Ethical criteria for procuring and distributing organs for transplantation

This article provides an ethical analysis and assessment of various actual and proposed policies of organ procurement and distribution in light of moral principles already embedded in U.S. institutions, laws, policies, and practices. Evaluating different methods of acquisition of human body parts--donation (express and presumed), sales, abandonment, and expropriation--the author argues for laws and policies, including required request, to maintain and facilitate express donation of organs by individuals and their families. Such laws and policies need adequate time for a determination of their effectiveness before society moves to other major alternatives, such as a market. In organ allocation and distribution, which have close moral connections with organ procurement, the author defends the judgment of the federal Task Force on Organ Transplantation that the community should have dispositional authority over donated organs, that professionals should be viewed as trustees and stewards of donated organs, and that the public should be heavily involved in the formation of policies of allocation and distribution. Concentrating on policies being developed in the United Network for Organ Sharing, the author examines the point system for cadaveric kidneys, the access of foreign nationals to organs donated in the U.S., and the multiple listings of patients seeking transplants. He concludes by identifying two major problems of equitable access to donated organs that will have to be addressed by social institutions other than UNOS: access to the waiting list for donated organs and the role of ability to pay in extrarenal transplants.     

Using decision science to gain insight into ethical issues: an example involving thresholds in workers' compensation.

Systematically analyzing and comparing the ethical dimensions of policy-decision alternatives is remarkably difficult. The ethical implications of a set of decision alternatives, as well as the ranking of that set, are subject to any number of quantitative and qualitative variables, not the least of which is differing individual interpretation. In spite of this, decision science offers a consistent, transparent framework from which to analyze the ethical components and implications of policy decisions. Workers' Compensation insurance programs are state-governed systems of insurance in which workers, in exchange for giving up the right to sue their employer and their coemployees, receive some compensation if they are injured on the job, without regard as to who was at fault. Importantly, Workers' Compensation does not compensate workers for all losses. Thus, injured workers often sue those who provide goods and services to their employer's production system. Different states set different thresholds relating to who can be brought into such a lawsuit and under what conditions a sued means-of-production entity can, in turn, bring the injured party's employer into the suit as a third-party defendant. Forensic engineers are often involved in such lawsuits to evaluate whether or not a given component of a production system is or is not defective. Using Workers' Compensation as an example, this paper explores the methodology and the difficulty of quantifying the ethical implications of policy decisions by examining the concept of thresholding a policy variable. Thresholding will be defined and the ethical effect on the various parties of varying a policy threshold will be discussed.     

Wrongful life actions: the legal and ethical hurdles

This article discusses the various legal and ethical issues arising out of the cause of action for wrongful life. This action involves a claim by a child that but for the negligence of the doctor, hospital or other medical institution, his or her mother would have terminated the pregnancy and he or she would not have been born. The courts have generally rejected this cause of action on the basis of legal, ethical and policy considerations. The author proposes that the legal hurdles can be overcome and that the ethical and policy considerations do not outweigh the desirability of upholding wrongful life claims.     

中国政策科学发展的历程与成就分析

中国政策科学走过了20多年的发展历程,大致分为两个阶段,即20世纪80年代的蕴育开创阶段和20世纪90年代后的快速发展阶段.取得了四大成就:围绕构建具有中国特色的政策科学理论体系发表了大量的学术论文,出版了许多学术著作;学科建设初具规模,研究队伍不断扩大;国内外学术交流日益频繁,学术气氛活跃;不少政策研究组织已经走向市场,产业化步伐加快,对推进决策科学化民主化起了重要的作用.     

