Abstract

This study describes the moral environment in which most decisions about transplantation are wade, including within the bioethics community, the popular media, and the medical professional world. It also examines the Old Order Amish to provide a distinctive perspective on these unique decisions and burdens of care and cost. Both ethnographic and philosophical methods are used to explore these ethical issues. I conclude that the results of the practice of transplantation are ambiguous at both personal and social levels; some individuals return to a healthy and productive life, while others suffer significant morbidity, psychological stress and economic hardships. The practice also requires a great deal of financial and intellectual support at a societal level. Because the Amish have a long history of sacrificing individual freedom for the good of the community, I assumed that the Amish might make socially responsible individual and community allocation decisions and have better systems of care. In fact, however, both Amish and non-Amish Americans have a difficult time giving informed consent when faced, with the possibility of their own or a loved one's death. The Amish are exemplary because they provide comprehensive, lifelong support for those who have received transplants. In light of the ambiguity of the results of transplantation and the ways in which decisions are made about transplantation, I suggest that bioethicists focus more of their energies on better informing the public about transplantation, attending to post-transplant care issues such as economic and practical support, and facilitating more peaceful deaths for transplant recipients when they become unable to speak for themselves