Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful (...) framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public. (shrink)

We are living in a time of war on multiple fronts. This is as true metaphorically as it is geographically. In particular, we live in an age in which war has been declared against disease, and war has been declared against terror. This essay considers in tandem the costs of those wars—more precisely, the costs of those metaphors of war.

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders’ meeting, with many stakeholders absent. In addition to ‘hearing out’ the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in (...) public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under‐attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of ‘consensus’ for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest. (shrink)

Introduction US data reveal a Caesarean rate discrepancy between insured and uninsured patients, with the C-section rate highest among the privately insured. The data have prompted concern that financial incentives associated with insurance status might influence American physicians' decisions to perform Caesarean deliveries. Objective To determine whether differences in medical risk factors account for the apparent Caesarean rate discrepancy between Medicaid and privately insured patients in Michigan, USA. Method A retrospective review was performed of 617 269 live birth deliveries in (...) Michigan hospitals during 2004–8. All live birth records that were able to be linked to their mothers' hospital discharge records were utilised. Diagnosis-related group codes from the hospitalisation records were used to identify Caesarean deliveries. Regression models determined Caesarean probability for the time period under study, adjusted for insurance type, maternal age, race, maternal medical conditions, multiple births, prematurity and birth weight. Results From 2004 to 2008, Caesarean rates were 33% for privately insured patients and 29% for Medicaid patients. The probability of Caesarean delivery was significantly greater for privately insured than Medicaid patients on univariate analysis (OR 1.2, 95% CI 1.19 to 1.22) but not on multivariate analysis (adjusted OR 1.01, 95% CI 0.99 to 1.02). Conclusion No significant disparity was found in the odds of Caesarean delivery between privately insured and Medicaid patients in Michigan after adjusting for other Caesarean risk factors. A positive disparity would have provided de facto evidence that financial incentives play a role in physician decision-making regarding Caesarean delivery. (shrink)

A FALSE DICHOTOMY BETWEEN INTEGRITY AND IMPARTIALITY HAS become entrenched in contemporary ethical and political theory. Drawing on the work of Bernard Williams and Alasdair MacIntyre, this essay sketches the dichotomy and argues for its ultimate falseness. Eco-theologians' innovative use of the term "integrity" suggests directions for transcending the false dichotomy. Increasingly, the term "integrity of creation" is used to flag religioethical dimensions of ecology. This usage changes the subject of integrity from individuals to systems, implying that personal integrity is (...) a derivative concept that is related to how one responds to the complexity of systems. A structurally parallel change in the subject of integrity would benefit political theory. It would promote an "ecological politics" that integrates alternative definitions of integrity as wholeness, consistency, and balance. It also would suggest new conceptions of civic virtue that avoid dichotomizing between personal integrity and public impartiality. (shrink)

Once upon a time, civic virtue described an ethic of political involvement for all citizens. As American democracy evolved, however, the public and private spheres separated. The latter became domesticated and disengaged from public life by an ideology based on gender and a "disinterested love" of neighbor. Private passion was to be isolated from public reason, private love from public justice. But it need not be so. Drawing on examples of ordinary heroes, Ann Mongoven argues for a transformed civic virtue (...) that articulates "just love": passionate care for fellow citizens as such. By connecting theory to practice, Mongoven dramatizes the challenges raised through tangible political examples and lets ordinary heroes suggest the path toward civic renewal. (shrink)

A FALSE DICHOTOMY BETWEEN INTEGRITY AND IMPARTIALITY HAS become entrenched in contemporary ethical and political theory. Drawing on the work of Bernard Williams and Alasdair MacIntyre, this essay sketches the dichotomy and argues for its ultimate falseness. Eco-theologians' innovative use of the term "integrity" suggests directions for transcending the false dichotomy. Increasingly, the term "integrity of creation" is used to flag religioethical dimensions of ecology. This usage changes the subject of integrity from individuals to systems, implying that personal integrity is (...) a derivative concept that is related to how one responds to the complexity of systems. A structurally parallel change in the subject of integrity would benefit political theory. It would promote an "ecological politics" that integrates alternative definitions of integrity as wholeness, consistency, and balance. It also would suggest new conceptions of civic virtue that avoid dichotomizing between personal integrity and public impartiality. (shrink)