Stumbling toward equity: the role of government in kidney transplantation

In Mortal Peril, Professor Epstein is critical of the current, regulated system for organ donation and suggests that a market for organ tissue would better meet the needs of patients. In this response to Professor Epstein, Professor Laura Dooley and Dr. Robert Gaston pair their skills to attack Professor Epstein's analysis. As they have done on several other occasions, Professors Dooley and Gaston argue that the kidney donation and transplantation arena is fraught with racial inequity, and that Professor Epstein's proposal for a market in kidneys will exacerbate this inequity. The authors maintain that to prevent the poor from being excluded from transplants, the government plays a critical (if imperfect) role in the allocation of these scarce resources. Furthermore, government intervention is acceptable to correct past discrimination because there is scientific evidence that the disproportionate incidence of kidney failure in African Americans is related to the evolutionary pressures of slave trading and slavery. Professors Dooley and Gaston also defend their previous efforts to change the government system of allocation and characterize the government's willingness to adopt their recommendations as an appropriate response to scientific research rather than a governmental susceptibility to lobbying from special interest groups. Finally, the authors criticize Professor Epstein's argument that dialysis is a viable alternative to transplantation because there are significant differences in "quality of life, morbidity and survival." Professors Dooley and Gaston conclude that government intervention is necessary for maintaining the equity in kidney transplantation that a market system would not.     

Dreams and Nightmares: Practical and Ethical Issues for Patients and Physicians Using Personal Health Records

Electronic health records for patients, personal health records (PHRs), have become increasingly popular among policy makers and purchasers, but uptake among patients and physicians has been relatively slow. PHRs have varying uses that might make them more or less appealing to different stakeholders. The three core uses for PHRs — promoting communication, data use, and patient responsibility — each raises a set of potential practical and financial dilemmas. But some ethical concerns are also at play, some of which are rarely recognized as values-based barriers to the use of PHRs. Recognizing these ethical issues, and addressing them explicitly in PHR design and policy making, would help PHRs to achieve their promise.     

Increasing Participation and Compliance in International Climate Change Agreements

Scientific and economic consensus points to the need for a credible and cost-effective approach to address the threat of global climate change, but the Kyoto Protocol to the U.N. Framework Convention on Climate Change appears incapable of inducing significant participation and compliance. We assess the Protocol and alternative policy architectures, with particular attention to their respective abilities to induce participation and compliance. We find that those approaches that offer cost-effective mitigation are unlikely to induce significant participation and compliance, while those approaches that are likely to enjoy a reasonably high level of implementation by sovereign states are sorely lacking in terms of their anticipated cost effectiveness. The feasible set of policy architectures is thus limited to second-best alternatives.     

Cloning for therapeutic purposes: ethical and policy considerations

This essay reviews how cloning techniques may be used for therapeutic purposes, analyzes ethical implications, and makes recommendations for public policy discourse. Although cloning may bring many potential benefits, they remain uncertain. Furthermore, human embryo research is morally problematic. Therefore, alternatives to human cloning for therapeutic aims should be sought at present. In addition to central ethical issues, public discourse should maintain an emphasis on the value of the human embryo over scientific expediency, the relativity of health, and the principle of justice. Society should support the laudable mission of medical research, while also attending to the moral concerns often threatened by the promises of scientific progress.     

Male Sex Work: Exploring Regulation in England and Wales

Whilst sex-work policy in England and Wales claims gender-neutrality, local and national prostitution strategies primarily focus on female street-based sex workers. Men who sell sex are generally absent or inadequately considered in such policies, and measures to regulate commercial sex markets are rarely considered in terms of their impact on male working practice. Drawing on the Coordinated Prostitution Strategy for England and Wales, this paper has two aims: first, to offer a gender-based critique of the current policy framework for England and Wales by arguing that sex-work policy is infused by a gendered understanding of sex work in which male identities are neglected or assumed deviant; and second to explore the notion that understanding sex work as it is performed locally is valuable when generating local and national policy. Informed by gendered readings of policy, social understandings of masculinity, and the (in)visibility of male sexual commerce this paper explores male sex work in the context of Manchester, England.     

The Shared History: Unknotting Fictive Kinship and Legal Process

This article looks in detail at a form of kinship that is contingently crafted and mobilized to achieve specific purposes. On the basis of ethnographic material collected among local actors within bodies that regulate kidney transplants in Israel, the objective of this article is to expand the sociolegal definition of fictive kinship. I use transplant relatedness to refer to the set of formal and informal norms that grow out of social and medico-legal practices in the field of kidney donations and sales; however, the form of fictive kinship that appears in this specific field tells us something broader about kinship as it is constructed and performed in legal processes more generally. The configuration of fictive kinship that is examined is the shared history ( historia meshoutefet ). I argue that in the present case, the shared history alters social and legal deep-seated understandings of kinship and ultimately makes the distinctions between allegedly real and pseudo-kinship collapse.     

