Transplantation Ethics

, by Veatch, Robert M.

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ISBN: 9780878408122 | 0878408126
Cover: Paperback
Copyright: 2/1/2002

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Summary

Supplemental Materials

The first complete and systematic account of the ethical and policy controversies surrounding organ transplants.

Acknowledgments

Preface

Introduction: Religious and Cultural Perspectives on Organ Transplantation

(27)

Defining Death and Desecrating the Corpse: Two Preliminary Issues

(10)

The Two Central Ethical Issues

(7)

Conclusion

(9)

An Ethical Framework

(15)

General Theories of Ethics

(9)

Conclusion

(6)

Part One I Defining Death

Brain Death: Welcome Definition or Dangerous Judgment?

(10)

Candidates for ``Death''

(1)

Moral, Not Technical

(1)

The Origins of the Confusion in the Tucker Case

(2)

Determining Who Should Have Made the Decision

(1)

Determining If This Was Really a Definition of Death Case

(2)

Determining If Tucker Was Neurologically Dead

(2)

The Definition of Death: Problems for Public Policy

(32)

The Public Policy Question

(5)

Preliminary Issues to Public Policy Discussion

(5)

The Issues of the Debate Proper

(8)

Some Remaining Issues

(5)

Conclusion

(8)

The Whole-Brain-Oriented Concept of Death: An Outmoded Philosophical Formulation

(18)

Preliminary Philosophical Assumptions

(2)

The Difficult Case for a Brain-Oriented Concept of Death

(3)

The Essentially Significant to the Nature of the Human

(4)

Problems with the Whole-Brain-Oriented Criteria of Death

(6)

Conclusion

101

(2)

The Impending Collapse of the Whole-Brain Definition of Death

103

(11)

Doubts about the Whole-Brain-Oriented Definition

104

(1)

The Higher-Brain-Oriented Alternative

105

(2)

Criticisms of the Higher-Brain Formulations

107

(4)

Conscience Clauses

111

(3)

The Conscience Clause: How Much Individual Choice Can Society Tolerate in Defining Death?

114

(22)

The Present State of the Law

115

(1)

Concepts, Criteria, and the Role of Value Pluralism

116

(7)

The Problem of Order: Objections to a Conscience Clause

123

(7)

Implementing a Conscience Clause

130

(1)

Conclusion

131

(5)

Crafting a New Definition of Death Law

136

(7)

Incorporating the Higher-Brain Notion

136

(1)

The Conscience Clause

137

(1)

A Proposed New Definition of Death for Public Policy Purposes

138

(1)

Conclusion

139

(4)

Part Two Procuring Organs

Gift or Salvage: The Two Models of Organ Procurement

143

(24)

Two Models for Justifying Organ Procurement

144

(2)

The Foundation of the Duty to Respect the Wishes of the Deceased

146

(1)

Surrogate Permission

147

(2)

Variants on the Two Models of Organ Procurement

149

(18)

The Myth of Presumed Consent: Ethical Problems in New Organ Procurement Strategies

167

(8)

The Difference between Presumed Consent and Salvaging

167

(1)

The State of the Law

168

(1)

Why Consent Cannot Validly Be Presumed

169

(2)

What Is at Stake

171

(4)

Required Response: An Alternative to Presumed Consent

175

(7)

The Inadequacy of Alternative Proposals

176

(2)

Required Response of Competent Persons

178

(4)

Live-Donor Transplant: Including the Permanently Unconscious and Paired- and Live-Donor/Cadaver Exchanges

182

(25)

The Dead Donor Rule

183

(1)

New Living Donor Cases

184

(5)

Two Approaches to the Ethics of Live Donation

189

(9)

Paired Exchanges

198

(1)

Live-Donor-Cadaver Exchanges

199

(1)

The Right of Persons to Become Donors

200

(2)

Conclusion

202

(5)

Non-Heart-Beating Cadaver Donors

207

(16)

