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William LaFleur (1936-2010), an eminent scholar of Japanese studies, left behind a substantial number of influential publications, as well as several unpublished works. The most significant of these examines debates concerning the practice of organ transplantation in Japan and the United States, and is published here for the first time. This provocative book challenges the North American medical and bioethical consensus that considers the transplantation of organs from brain dead donors as an unalloyed good. It joins a growing chorus of voices that question the assumption that brain death can be equated facilely with death. It provides a deep investigation of debates in Japan, introducing numerous Japanese bioethicists whose work has never been treated in English. It also provides a history of similar debates in the United States, problematizing the commonly held view that the American public was quick and eager to accept the redefinition of death. A work of intellectual and social history, this book also directly engages with questions that grow ever more relevant as the technologies we develop to extend life continue to advance. While the benefits of these technologies are obvious, their costs are often more difficult to articulate. Calling attention to the risks associated with our current biotech trajectory, LaFleur stakes out a highly original position that does not fall neatly onto either side of contemporary US ideological divides.
"In addition to a large body of influential publications, William LaFleur (1936-2010) left behind several unpublished works. The most significant of these examines debates concerning the practice of organ transplantation in Japan and the United States and is published here for the first time. This provocative book challenges the North American medical and bioethical consensus that considers the transplantation of organs from brain dead donors as an unalloyed good. It joins a growing chorus of voices that question the assumption that brain death can be equated with death. It provides a deep investigation of debates in Japan, introducing numerous Japanese bioethicists whose work has never been treated in English. It also provides a history of similar debates in the United States, problematizing the commonly held view that the American public was quick and eager to accept the redefinition of death. A work of intellectual and social history, it also directly engages with questions that have become all the more salient in recent years: should limits be placed on the technologies we develop to extend life? If so, where should lines be drawn? LaFleur stakes out a highly original position that does not fall neatly onto either side of the ideological divides easily recognizable in contemporary US culture wars."--
William LaFleur (1936-2010), an eminent scholar of Japanese studies, left behind a substantial number of influential publications, as well as several unpublished works. The most significant of these examines debates concerning the practice of organ transplantation in Japan and the United States, and is published here for the first time. This provocative book challenges the North American medical and bioethical consensus that considers the transplantation of organs from brain dead donors as an unalloyed good. It joins a growing chorus of voices that question the assumption that brain death can be equated facilely with death. It provides a deep investigation of debates in Japan, introducing numerous Japanese bioethicists whose work has never been treated in English. It also provides a history of similar debates in the United States, problematizing the commonly held view that the American public was quick and eager to accept the redefinition of death. A work of intellectual and social history, this book also directly engages with questions that grow ever more relevant as the technologies we develop to extend life continue to advance. While the benefits of these technologies are obvious, their costs are often more difficult to articulate. Calling attention to the risks associated with our current biotech trajectory, LaFleur stakes out a highly original position that does not fall neatly onto either side of contemporary US ideological divides.
Medical knowledge and technology have been sufficiently advanced for surgeons to perform thousands of transplants each year. This text traces the discourse since 1970 that contributed to the locating of a new criterion of death in the brain.
Addressing all aspects of brain death and thoroughly detailing how a potential organ donor should be maintained to ensure maximum use of the organs and cells, The Brain-Dead Organ Donor: Pathophysiology and Management is a landmark addition to the literature. This first-of-its-kind, multidisciplinary volume will be of interest to a large section of the medical community. The first section of the book reviews the historical, medical, legal, and ethical aspects of brain death. That is followed by two chapters on the pathophysiology of brain death as investigated in small and large animal models. This includes a review of the many hormonal changes, including the neuroendocrine- adrenergic ‘storm’, that takes place during and following the induction of brain death, and how they impact metabolism. The next section of the book reviews various effects of brain death, namely its impact on thyroid function, the inflammatory response that develops, and those relating to innate immunity. The chapters relating to assessment and management of potential organ donors will be of interest to a very large group of transplant surgeons and physicians as well as critical care and neurocritical care physicians and nurses. Neurologists, endocrinologists, neurosurgeons, and pathologists will also be interested, especially in the more basic science sections on various aspects of brain-death and hormonal therapy. Organ procurement organizations and transplant coordinators worldwide will also be interested in this title. Other chapters will be of interest to medical historians, medico-legal experts, and ethicists.
