The American Journal of Bioethics, Volume 11, Issue 8, Page 48-49, August 2011.

Objectives: The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation.Methods: Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative content analysis, (...) and the concept of the ideal type.Results: Before surgery, “openly motivated” donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual—partly in subconscious expectations and wishes. In contrast, “openly ambivalent” donors formulate their anxieties and express arguments against donation.Conclusions: Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process. (shrink)

Genomic research projects that collect tissues from deceased organ and tissue donors must obtain the authorization of family decision makers under difficult circumstances that may affect the authorization process. Using a quasi-experimental design, the Ethical, Legal, and Social Issues (ELSI) substudy of the Genotype-Tissue Expression (GTEx) project compared the recall and understanding of the donation authorization process of two groups: family members who had authorized donation of tissues to the GTEx project (the comparison group) and family members who had authorized (...) organ and tissue donations in years previous, who subsequently participated in two different mock-authorization processes that mimicked the GTEx authorization process (the intervention groups). Participants in the comparison and intervention groups were matched on key demographic characteristics.We found that participants in the intervention groups who experienced a mock-authorization process demonstrated better recall of the tissue donation request than members of the comparison group. Our data indicate that the stress associated with the loss of a loved one limited the ability of family members to recall details about the GTEx project. However, we found a similar lack of knowledge in both the comparison and the intervention group participants, suggesting lack of knowledge may be due to the complexity and unfamiliarity of the information presented to them during the authorization process. We discuss these findings in the context of everyday clinical decision making in cognitively challenging conditions. (shrink)

With the gap between the number of transplantable organs and the number of people needing transplants widening, many have argued for moving from an opt-in to an opt-out system of deceased organ donation. In the first system, individuals must register their willingness to become donors after they die. In the second system, it is assumed that individuals wish to become donors unless they have registered an objection to donation. Opting out has also been described as presumed consent. Spain has had (...) the most successful presumed consent policy, resulting in a substantial increase in the donation rate. 1 Despite support for an opt-out system from the British Medical Association and other groups since 1999, the report of a task force delivered in November 2008 recommended that the current opt-in system in the UK be retained. 2 The USA has also retained an opt-in system.3 Two prominent American bioethicists, Tom Beauchamp and James Childress, claim that an opt-out policy “would not likely be adopted in the United States, and if it were adopted, it probably would not increase the number of organs for transplantation because so many citizens would opt out.”4Offering financial incentives such as paying funeral expenses for a deceased donor’s family is one way of increasing the number of organs. A regulated market in organs is another.5 In the UK at least, there is broader support for presumed consent. Among the alternatives to opting in, this system has the best prospect of eventually being adopted. Presumed consent would not obviate but retain the basic idea of consent, because individuals would still have the right to opt out and choose not to donate. 6One argument for presumed consent is that it would reduce the incidence of free riding. For a free rider, it is not rational …. (shrink)

In 1999, a case was described on national television in which a woman had enlisted onto an international bone marrow registry with the altruistic desire to offer her bone marrow to some unidentified individual in need of a transplant. The potential donor then was notified that she was a compatible match with someone dying from leukemia and gladly donated her marrow, which cured the recipient of the disease. Years later, though, the recipient developed end-stage renal disease, a consequence of the (...) high-dose chemotherapy she received earlier to destroy her stem cells and prepare her for the bone marrow transplant. Finding a suitable donor for a kidney transplant proved extremely difficult. Desperate, she requested that the donor registry personnel help her locate the individual who earlier was determined to be a compatible donor and asked this now-identifiable individual to consider donating one of her two normally functioning kidneys for a kidney transplant. (shrink)

In this paper we assume the contours of the libertarian philosophy, its view toward the unjustified state, and, also, the punishment theory of this perspective. We address the narrow question of what punishment is justified for partaking in statist activities.