The Rights and Welfare of the Caregivers

208

(1)

The Organ Source Must Really Be Dead

209

(2)

The Organs Must Really Be Donated

211

(3)

Ways around Absence of Explicit Consent

214

(3)

Determining If Planned Donation Hastens Death Unethically

217

(6)

Report of the Anencephaly Task Force of the Washington Regional Transplant Consortium

223

(13)

The Need for and Availability of Organs and Tissues

224

(2)

Present Requirements that Organ Sources Be Dead

226

(2)

Possible Changes in Public Policy

228

(2)

Criteria for the Humane Treatment of Living Anencephalic Infants

230

(1)

Conclusion

231

(1)

Addendum: Events Related to Anencephalic Organ Procurement since the Writing of the WRTC Report

232

(4)

The Role of Age in Procurement: Minors and the Elderly as Organ Sources

236

(9)

``Donation'' from Minors

236

(3)

Donation from Older Persons

239

(6)

Tainted Organs: HIV-Positive and Other Controversial Donors

245

(14)

Types of Tainted Organs

246

(4)

HIV-Positive Recipients and Transplant

250

(1)

An Assessment

251

(4)

A Proposal for a Policy Change

255

(4)

The Ethics of Xenografts

259

(18)

The Natural Law Problem

261

(1)

The Animal Rights Problem

261

(1)

The Nontherapeutic Interventions Problem

262

(2)

The Resource Allocation Problem

264

(3)

The Virus Problem

267

(4)

Conclusion

271

(6)

Part Three Allocating Organs

Who Empowers Medical Doctors to Make Allocative Decisions for Dialysis and Organ Transplantation?

277

(10)

The Reality of Allocation

277

(2)

Allocation as a Moral Rather Than a Technical Matter

279

(5)

The U.S. Kidney Allocation Formula: An Example

284

(1)

Conclusion

285

(2)

A General Theory of Allocation

287

(24)

Utility

288

(6)

Justice

294

(7)

Respect for Persons

301

(4)

Conclusion

305

(6)

Voluntary Risks and Allocation: Does the Alcoholic Deserve a New Liver?

311

(14)

The Theory of Voluntary Health-Risky Behavior

311

(5)

Alcohol and Liver Transplants

316

(5)

Other Voluntary Behaviors

321

(4)

Multiorgan, Split-Organ, and Repeat Transplants

325

(11)

Multiorgan Transplants

326

(3)

Repeat Transplants

329

(3)

Splitting Organs

332

(4)

The Role of Age in Allocation

336

(16)

The Moral Norms for Allocation

336

(7)

A Formula for Taking Age into Account

343

(2)

Over-a-Lifetime Need versus Present Need

345

(7)

The Role of Status: Did Mickey Mantle Get Special Treatment?

352

(11)

Mickey Mantle: The Real Facts

352

(3)

Governor Casey's Case

355

(2)

Social Worth versus Social Status

357

(6)

Urgency versus Geography: The Controversy between UNOS and Donna Shalala

363

(25)

The Role of Geography in Allocation

363

(2)

The Reasons for the Local Priority

365

(5)

The Demand for a National List

370

(7)

The Ethics of the Conflict over Geography

377

(4)

Determining Whether the UNOS Response Is Adequate

381

(7)

Directed Donation of Organs for Transplant: Egalitarian and Maximin Approaches

388

(25)

The Problem in Theory

389

(2)

Directed Donation: A New Example

391

(3)

The Inadequate Case for the Maximin

394

(3)

Egalitarian Justice as a Prima Facie Principle

397

(4)

The True Egalitarian Alternative

401

(1)

Conclusion

401

(1)

Appendix to Chapter 25: Does the Maximin Apply at this Level of Specificity?

402

(1)

Two Reasons to Believe the Maximin Applies

402

(1)

Three More Egalitarian Interpretations of Rawls

403

(10)

Index

413

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Transplantation Ethics

Summary

Table of Contents

Supplemental Materials