Is organ procurement causing the death of patients?

This article offers a philosophical foundation for the Uniform Determination of Death Act as it first examines death per se, and then examines brain death and the non-heart beating donor criteria for determining death. The author suggests that many of the debates over death can be bypassed by changing the terms of the debate: what matters is not whether death is a process or an event, but death as a state. Understanding death as a state allows us to determine death in a functional manner that is compatible with the needs of law and medicine. The second part examines objections that arise from ignoring or rejecting the distinction between killing and letting die and the principle of double effect. By clarifying the lines between life and death, on the one hand, and between intentionally killing and unintentionally hastening death, on the other, the author hopes to restore a sense that the proposals to drop the dead donor rule are radical recommendations to cross lines we have never crossed before.     

Physician-assisted suicide and public virtue: a reply to the liberty thesis of "the Philosophers' Brief"

The "Philosophers' Brief," penned by six of today's most influential philosophers, was submitted as an amicus curiae brief to the Supreme Court as it prepared to consider the cases of Washington v. Glucksberg and Vacco v. Quill. It set precedent as the first such brief submitted by a group representing itself solely as moral philosophers. The brief became an overnight gold standard statement of the liberal philosophical understanding of the relationship of the State to so-called 'private morality.' The main thesis of the brief is that physician-assisted suicide regards the deeply personal event of death, and that individuals have a constitutionally guaranteed right to make decisions for themselves about the intimate details of their lives. In this article, James DuBois calls this the 'liberty thesis,' and he argues that the brief's application of this principle is both contradictory and impracticable. The contradiction arises as the brief proposes restrictions on the right to physician-assisted suicide--restrictions that require the State to abandon neutrality on intimate value judgments about life's worth. The impracticability arises insofar as the brief fails to leave room for a compelling State interest in promoting a minimal level of public virtue. Ironically, one of the strongest arguments that can be proffered on behalf of a State interest in preserving a minimal level of public virtue stems from its role in safeguarding human liberty.     

Non-Heart-Beating Organ Donation: A Defense of the Required Determination of Death

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved .     

Self-esteem in early adolescence: The identification and prediction of contrasting longitudinal trajectories

The present study focused on differences in self-esteem trajectory in early adolescence rather than on average change across all children. Longitudinal data from 128 adolescents were obtained over a 2-year period that encompassed the transition from elementary school to junior high school. Cluster analysis revealed four markedly divergent self-esteem trajectories: consistently high (35%), chronically low (13%), steeply declining (21%), and small increase (31%). Attempts to predict trajectories were only partially successful. Peer social support was the strongest predictor, but its relation to self-esteem appears more circumscribed than had been thought. The discussion considers differences in the experience of early adolescence, as well as implications for the design and evaluation of preventive intervention.Funding for this research was provided via awards to Barton J. Hirsch from the National Institute of Mental health (New Investigator Research Award in Prevention), the University of Illinois Research Board, and the Northwestern University Research Grants Committee. Abbreviated versions of this article were presented at the meetings of the Society for Research on Adolescence, Alexandria, Virginia, March 1988, and the Society for Research in Child Development, Kansas City, April 1989. We are grateful to Joyce Epstein for her comments on an earlier draft.Received Ph.D. in clinical psychology from the University of Oregon. Research interests include community psychology, ecology of adolescent development, social networks, and social policy.Research interests include peer relations and school-based preventive intervention.