In the early days of organ transplantation from deceased donors, the surgical team would bring the donor into the operating room with the recipient, the respirator would be stopped, and the team would wait for the donor’s heart to cease beating. This type of organ donation has been defined as donation after cardiac death, also referred to as non-heart-beating donation. These donors were not declared dead using neurological criteria, but rather using conventional cardiorespiratory criteria. In 1959, Mollaret and Goulon coined (...) the term “coma dépassé” for the patients with an irreversible state of coma and apnea. Jean Morelle and Guy Alexandre of the Catholic University of Louvain, Belgium, were the first to introduce a set of brain death criteria based on the description of coma dépassé, and carried out, in 1963, the first transplants from a brain dead donor in their country and in the world. (shrink)

In a recent article in this journal, we argued that living organ donation from a parent to a child should be described as a beneficent rather than an altruistic act. Emotional relationships can generate an obligation of beneficence to help those with whom we have these relationships. This may involve an obligation for a parent to donate an organ to a child, even though it entails some risk to the parent. The parent's donation is not altruistic because altruistic acts are (...) not obligatory but optional, and they are motivated solely or primarily by other-regarding concerns. In contrast, donor parents' other-regarding concerns are inseparable from their own self-regarding concerns. An individual who donates to a stranger is acting altruistically. She may choose to help others to whom she is not emotionally related for a variety of reasons—sympathy, compassion, generosity, or a desire to give something back to humanity. But she does not have an obligation to do so. Although she may benefit as a consequence of donating, this is not her reason for donating. Instead, her action is motivated by a concern for the recipient's own sake. This is what makes the donation altruistic, and it can be justified without any expectation of benefit to the donor. However, although the potential competent donor decides whether the donation is in her best interests, physicians have the right to refuse to perform a transplant if the risks to the donor are too great or the potential benefits to the recipient are too small. (shrink)

The present trend toward routine inquiry appears to be based on the false premise that the individual's wishes cannot be known and that, therefore, the family is the only alternative for making donation decisions. The UAGA states that the family should be turned to only when the wishes of the individual are not known.To protect the right of individuals to make their own decision, an effective and efficient process for making the wishes of individuals known should be devised and the (...) UAGA amended accordingly. I have presented the policy of strong required request as the best way to effectively protect the rights that the UAGA ostensibly gives to the individual. This policy ensures that the individual's wishes, both for and against donation, are known. It also alleviates some of the problems in the original approach that hindered the procurement of organs from willing donors. Strong required request saves families from making critical decisions, which may be painful and conflicted for some, at a time of emotional shock and grief. (shrink)

In a recent set of papers, Aaron Spital has proposed conscription or routine recovery of cadaveric organs without consent as a way of ameliorating the severe shortage of organs for transplantation. Under the existing consent requirement, organs can be taken from the bodies of the deceased if they expressed a wish and intention to donate while alive. Organs may also be taken when families or other substitute decisionmakers decide on behalf of the deceased to allow organ procurement for the purpose (...) of transplantation. When patients or families do not consent to organ procurement, many transplantable organs are lost. This is a tragic yet avoidable situation. The dead are beyond any benefit or harm, and their organs could be used to prevent harm by saving and improving the lives of many people suffering and dying from end-stage organ failure. (shrink)

The mechanical view on the human body may be considered as the context in which the highly technological medicine of these days originated. Organ transplantation is certainly one of the most impressive possibilities of this new evolution in medical technology. It exists by the grace of the paradigm of the body as a “Körper” : this paradigm leads to a self-evident acceptance of transplantation medicine in its most brilliant applications. Refinement of surgical techniques, better preservation of organs, the development of (...) more effective immunosuppressives, better procedures for the establishment of brain death criteria and better criteria for the selection and matching of donors and receptors are immanent goals of this type of medicine. Meanwhile the lives of many thousands of patients are saved and these patients even receive the chance for a new life, with much more quality. The ethical reflection on organ transplantation has followed rather rapidly this technical discourse and sounds as a kind of “moral engineering”. This is certainly connected with the upcoming success of “Principlism” , whereby medical decision making is oriented by applying four major principles to medical cases . It is also connected with the ethical approach of utilitarianism, which fits almost perfectly in this technological atmosphere. The authors question this approach and suggest that a more relational understanding of the human body as “Leib” would be a better paradigm for the promotion of solidarity in the context of organ donation and transplantation. Human beings do not only ‘have’ a body, but ‘are’ also their body. The body of the deceased refers to the life of a loved one. Technical procedures surrounding organ removals sometimes hinder the possibility for the family to bereave adequately around their loved one. The authors are convinced that the urging problem of organ shortage is not only caused by lack of solidarity or laziness, but also by the reductionist discourse of transplantation medicine itself. They suggest that we have to find – eventually with the help of poets and writers – an adequate new language to replace the alienating discourse of current transplantation medicine. They see also in communitarianism and personalist care ethics a better ethical approach for touching the peculiar sensitivities of eventual donors and receptors. (shrink)

