Should a criminal receive a heart transplant? Medical Justice vs. Societal Justice

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a “decent minimum” level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of “rudimentary decent minimum” granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.     

From agape to organs: religious difference between Japan and America in judging the ethics of transplant

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed "brain dead" may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical "window of opportunity" for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of "updating" Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions.     

Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

正常高值血压者血压昼夜节律与靶器官损害的相关性研究

探讨正常高值血压昼夜节律与靶器官损害的相关性。入选正常高值血压者150例,其中杓型组72例,非杓型组78例,60例正常血压者为对照组。检测尿白蛋白排泄率（UAE）、颈动脉内膜中层厚度（IMT）和左心室重量指数（LVMI）。杓型组和非杓型组UAE、IMT、LVMI高于对照组（P＜0．01）。非杓型组UAE、IMT、LVMI高于杓型组（P＜0．05）。正常高值血压人群已出现靶器官损害,血压昼夜节律异常与早期靶器官损害密切相关。     

人体器官买卖成因和对策的法学思考

器官供需严重不平衡导致了人体器官买卖的产生,器官买卖对供体和受体均存在潜在风险,对社会危险性也不容忽视.分析了器官买卖链条中供体、受体和中介各自的角色和地位,并提出了立法推动尸体器官捐献、加强医院和医务人员承担的法律责任、打击买卖中介和加强网络监管等建议.     

家庭成员间活体器官及组织捐赠的伦理问题

家庭成员间活体器官及组织捐赠是被绝大多数国家所允许的.虽然利益化减少了很多,但是目前发现其也存在许多的伦理问题.就家庭成员间活体器官及组织捐赠的伦理基础,以及就捐赠风险、种族差异、失衡之爱、操纵、拒绝、退出、潜在利益、特殊疾病等涉及的相关伦理问题进行综述,并就存在的相关问题的解决方法进行探讨.     

THE INTERPLAY BETWEEN RELIGIOUS LEADERS AND ORGAN DONATION AMONG MUSLIMS

Bioethics and health researchers often turn to Islamic jurisconsults (fuqahā’) and their verdicts (fatāwā) to understand how Islam and health intersect. Yet when using fatwā to promote health behavior change, researchers have often found less than ideal results. In this article we examine several health behavior change interventions that partnered with Muslim religious leaders aiming at promoting organ donation. As these efforts have generally met with limited success, we reanalyze these efforts through the lens of the theory of planned behavior, and in light of two distinct scholarly imperatives of Muslim religious leaders, the ?ilmī and the islāhī. We argue for a new approach to health behavior change interventions within the Muslim community that are grounded in theoretical frameworks from the science of behavior change, as well the religious leadership paradigms innate to the Islamic tradition. We conclude by exploring the implications of our proposed model for applied Islamic bioethics and health research.     

Resolving the theory of planned behaviour's ‘expectancy-value muddle’ using dimensional salience

The theory of planned behaviour is one of the most widely used models of decision-making in the health literature. Unfortunately, the primary method for assessing the theory's belief-based expectancy-value models results in statistically uninterpretable findings, giving rise to what has become known as the ‘expectancy-value muddle’. Moreover, existing methods for resolving this muddle are associated with various conceptual or practical limitations. This study addresses these issues by identifying and evaluating a parsimonious method for resolving the expectancy-value muddle. Three hundred and nine Australian residents aged 18–24 years rated the expectancy and value of 18 beliefs about posthumous organ donation. Participants also nominated their five most salient beliefs using a dimensional salience approach. Salient beliefs were perceived as being more likely to eventuate than non-salient beliefs, indicating that salient beliefs could be used to signify the expectancy component. The expectancy-value term was therefore represented by summing the value ratings of salient beliefs, an approach that predicted attitude (adjusted R ²?=?0.21) and intention (adjusted R ²?=?0.21). These findings suggest that the dimensional salience approach is a useful method for overcoming the expectancy-value muddle in applied research settings.