Clarifying the paradigm for the ethics of donation and transplantation: Was 'dead' really so clear before organ donation?

Recent commentaries by Verheijde et al, Evans and Potts suggesting that donation after cardiac death practices routinely violate the dead donor rule are based on flawed presumptions. Cell biology, cardiopulmonary resuscitation, critical care life support technologies, donation and transplantation continue to inform concepts of life and death. The impact of oxygen deprivation to cells, organs and the brain is discussed in relation to death as a biological transition. In the face of advancing organ support and replacement technologies, the reversibility of cardiac arrest is now purely related to the context in which it occurs, in association to the availability and application of support systems to maintain oxygenated circulation. The 'complete and irreversible' lexicon commonly used in death discussions and legal statutes are ambiguous, indefinable and should be replaced by accurate terms. Criticism of controlled DCD on the basis of violating the dead donor rule, where autoresuscitation has not been described beyond 2 minutes, in which life support is withdrawn and CPR is not provided, is not valid. However, any post mortem intervention that re-establishes brain blood flow should be prohibited. In comparison to traditional practice, organ donation has forced the clarification of the diagnostic criteria for death and improved the rigour of the determinations.     

Rationales for organ donation: Charity or duty?

Media appeals encouraging people to sign organ donor cards suggest that donating one's own organs after death or donating the organs of a deceased family member is an act of charity, i.e., something which it would be meritorious for people to do but not wrong to avoid. This paper argues to the contrary that posthumous organ donation is a moral duty, a duty of the type that rests at the base of recently enacted state “Good Samaritan” laws which require a witness to an emergency situation to render aid to the victim(s) when this can be done at minimal cost/risk to the potential rescuer.     

Harvesting the living?: separating "brain death" and organ transplantation

The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued that there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens.     

Organ donation terminology: are we communicating life or death?

The continued functioning of organ transplantation depends on obtaining the permission of the next of kin. This communication process between medical or transplant professionals and a donor family hinges heavily on the understanding of certain critical terms like brain dead, life support, and transplantation. Communication issues in obtaining organ donation consent were examined, with particular focus on what are literally life-and-death decisions. Using an experimental simulation methodology, data are offered in support of the claim that much miscommunication occurs in such situations. Directions for improving such communication by allaying latent fears and more carefully defining crucial terminology are offered.     

What is an organ? Heidegger and the phenomenology of organ transplantation

This paper investigates the question of what an organ is from a phenomenological perspective. Proceeding from the phenomenology of being-in-the-world developed by Heidegger in Being and Time and subsequent works, it compares the being of the organ with the being of the tool. It attempts to display similarities and differences between the embodied nature of the organs and the way tools of the world are handled. It explicates the way tools belong to the totalities of things of the world that are ready to use and the way organs belong to the totality of a bodily being able to be in this very world. In so doing, the paper argues that while the organ is in some respects similar to a bodily tool, this tool is nonetheless different from the tools of the world in being tied to the organism as a whole, which offers the founding ground of the being of the person. However, from a phenomenological point of view, the line between organs and tools cannot simply be drawn by determining what is inside and outside the physiological borders of the organism. We have, from the beginning of history, integrated technological devices (tools) in our being-in-the-world in ways that make them parts of ourselves rather than parts of the world (more organ- than tool-like), and also, more recently, have started to make our organs more tool-like by visualising, moving, manipulating, and controlling them through medical technology. In this paper, Heidegger’s analysis of organ, tool, and world-making is confronted with this development brought about by contemporary medical technology. It is argued that this development has, to a large extent, changed the phenomenology of the organ in making our bodies more similar to machines with parts that have certain functions and that can be exchanged. This development harbours the threat of instrumentalising our bodily being but also the possibility of curing or alleviating suffering brought about by diseases which disturb and destroy the normal functioning of our organs.     

The "spare parts person"? Conceptions of the human body and their implications for public attitudes towards organ donation and organ sale

Background  

The increasing debate on financial incentives for organ donation raises concerns about a "commodification of the human body". Philosophical-ethical stances on this development depend on assumptions concerning the body and how people think about it. In our qualitative empirical study we analyze public attitudes towards organ donation in their specific relation to conceptions of the human body in four European countries (Cyprus, Germany, the Netherlands and Sweden). This approach aims at a more context-sensitive picture of what "commodification of the body" can mean in concrete clinical decisions concerning organ donation.     

Living donation and cosmetic surgery: a double standard in medical ethics?

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.     

The death and transfiguration of career-and of career guidance?

The predominant understanding of career in the industrial era has focused on progression within hierarchical work organisations. With the move into a post-industrial era, the possibility of such careers is rapidly receding. The concept of career, however, has always been broader than this, and other aspects of it are now claiming increased attention. They focus more upon individual experiences in terms of development in learning and work throughout life. The role of career guidance in relation to such experiences is potentially of much greater social significance. A number of implications for career guidance provision and practice are discussed.     