The shortage of available organs for transplantation, organ tourism and illegal kidney transplantations put the question of paid organ donation and commercialism high on the agenda. Ethicists as J. Radcliffe-Richards and R.Veatch have reopened the debate. Therefore it is necessary and useful to check the main arguments pro and con. The advocates of paid organ donation refer to autonomy and pragmatic considerations. Why not regulate an ineradicable practice? The opponents rely on the dignity and integrity of the human body and (...) on justice. They are afraid of exploitation of the poor. A thorough analysis of the debate reveals that the arguments pro and con are incompatible and that the ethical debate leads nowhere. Furthermore, paid organ donation will stimulate the instrumentalisation and commodification of the human body. It brings about a further medicalisation of society where the wishes of the patient and the ‘cure’ prevails over the ‘care’, prevention of organ failure and scientific research . On the basis of the ethical impasse and especially on the basis of these implicit sociological considerations we make a plea against paid organ donation. Altruistic donation and solidarity must remain the basis of organ transplantation. Solidarity is fed by charity and fraternity , the two great sources of western culture and morality. These also must remain the basic inspiration of medicine in general and of organ transplantation in particular. (shrink)

In this issue, Walter Sinnott-Armstrong and Franklin G. Miller argue that what makes killing wrong, when it is wrong, is not that it ends life, but that it causes complete and irreversible disability—what they call total disability. They hold that the wrongness of killing should be explained by reference to the harm that killing causes to the person who dies. And the only harm of this sort that killing causes, they argue, is the harm of being totally disabled: once (...) one is totally disabled, there is no further harm to one in losing one's life. It is no worse to be dead, and thus totally disabled, than it is to be totally disabled but alive.In fact, Sinnott-Armstrong and Miller concede that the story may be more complicated than this. For example, it may be that what makes killing wrong, when it is wrong, is not that it causes harm, but that it is intended to do so, or that it violates a right which protects against harm. But either way, harm plays a crucial role in explaining the wrongness of killing, and the relevant harm, they claim, is the harm of being disabled, not that of losing one's life.The Authors’ argument has important implications for medical ethics. Their view implies that killing a person need not be wrong when that person is already completely and irreversibly disabled. This suggests, for example, that the dead donor rule in organ donation is mistaken. Contrary to the rule, it could be morally permissible to harvest organs from a living donor provided that the donor is totally disabled. Harvesting organs will kill the donor, but it will not disable her, since the donor has no abilities left to lose.Four …. (shrink)

Against the backdrop of Walter Benjamin's famous essay, “Unpacking My Library”, this article, by the Librarian of the Warburg Institute, tells the story of the many times that the Warburg Library has been packed and unpacked. First it was the private collection of Aby Warburg, later a public institution, originally in Hamburg and then in London from 1933 to the present. This essay also explores the various ways in which books have been — and continue to be — acquired (...) by the Warburg Library, including publication, donation, recommendation, and purchase. Each of these methods is not only discussed but also examined in light of Benjamin's account of the acquisition of his own library. Moreover, Benjamin's view that collections lose their meaning when they cease to be personal is challenged by the example of the Warburg Library, which has been transformed from a private collection containing around 15,000 books in 1911 to a public institution today housing over 350,000 volumes, while still maintaining its unique character. (shrink)

