Abstract

The dissertation appropriates H. Richard Niebuhr's responsibility ethics for both descriptive and normative purposes within the clinical context of organ transplantation. Cases involving living donors are of particular interest. In such situations difficult issues are raised pertaining to complex interrelations, informed consent, mutilation of healthy donors for the medical benefit of another, just allocation of scarce resources, patients' compliance and clinicians' paternalism, extension of lives and acceptance of limits, etc. Yet our various moral traditions, deontological and teleological, have not yielded sufficient guidance for deliberative discernment in this realm of high-tech medicine. ;The author explores agency in living donor organ transplantation under the guidance of Niebuhr's constructive moral philosophy so as to bring greater moral clarity to situations in kidney transplantation encountered as a clerical-clinical ethicist. The focus is on understanding better the relational contexts in which and deliberative workings by which decisions to act are made. The focal question in regard to any particular case is stated as, "What does it mean to be a 'responsible' clinician or clinical participant in this situation?" It is contended that an explication of "responsibility" with its normative potential for living donor evaluative processes may be useful in addressing moral perplexity within the transplant center even by those who do not share the author's own clerical concerns or theistic convictions and especially by those who do. The stated thesis is that LDOT evaluative practices are explicated aptly by reference to this Niebuhrian responsibility ethics, one which can be normative in the fostering of optimally "fitting" responses to often tragic MOT situations. ;A brief history notes that organ transplantation began with living donors, shifted to cadaveric sources, and is marked now by a "new quest for living donors" apparently due to static cadaveric donor rates and increased recipient demand. Three ethics consultations illustrate conundrums arising within LDOT. Religious responses are discussed, including a Niebuhrian ethics utilized then for analysis of a fourth case consultation involving a Korean-American family