Do the myths still exist? Revisiting people's negative beliefs about organ donation upon death

The prevalence of myths preventing people partial to donation in Australia from consenting is unknown. Respondents (N?=?468: 381 donors, 26 non-donors, 61 undecided) were surveyed about their (negative) donation beliefs. Approximately 30% of donors were neutral or supported negative beliefs about organ allocation, especially donation to undesirable organ recipients and a black market organ trade. Confusion about brain death, lack of family and religious support, and discomfort with donation were negative beliefs endorsed by some respondents irrespective of donor preference. Proportionally, donors had greater trust in hospitals/doctors than other groups. Some myths still exist but may vary with donation preference.     

The challenges and future of applied Islamic ethics discourse: a radical reform?

In this paper, I explore the concept of applied Islamic ethics, the facts, its challenges, and its future. I aim to highlight some of the deep-rooted issues that Muslims have faced historically and continue to experience today as they apply religious guidance to their daily lives. I consider the causes and rationale behind the current situation and look beyond to suggest ways in which this may evolve, calling for a radical reform. Muslims throughout the world are experiencing a deepening crisis of identity and confusion about their faith's principles and practices. I suggest how improvements might be achieved, in order to gain more coherence and understanding. This approach recognizes the importance of inviting an in-depth, deliberate analysis of relevant dialogues between religious experts of the text (scholars) and practitioners, those working at the grassroots. This approach remains faithful to the fundamental principles of the Islamic sources but also considers our present context. I recommend a shift in authority from scholars alone to a more inclusive, critical engagement of practitioners. Through this more comprehensive methodology of applied Islamic ethics, I suggest that Muslim communities, organizations, and individuals can remain faithful to their religious principles while, at the same time, actively participating in and contributing to our evolving societies. While I recognize that this will be a long process, I am confident that with applied Islamic ethics, the current feelings of confusion, self-doubt, and even apathy, given the previous failed processes of adaptation and reform, will give way to a new confidence in knowing how to address contemporary challenges.     

The impact of mental health evidence on support for capital punishment: are defendants labeled psychopathic considered more deserving of death?

Controversy surrounds the use of the Hare Psychopathy Checklist--Revised (Hare, 1991, 2003) in capital murder cases, where it has been introduced to support prosecution claims that a defendant represents a "continuing threat to society". Although widely presumed to have a prejudicial impact (e.g., American Psychological Association, 2004), little is known about how the lay public reacts to data derived from ostensibly stigmatizing assessment instruments such as the PCL-R. The present study examined the effect of psychopathy data on layperson attitudes by having 203 undergraduates review a capital murder case where the results of the defendant's psychological evaluation were experimentally manipulated. When expert testimony described the defendant as psychopathic, a much larger percentage of participants supported a death sentence (60%) than when testimony indicated that he was psychotic (30%) or not mentally disordered (38%). Interestingly, participant ratings of how psychopathic they perceived the defendant to be--regardless of the testimony condition to which they had been assigned--also predicted support for a death sentence. Given the limited probative value of the PCL-R in capital cases and the prejudicial nature of the effects noted in this study, we recommend that forensic examiners avoid using it in these trials.     

The death of discipline: is the requiem premature?

There is a current trend among one sector of the professional mental-health community against the use of confrontive discipline with children and toward a positive-only approach to child behavior management. The current paper addresses this position by providing an overview of family process research as well as parent training outcome research related to parent disciplinary (punishment) practices. Consistent with research from developmental psychology showing that “authoritative” parenting is associated with the best developmental outcomes, this overview concludes that child management which combines positive approaches with age appropriate structures, limits, and non-hostile, nonviolent punishment is associated with the best treatment outcomes. The paper challenges positions calling for an end to the use of punishment with children.     

The problem of business ethics: Oxymoron or inadequate vocabulary?

Recently critics have faulted American business schools for failing to impart to their students an understanding of ethics and its role in business. In this paper, we agree and attribute this situation, at least in part, to the need for a vocabulary of ethics and a failure to communicate Adam Smith's moral orientation to capitalism. So long as business schools fail to recognize explicitly that Smith, whoseThe Wealth of Nations serves as an intellectual backdrop for business school curricula, did in fact provide a place for ethics in capitalist economic relations (indeed, some would argue a dominant place), they will continue to advocate implicitly the theory of amorality in business—the idea that ethics has no place in business. By examining Smith's ethical arguments we can explicate the moral underpinnings of stakeholder analysis, a currently popular approach to management decision-making.Although we will use ethics and morality interchangeably in this paper, there is a distinction to be made. Ethics is the branch of philosophy concentrating on morality. Morality pertains to what is right and wrong.     

When distorted logos are recognized as original? The role of the DRM procedure in detection of immediate and delayed consumers’ errors

IntroductionTo deal effectively with the market, one must create a distinct logo from competing logos. However, it is not uncommon that similarities between logos of various companies are enough to mislead consumers. This paper shows how the DRM paradigm as well as prototype theories can be used to investigate correct and erroneous recognitions of distorted familiar and unfamiliar logos in short- and long-term memory.MethodThe modified hybrid DRM procedure was adopted to test brand images that were distorted but perceptually similar. Participants performed the experimental task in which short- and long-term memory for logos were tested.ResultsThe results demonstrated no difference in memory performance between familiar and unfamiliar logos after a short delay. However, a discrepancy between recognizing both types of logos arose in long term memroy toward more errors for familiar images.ConclusionsThe results confirm that the DRM procedure can be successfully used by marketers as a potential tool in either detecting unfair competition or launching new brands.