The consumption of patriarchy: commodification to facilitation and reification

There is an abundance of research from cultural, critical and feminist criminology that has recognized media as a vehicle to propagate various forms of gender inequality and violence against women. Likewise, there has been extensive research on how childhood products and toys replicate the patriarchal construction of gender. However, these bodies of research have been relatively silent on how the commodification of culture is consumed and reified by the very population it oppresses (i.e. women). Here, we argue that violence against women is commodified and eagerly consumed in an age of neo-liberalism, legitimizing the patriarchal power structures that subordinate women. Our goal is to begin a discussion of female consumption of the commodification that gives consent and facilitates the patriarchal perpetual power system. Using examples from media and the consumer market, we hope to begin a broader discussion of how patriarchy, gender roles and inequality are reinforced through everyday banal consumption by both sexes. However, this banal consumption by females not only lends to the legitimization of the heteronormative patriarchal status quo but also makes them active participants in the continuation of inequality and power structures inherent within this patriarchal society.     

Families and future children: the role of rights and interests in determining ethical policy for regulating families

"Rights" and "interests" are key ethical concepts in the debate on the regulation of Assisted Reproductive Technology. This article examines some of the ways in which these terms have been used in the debate, concentrating on their application to the situation of the potential children resulting from the technology. The article argues that, while there have been many misuses of these terms by the parties to the often acrimonious debate, nevertheless ethical regulation depends on maintaining the concepts as of central importance, but at the same time clarifying their use.     

“道德银行”的困境及其伦理启示

"道德银行"是近年来推出的旨在推进公民道德建设的一种创新式的方式,其伦理实质是用一种功利化的方式推进美德建设."道德银行"的实施存在着理论与实践上的双重困境:在理论上,"道德银行"与美德存在着内在的冲突;在实践中,"道德银行"容易产生伪善."道德银行"所产生的困境给我们的主要启示是:道德建设应合理地明晰道德的层次,结合道德自身的特点;道德建设尤其是美德建设不能采用功利化的推行手段;应在充分考量现实道德生活环境的基础上合理地运用不同的伦理理论.     

Business Ethics as Corporate Governance

The paper analyses ethical business codes as governance mechanisms, i.e. institutions which facilitate coordination of economic behaviour. Ethical business codes are compared to other social institutions (market solutions, government intervention, the prevailing social ethic), and their efficiency is evaluated in terms of transaction costs. A normative rationale for ethical codes is found when other institutions fail to achieve socially optimal outcomes, in particular when the firm has access to unique information. Some economic incentives are identified which induce firms to commit to socially optimal ethical codes but it is argued that economic forces will not in general be sufficient for optimality.     

Commodifying life? A pilot study of opinions regarding financial incentives for organ donation

In recent years many policy proposals have been put forward to create financial incentives to encourage families to allow the harvesting of organs from their deceased relatives. While research has focused on whether these policies would actually increase the supply of organs, no research has focused on testing the ethical concerns about such policies. This article presents the findings of a pilot study conducted to determine whether people think that families should end life support of a family member in order to harvest organs if various incentive policies are in place. While the findings do not suggest a direct effect of these inducements, they do indicate that the amount of money received from organ donation is a consideration in making the decision whether to end life support. The implications of this finding for ethical debates and health policy are reviewed.     

Posthumous reproduction and the meanings of autonomy

In recent years there has been considerable debate over the legal and ethical issues associated with posthumous reproduction. This article analyses recent cases and legal regulation of reproductive technologies in Australia. The issues associated with posthumous reproduction are explored through a consideration of the nature of an individual's interest in their reproductive material. The suitability of a property-based model as a means of conceptualising interests in reproductive material is explored. The article concludes that the issues in this area need to be analysed in terms of autonomy interests that are understood relationally.