The “standard position” on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that brain death is not death, and even though “brain dead” patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US (...) “whole brain” criterion and the UK “brain stem” criterion. Then we answer their arguments in favour of removing vital organs from “brain dead” and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to “letting nature take its course”, arguing that, unlike “allowing to die”, it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation. (shrink)

Neuroimaging, psychosurgery, deep-brain stimulation, and psychopharmacology hold considerable promise for more accurate prediction and diagnosis and more effective treatment of neurological and psychiatric disorders. Some forms of psychopharmacology may even be able to enhance normal cognitive and affective capacities. But the brain remains the most complex and least understood of all the organs in the human body. Mapping the neural correlates of the mind through brain scans, and altering these correlates through surgery, stimulation, or pharmacological interventions can affect us in (...) both positive and negative ways. We need to carefully weigh the potential benefit against the potential harm of such techniques. This paper examines some of these techniques and explores the emerging ethical issues in clinical neuroscience. (shrink)

How can Africans escape the control of the complex power relationships established during Colonization and successfully achieve self-development? More importantly, and the primary concern of this book, can African female characters ever hope to arrive at such individuation given the dual challenges of the power structures defined and enforced by European colonizers and the patriarchal structures that contort issues related to gender? Tracing Personal Expansion reads late 20th Century works by African female novelists Buchi Emecheta, Tsitsi Dangarembga, and Calixthe Beyala (...) as modern Bildungsromane, novels of self-development, to reveal the dynamics, complexities, and challenges the characters and authors experience. By exploring the possibility of self-development in African female protagonists, this engrossing work augments existing feminist critiques that have analyzed the possibilities and potentials for the individuation of mostly Western, mostly European female characters. (shrink)

In this radical reinterpretation of Aristotle's Metaphysics, Walter E. Wehrle demonstrates that developmental theories of Aristotle are based on a faulty assumption: that the fifth chapter of Categories is an early theory of metaphysics that Aristotle later abandoned.

A noção de comportamento se faz importante em Wittgenstein, principalmente relacionada a argumentação da linguagem privada e o seguir regras. O Behaviorismo propõe, justamente, o comportamento, que é desenvolvido posteriormente, como objeto de estudo em uma espécie de revolução da ciência psicológica para que esta ganhasse o estatuto de ciência. Partindo de noções de comportamento distintas em Wittgenstein, no behaviorismo metodológico e no comportamentalismo, o presente ensaio tem quatro objetivos: 1) apresentar uma noção de comportamento em Wittgenstein; 2) apresentar a (...) noção de comportamento para o behaviorismo metodológico; 3) apresentar a noção de comportamento para o comportamentalismo; 4) se a noção de comportamento do comportamentalismo estaria ou não sujeita às críticas de Wittgenstein. Para tanto, inicialmente, apresentaremos brevemente o que ficou conhecido como o Argumento da Linguagem privada nas IF e em seguida serão apresentadas as concepções de comportamento. (shrink)

Although there are suggestions that the environmental attitudes of men and of women differ, there have been few studies that study and evaluate these differences at the workplace. Given the claim of Ecofeminist writers about the environmental superiority of women's environmental attitudes, and the proclaimed need of business to change attitudes and behaviour with regard to the environment, this is a surprise. The paper is based on 1022 (37% from women) questionnaires which were collected in a U.K. pharmaceutical company, and (...) it compares the empirical results with environmental attitude archetypes, such as those prescribed by O'Riordan. However, the attitude clusters that were found do not correspond greatly with such theoretical modes of environmental ethics. Instead, it appears that women were more likely to be actively involved in environmental behaviour, and showed greater scepticism towards the role of technology in the search for solutions to environmental problems. In addition, men sought to a much greater extent a consistency between an environmental rationality and their behaviour. Men's attitudes were also much more influenced by their position in the organisational hierarchy. There were few significant differences across age groups. (shrink)