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Selling organs and souls: should the state prohibit 'demeaning' practices?

It is sometimes argued that practices such as organ-selling should be prohibited because they are demeaning to the individuals involved. In this article the plausibility of such an argument is questioned. I will examine what it means to demean or be demeaned, and suggest that the mere fact that an individual is demeaning themself does not provide sufficient justification for legal prohibition. On the contrary, such laws might be argued to be demeaning.

Commerce↗

Health care allocation, public consultation and the concept of 'health'.

By comparing models of market-based allocation with state-controlled national health care systems, it will be suggested that the way in which different communities deal with the allocation of health care is central to their expression of what might be called a moral self-understanding. That is to say that the provision of health care may be expected to be a focus of communal debate, not simply about morally acceptable and unacceptable actions, but also about the community's understanding of what it is that makes for a worthwhile and morally defensible human life. This moral self-understanding is seen to be entwined with the different concepts of 'health' that are implicit in different systems of allocation. In conclusion, it will be suggested that decisions concerning health care allocation must be made in response to a continuing, public and open debate about what health and health care mean to a particular community.

Attitude to Health↗

Curiosity, imagination, compassion, science and ethics: do curiosity and imagination serve a central function?

Curiosity and imagination have been neglected in epistemology. This paper argues that the role of curiosity and imagination is central to the way we think, regardless of whether it is thinking about problems of ethics or problems of science. In our ever more materialistic society, curiosity and reason are either discouraged or narrowly channeled. I shall argue that the role of curiosity and imagination for both science and ethics is so important that nurturing them can be seen as an ethical obligation and suppressing them as ethically problematic.

Capitalism↗

Commodity fetichismo, the Holy Spirit, and the turn to Pentecostal and African Independent Churches in Central Mozambique.

Pentecostal and African Independent Churches have rapidly spread throughout central Mozambique in the aftermath of war and in the midst of a recent structural adjustment program that has hastened commoditization of community life and intensified local inequalities. This extraordinary expansion signals a shift away from reliance on "traditional" healers to treat persistent afflictions believed to have spiritual causes. Survey data and illness narratives collected from recent church recruits and local residents during research in 2002 and 2003 in the city of Chimoio reveal that healers have increased fees and tailored treatments to clients searching for good fortune in ways that have alienated many other help seekers in this changing social environment. While traditional healing has been celebrated in the international health world, community attitudes are less generous; many healers are increasingly viewed with suspicion because of their engagement with malevolent occult forces to foment social conflict, competition, and confrontation for high fees. Church healing approaches offer free and less divisive spiritual protection reinforced by social support in a new collectivity. One vital source of church popularity derives from pastors' efforts to tap the already considerable community anxiety over rising healer fees and their socially divisive treatments in an insecure environment.

Capitalism↗

Patients' health or company profits? The commercialisation of academic research.

This paper is a personal account of the events associated with the author's work at the University of Toronto's Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author's academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good.

Biomedical Research↗

Compensation and egg donation for research.

Financial compensation to egg donors for their time and inconvenience in donating is established in the United States as ethically and legally acceptable. That system should be extended to egg donation for research.

Commodification↗

Ethical issues in transnational "mail order" oocyte donation.

The rising demand for donor oocytes in developed countries has led to what is referred to as transnational or international oocyte donation, or the outsourcing of oocyte donation to poorer countries. In a further twist, frozen sperm from a recipient's partner can also be mailed to a foreign clinic to fertilize donor oocytes, and the resulting embryos are mailed back, cryopreserved, for transfer to the recipient. Among the numerous ethical concerns raised by this practice of mail order oocyte donation, the most obvious are that underprivileged women from poorer countries are often exploited; fertility physicians from richer counties abdicate responsibility for the welfare of donors; and responsibility could become an issue of contention if transmission of disease to the oocyte recipient or congenital defects in offspring born from such oocyte donation were to occur. Moreover, savings from utilizing donors from poorer countries ought to be shared with oocyte recipients.

Bioethics↗

'It's only a blood test': what people know and think about venepuncture and blood.

