The paper reviews the discussion within transplantation medicine about the organ supply and demand problem. The focus is on the evolution of attitudes toward compensation plans from the early 1980s to the present. A vehement rejection on ethical grounds of anything but uncompensated donation—once the professional norm—has slowly been replaced by an open debate of plans that offer financial rewards to persons willing to have their organs, or the organs of deceased kin, taken for transplantation. The paper asks how this (...) shift has occurred and what it tells us about the dynamics of bioethical debates, both within professional circles and in wider public arenas. (shrink)

Proposals to compensate families for transplantable organs are gathering momentum. These proposals assume that the body is not integral to the self—that it can be treated like property. Most people believe otherwise.

There was a remarkable outpouring of publications related to the concept of medical futility between 1988 and 1995, and there has been a substantial drop-off since then. A wide variety of definitions of the concept were offered from many corners of the medical profession, from medical social sciences, as well as from judges in several state and federal courts. Attention was drawn to the conflicts over when it is appropriate to declare further treatment futile, who has the authority to make (...) such determinations, and what evidence is required. (shrink)

Schneiderman, Teetzel, and Gilmer offer an amusing but misleading response to my article on medical futility. Although I did make note of the falloff in citations to medical futility in Medline and Bioethicsline after 1995, my analysis focused on the precipitous rise in professional publications on the concept in the period from 1988 to 1995—a trend confirmed by the authors' own search results. I certainly did not argue, either explicitly or implicitly, that the discussion of medical futility was over. I (...) made limited use of this citation survey—to raise a question about what sparked so much professional debate after 1988. This seems to me an entirely appropriate methodology. (shrink)