Since its inception in 1968, the brain-death criterion for human death has enjoyed the status of one of the few relatively well-settled issues in bioethics. However, over the last fifteen years or so, a growing number of experts in medicine, philosophy, and religion have come to regard brain death as an untenable criterion for the determination of death. Given that the debate about brain death has occupied a relatively small group of professionals, few are aware that brain death fails to correspond to any coherent biological or philosophical conception of death. This is significant, for if the brain-dead are not dead, then the removal of their vital organs for transplantation is the direct cause of their deaths, and a violation of the Dead Donor Rule. This unique monograph synthesizes the social, legal, medical, religious, and philosophical problems inherent in current social policy allowing for organ donation under the brain-death criterion. In so doing, this bioethical appraisal offers a provocative investigation of the ethical quandaries inherent in the way transplantable organs are currently procured. Drawing together these multidisciplinary threads, this book advocates the abandonment of the brain-death criterion in light of its adverse failures, and concludes by laying the groundwork for a new policy of death in an effort to further the good of organ donation and transplantation.
Beyond Brain Death offers a provocative challenge to one of the most widely accepted conclusions of contemporary bioethics: the position that brain death marks the death of the human person. Eleven chapters by physicians, philosophers, and theologians present the case against brain-based criteria for human death. Each author believes that this position calls into question the moral acceptability of the transplantation of unpaired vital organs from brain-dead patients who have continuing function of the circulatory system. One strength of the book is its international approach to the question: contributors are from the United States, the United Kingdom, Liechtenstein, and Japan. This book will appeal to a wide audience, including physicians and other health care professionals, philosophers, theologians, medical sociologists, and social workers.
This book analyses the impact of organ transplantation. It also presents new, original analyses of data, and assesses medical practices, social and economic observations, and other information on: access to transplantation services for low-income populations and racial and ethnic minority groups; organ donation rates; waiting times for transplantation; patient survival rates and organ failure rates leading to retransplantation; and cost of organ transplantation services. It includes chapters on the possibilities of expanding the pool of available cadaver organs. It also analyzes the results of transplantation of cadaver organs from older donors and marginal, non-heart beating donors. Transplantation policies based on the offering of organs by living donors are also described, as is the impact of delayed graft function on organ allocation.
Mahayana, Theravada, ancient, modern? Even at the most basic level, the diversity of Buddhism makes a comprehensive approach daunting. This book is a first step in solving the problem. In foregrounding the bodies of practitioners, a solid platform for analysing the philosophy of Buddhism begins to become apparent. Building upon somaesthetics Buddhism is seen for its ameliorative effect, which spans the range of how the mind integrates with the body. This exploration of positive effect spans from dreams to medicine. Beyond the historical side of these questions, a contemporary analysis includes its intersection with art, philosophy, and ethnography.
In Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Miller and Truog challenge fundamental doctrines of established medical ethics. They argue that the routine practice of stopping life support technology in hospitals causes the death of patients and that donors of vital organs (hearts, lungs, liver, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. These practices are ethically legitimate but are not compatible with traditional rules of medical ethics that doctors must not intentionally cause the death of their patients and that vital organs can be obtained for transplantation only from dead donors. In this book Miller and Truog undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. They expose the misconception that stopping life support merely allows patients to die from their medical conditions, and they dispute the accuracy of determining death of hospitalized patients on the basis of a diagnosis of "brain death" prior to vital organ donation. After detailing the factual and conceptual errors surrounding current practices of determining death for the purpose of organ donation, the authors develop a novel ethical account of procuring vital organs. In the context of reasonable plans to withdraw life support, still-living patients are not harmed or wronged by organ donation prior to their death, provided that valid consent has been obtained for stopping treatment and for organ donation. Recognizing practical difficulties in facing the truth regarding organ donation, the authors also develop a pragmatic alternative account based on the concept of transparent legal fictions. In sum, Miller and Truog argue that in order to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics.