Abstract
Consensus is the holy grail of bioethics, the lynch pin of the assumption that well informed, well intentioned people may reach generally acceptable positions on ethically contentious issues. It has been especially important in bioethics, where advancing technology has assured an increasing field of complex medical dilemmas. This paper results on the use of a multicriterion decision making system (MCDM) analyzing group process in an attempt to better define hospital policy. In a pilot program at The Hospital for Sick Children, Toronto, a series of small scale focus groups was constituted to examine criteria defining organ transplant eligibility. Criteria were organized hierarchically using the Analytic Hierarchy Process, an MCDM approach, and the resulting data was analyzed using Expert Choice 9.0, software designed to facilitate AHP analysis. Qualitative and quantitative analysis map barriers to practical consensus in a way not previously possible.
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REFERENCES
Rescher, Nicholas. Pluralism: Against the Demand for Consensus. NY: Oxford University Press, 1993; 185.
Moreno, Jonathan D. Deciding Together: Bioethics and Moral Consensus. NY: Oxford University Press, 1995.
Kuczewski, Michael. Review of Moreno, Jonathan D. Deciding Together: Bioethics and Moral Consensus. NY: Oxford University Press, 1995. In Cambridge Quarterly of Healthcare Ethics. 6: 3, 358–359.
Post, Stephen. The Moral challenge of Alzheimer Disease. Baltimore, MD. 1995. For an insightful review of Post's Book see McCurdy, David B. Alzheimer disease Making the Rounds in Health, Faith & Ethics. Chicago, III. Parkridge Center, March 25, 1996, 5.
Habermas, Jurgen. Justification and Application: Remarks on Discourse Ethics. Cambridge, Mass: MIT Press: 1993; Habermas, Jurgen. Moral Consciousness and Communicative Action. Cambridge, Mass: MIT Press, 1990.
Rescher, Nicholas. Pluralism Op. Cit. note 1, 185.
Pasternack, Martin S. The Black Stork; Eugenics and the Death of 'Defective'Babies in American Medicine and Motion Pictures since 1915. NY: Oxford University Press, 1996; Binding, Karl and Hoche, Alfred. Permitting the destruction of unworthy life. Walter Wright, trans. Issues in Law and Medicine 1992; 8: 2231–2268.
Koch, Tom. Normative and prescriptive criteria: The efficacy of organ transplantation allocation protocols. Theoretical Medicine 1996; 17: 1, 75–93.
Koch, Tom and Rowell, Mary. A pilot study on transplant eligibility criteria: Valuing the stories in numbers. Pediatric Nursing 1997; 23: 2, 160–166.
Koch, T. Normative and Prescriptive Criteria. Op. Cit. Note 8. Koch, Tom and Rowell, Mary, ibid.
Including Cook, RD, Staschak, S, Green, WT. And Vargas, LG, A method to allocate livers for orthotopic transplantation: An application of the analytic hierarchy process. Proceedings of the International Conference on Multiple Criteria Decision Making. Bangkok, December 6–8 1989; Corley, ME and Sneed, G. Criteria in the selection of organ transplant recipients. Heart and Lung. 1994; 23: 6, 453–454; Obrisch, ME & Levenson, JL Psychosocial evaluation of heart transplant candidates; an international survey of process, criteria, and outcomes. Journal of Heart Lung Transplant. 1991; 948–955.
These included the initial rejection of persons with Down Syndrome as suitable candidates and the transplantation of both former baseball player Mickey Mantle and of actor Larry Hagman. These cases are reviewed in Koch, T. Normative and Prescriptive Criteria, op. cit. note 10.
Fernandez, AA. Expert choice: Pro Version 9.0 for Windows confirms product as an outstanding choice for addressing complex, multicriteria problems. OR/MS Today, 1996; 23, 4.
Koch, T. The Canadian question: What's so great about intelligence? Cambridge Quarterly of Healthcare Ethics. 1996; 5: 2, 307–310.
For a brief review of the method used in this program, see Saaty, Thomas L. Decision Making for Leaders: The Analytic Hierarchy Process for Decisions in a Complex World. Vol. II. Pittsburgh: RWS Publications, 82–84.
Ott, Barbara B. Commentary on Koch and Rowell article: Changes in liver transplant policy. Pediatric Nursing. 1997; 23: 2, 167–168.
Osorio, RS, Ascher, NL, Advery, M, et al. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hematology 1994; 20: 1: 1, 105–110.
Chambliss, Daniel F. Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics. Chicago: University of Chicago Press, 1996, 138.
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Koch, T., Rowell, M. The Dream of Consensus: Finding Common Ground in a Bioethical Context. Theor Med Bioeth 20, 261–273 (1999). https://doi.org/10.1023/A:1009995919835
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DOI: https://doi.org/10.1023/A:1009995919835