: Moral frameworks for evaluating non-donation strategies to increase the supply of cadaveric human organs for transplantation and ways to overcome barriers to organ donation are explored. Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices. From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible but then turn out to be ineffective and perhaps (...) even counterproductive because of inadequate attention to these rich and complex features of human body parts. Excessively rationalistic policies neglect deep beliefs, symbols, sentiments, and emotions and the like, and that deficiency marks many actual and proposed policies. In addition, policies are often too individualistic and too legalistic. (shrink)
This article responds to the four pieces in this special symposium of the Journal of Law, Medicine & Ethics on uncontrolled organ donation following circulatory death . The response will focus on lessons and debates about the kinds of consent necessary and sufficient for temporary organ preservation in the context of DCD and for organ donation itself; on conflicts of obligation, loyalty, and interest in DCD and ways to address those conflicts; and on benefit, cost, risk assessments of uDCD programs, (...) including measures to achieve a more favorable balance of benefits, costs, and risks. (shrink)
"A very good book indeed: there is scarcely an issue anyone has thought to raise about the topic which Childress fails to treat with sensitivity and good judgement....Future discussions of paternalism in health care will have to come to terms with the contentions of this book, which must be reckoned the best existing treatment of its subject."--Ethics. "A clear, scholarly and balanced analysis....This is a book I can recommend to physicians, ethicists, students of both fields, and to those most affected--the (...) patients themselves."--Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Humanities, Georgetown University Medical Center. (shrink)
This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as "mercy killing" and some decisions not to treat incompetent (...) patients. Keywords: illegal actions, mercy killing, non-treatment of incompetent patients, civil disobedience, conscientious objection, evasive non-compliance, moral justification and disobedience, dissent in health care CiteULike Connotea Del.icio.us What's this? (shrink)
Organ allocation policy involves a mixture of ethical, scientific, medical, legal, and political factors, among others. It is thus hard, and perhaps even impossible, to identify and fully separate ethical considerations from all these other factors. Yet I will focus primarily on the ethical considerations embedded in the current debate in the United States about organ allocation policy. I will argue that it is important to putpatientsfirstbut even then significant ethical questions will remain about exactly how to put patients first.
: Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.
This study examines some of the moral and theological convictions that created tensions for early Christians who affirmed that the government's sword is ordained by God for a fallen world but also that Christians should not exercise it at least in warfare. Three important moral pressures toward Christian participation in war were the recognition of prevention or removal of harm as a requirement of neighbor-love, the related sense of responsibility, fault, and guilt for omissions, and the generalization test proposed by (...) Celsus, who asked Christians to consider what would happen if everyone did what they were doing, i.e., refrained from military service. Along with many other factors, these ideas contributed to the legitimation of Christian participation in war. But this legitimation itself created additional tensions, particularly because of the requirements to "turn the other cheek," to "go the second mile," etc. In order to lessen these tensions, the Church and its theologians developed several interrelated distinctions that could reduce the scope or strength of the radical demands: higher/lower; for oneself/ for others; inner/outer; and private/public. (shrink)
This paper analyzes nonviolent resistance and direct action, as seen by its practitioners and theoreticians, from the standpoint of trust and risk-taking. After an examination of the nature of trust, the author indicates how it can illuminate what selected figures such as Gandhi and King have claimed about nonviolence. He offers this analysis not as a defense but as a way of understanding nonviolence that can serve as a starting point for further discussion.
While greatly appreciative of Kaveny's important study of a neglected form of religious/moral discourse in the public square, this essay critically examines her metaphors for prophetic indictments and finds the metaphor of moral chemotherapy particularly problematic and the metaphor of warfare, connected with the just-war tradition, more promising. It stresses the difficulty, if not the impossibility, of avoiding contempt in prophetic indictments, as Kaveny conceives them, and finds her proposed solutions to this problem—standing with the people and expressing empathy and (...) compassion toward them—inadequate to the task. It further argues that attending to prophetic imagination, in addition to prophetic denunciation, can broaden the scope of practical deliberation and, at the same time, increase possible prophetic contributions to moral and political discourse. (shrink)
Do pacifists and proponents of justified violence share a starting point? Whether or not just war theory contains an embedded presumption against violence is an important and disputed question. Substantively it is important not only because it has implications for the possibility of dialogue among Christians of different persuasions but also because the belief that the tradition advances no moral reservations about the use of force may have the effect of lowering the moral barriers against the resort to war. Conceptually (...) it is important because it reflects a fundamental methodological disagreement concerning the meaning and resolution of conflicts among moral duties. (shrink)
This paper analyzes some issues that emerge in attempts to distinguish and relate "moral" and "nonmora1' action-guides. It examines one material criterion (otherregardingness) and three formal criteria (universalizability, prescriptivity, and overridingness) and considers whether they constitute necessary and/or sufficient conditions of "morality." It treats these criteria in relation to ideals and prudential, political, and religious considerations. Furthermore, it contends that the classification of action-guides as moral or nonmoral should not prejudge their respective weights or replace substantive moral debate. The formal (...) and material criteria may determine what counts as morality, not how much morality counts. (shrink)