solutions to a Pressing Problem

Arthur L. Caplan

in The Future of Bioethics: International Dialogues

Trafficking is a major source of kidneys for transplant in the world today. This practice involving the exploitation and even murder of organ sources is ethically indefensible. Some argue that a ... More

Trafficking is a major source of kidneys for transplant in the world today. This practice involving the exploitation and even murder of organ sources is ethically indefensible. Some argue that a regulated market would be far more preferable. It would not. There is no evidence that a market would increase the supply of kidneys, it does nothing for other vital organs and it is almost certain that a market could not be regulated. Selling organs, even in a tightly regulated market, violates the existing bioethical framework of respect for persons since the sale is clearly being driven by only by profit. It also violates, in the case of living persons, the ethics of medicine itself. The core ethical norm of the medical profession is the principle, “Do no harm.” The only way that removing an organ from a living person is morally defensible is if the donor chooses to undergo the harm of surgery solely to help another; not to make money. The creation of commerce in body parts puts medicine in the position of removing body parts from people solely to abet those people’s interest in securing compensation as well as to let middle-men profitLess