Organ transplantation is at once a technology that raises new ethical problems and a good testing ground for various moral principles. It has become a common procedure in some countries and, at least in the United States, promises to become even more so. It poses questions about costs and benefits as well as the very large question of whether we should try to renew human life indefinitely and, if so, at what cost. It raises the problem of whether organs are (...) the property of their possessors – at least when the possessors are competent adults. It raises issues of organ sales, of what might be called donor recruitment, of informed consent, of reparations when transplant fails, of eligibility for transplant, and of competition for medical time and expertise between transplantation and other, less dramatic kinds of medical care. This essay touches on all of these topics, with the aim of identifying the broad dimensions of the ethical problems of organ transplantation and some of the moral principles that may help us solve them. (shrink)

Alan Gewirth extends his fundamental principle of equal and universal human rights, the Principle of Generic Consistency, into the arena of social and political philosophy, exploring its implications for both social and economic rights. He argues that the ethical requirements logically imposed on individual action hold equally for the supportive state as a community of rights, whose chief function is to maintain and promote the universal human rights to freedom and well-being. Such social afflictions as unemployment, homelessness, and poverty are (...) basic violations of these rights, which the supportive state is required to overcome. A critical alternative to both "liberal" and "communitarian" views, this book will command the attention of anyone engaged in the debate over social and economic justice. (shrink)

Professor Narveson's comments about my papers on equality are both penetrating and comprehensive. I cannot hope to discuss all the issues he raises in any detail. But there is a special problem: his main question is about what I have not said. He asks how I might defend equality of resources other than simply by describing a version of it, and of course this question will require some extended discussion. But he is right to say that this is his most (...) important question, and I should hate to lose the opportunity of encouraging discussion of it. So I shall begin with some general remarks about the defence of the idea of equality and then take up, in a very hasty and summary way, the other problems he discusses or raises. Please allow me, however, this apology and caution. I know that what I shall say about the defense of equality is at many points dogmatic and at others unmindful of very natural objections and replies. I want to answer Narveson only by showing in a rough and general way how far I think a defense of equality is possible, what kind of defense this can be, and what form it should take. (shrink)

On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self‐evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas (...) for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost‐benefit, or patient autonomy. (shrink)