Medicine finds human blood infinitely useful. It is a source of important and sometimes controversial information about individuals, their relatives and the general public. Blood also has economic value, carries a heavy cultural freight, and can transmit dangerous diseases. Yet there is precious little sociological analysis of how these radically different applications, potentials and significations are managed in health care settings where, it is no exaggeration to claim, everyday a vast quantity of blood is produced by venepuncture. This paper focuses on blood produced in hospitals for tests. The data were derived from 19 focus groups of patients, health care professionals, and members of the public, held between 2002 and 2003, in and around the obstetrics and gynaecology department of a large London teaching hospital. Not surprisingly, all the participants had had a blood test at some time or other. Yet their responses suggest no template exists for talking about them. No-one--lay or professional--had a full picture of how blood produced for tests circulates around the hospital. Lay people tended to envisage it as remaining in a liquid form whereas health care professionals saw it as materially and substantially transformed. Participants deployed a variety of ritual and rhetorical devices that devalue blood produced for tests. Nonetheless, blood left over from tests emerged as a significant anomaly, simultaneously an excess (waste), a challenge (to use wisely), or a potential crime (illegitimate research).

Adult↗

Ethical and legal issues in human embryo donation.

OBJECTIVE: To identify main ethical and legal issues that arise with donation of embryos left over from IVF treatments of infertility or created from separate gamete donations. DESIGN: Analysis of ethical commentary, advisory committee reports, statutes, court cases, and legal commentary relating to gamete and embryo donation and assisted reproduction to assess their effect on donation of created or leftover embryos. RESULTS: Donation of surplus embryos or embryos created from separate gamete donations would help a subset of infertile couples to form families. A program undertaking embryo donation will have to coordinate the donation of embryos from its own patients or other programs or arrange for separate gamete donations to form embryos. The main ethical issues concern the effect on offspring, consent and counseling of donors and recipients, avoidance of mixing embryos or gametes from different sources, and payment of donor expenses. The main legal issues concern whether embryo donation is viewed as gamete donation or adoption; the rearing rights and duties of donors and recipients in resulting offspring; liability; and compensation issues; and the legality of monetary compensation for donors. Donation of embryos for research raises separate issues. CONCLUSION: Human embryo donation is an ethically and legally acceptable way for infertile couples to form families.

Commodification↗

'Double or quits': perceptions and management of organ transplantation by adults with cystic fibrosis.

Medical sociologists have often considered lay perceptions of the risks of medical interventions, yet in many empirical studies respondents are people who are not likely to be exposed to a particular intervention. Furthermore, it has been well documented that risk perceptions may change over time and with diminishing health state. This paper explores perceptions and management of the risks of organ transplantation amongst adults with cystic fibrosis (CF), the most common autosomal recessive genetic disease in the UK. Although the focus of medical research is now on providing gene replacement therapy to this group, transplantation is currently the last treatment that an adult with CF can be offered when all other treatment has failed to maintain their health. Thirty-one respondents with varying degrees of health state from a specialist CF centre were interviewed as part of a larger study concerning perceptions of health and risks of treatment. Interviews were audiotaped, transcribed and analysed using ATLAS-ti. During analysis respondents' transcripts were divided into two groups: firstly those who did not anticipate needing a transplant in the near future (if at all) and secondly those who were currently being considered for transplantation, on the transplant list, or who had already received donor organs. The paper focuses on themes arising from interview transcripts and finds that although the focus of risk differs between the two groups, the influence of luck is perceived as strong for both groups and emotion work features heavily in those undergoing the transplant process. Contrary to previous research, fears of inheriting donor characteristics are not found amongst adults with CF, but rather body components are commodified when talking of both giving and receiving organs.

Adult↗

In quest of the perfect analogy for using in vitro fertilization patients as oocyte donors.

Whether painted in totalitarian terror, like the organ farm story and The Handmaid's Tale, the science-fiction reality of Make Room! Make Room!, the cinema noir urban tragedy of prostitution, or the portrayals of slavery (Afro-American, Nazi-European, and Russian), this series of resemblances, I hope, illustrates the power of analogy to surface sensitivity to ethical issues in the efficient, and possibly entertaining, texture demanded by medical personnel. Although my quest was quixotic from the start, I hope that this exercise will encourage your consideration of using analogy as an educational tool to heighten the awareness in medical personnel to many issues, to allow our better service of patients and society.

Commodification↗