One goal of the transplant community is to seek ways to increase the number of people who are willing and able to donate organs. People in states between life and death are often medically excellent candidates for donating organs. Yet public policy surrounding organ procurement is a delicate matter. While there is the utilitarian goal of increasing organ supply, there is also the deontologic concern about respect for persons. Public policy must properly mediate between these two concerns. Currently the dead (...) donor (dd) rule is appealed to as an attempt at such mediation. I argue that given the lack of consensus on a definition of death, the dd rule is no longer successful at mediating utilitarian and deontologic concerns. I suggest instead that focusing on a particular person's history can be successful. (shrink)

This dissertation explores the phenomenological and moral dimensions of integrity as it pertains to clinical ethics. It is a diacritical project with two trajectories: Aron Gurwitsch's field-theory of consciousness fortified and complemented by Richard Zaner's phenomenology and areteic and formalist notions of moral integrity described by philosopher Hayden Ramsay. Gurwitsch's field-theory relies on the concept of gestalt with respect to which constituent elements and the whole thereby formed are integrally related. I argue that Gurwitsch's theory is valuable for describing and (...) conceptualizing the gestalts of clinical moral experience. ;In general, integrity displays two dimensions: the unity of parts within a whole in which an impression of the whole can be glimpsed by means of the constituent elements, and the moral ideal of integrity as virtue or as principled coherence. I describe in rich detail a representative case in clinical ethics and analyze various moral and medical dimensions of the case using integrity as a guide. ;Formalist and areteic explanations of integrity are the locus of the second theoretical trajectory of the dissertation insofar as they serve to critique and complement the phenomenological approach. Areteic moral integrity is sometimes understood in terms of one's character---in which the fabric of one's identity is woven through reasoned, habituated, and principled moral acts. These acts are further oriented toward a kind of singular moral fulfillment which is often shaped by philosophical and theological commitments. In contrast, formalist understandings of integrity are structured around discovering who one is and pertain to the coherence of commitments, behaviors and dispositions which make the individual who s/he is. I argue that the goal-orientation of teleological accounts should be preserved in the clinical setting and that formalist integrity is normatively valuable because it allows for the dynamism of identity which shapes the patient's experience of illness within the context of clinical medicine. (shrink)