This book supports the emerging field of vascularized composite allotransplantation for face and upper-limb transplants by providing a revised, ethically appropriate consent model which takes into account what is actually required of facial and upper extremity transplant recipients. In place of consent as permission-giving, waiver, or autonomous authorization, this book imagines consent as an ongoing mutual commitment, i.e. as covenant consent. The covenant consent model highlights the need for a durable personal relationship between the patient/subject and the care provider/researcher. Such (...) a relationship is crucial given the recovery period of 5 years or more for VCA recipients. The case for covenant consent is made by first examining the field of vascularized composite allotransplantation, the history and present understandings of consent in health care, and the history and use of the covenant concept from its origins through its applications to health care ethics today. This book explains how standard approaches to consent are inadequate in light of the particular features of facial and upper limb transplantation. In contrast, use of the covenant concept creates a consent model that is more appropriate ethically for these very complex surgeries and long-term recoveries. (shrink)

One response to the chronic shortage of organs for transplant in the United States has been the passage of laws establishing first-person authorization for donation of organs, providing legal grounds for the retrieval of organs and tissues from registered donors, even over the objections of their next of kin. The ethical justification for first-person authorization is that it is a matter of respecting the donor’s wishes. The objection of some next of kin may be that the donor would not have (...) wished for his or her loved ones to have their preferences overridden, had they considered that possibility. This article examines the basis of the conflict and suggests a remedy grounded in the provision of donor-intent options that have the ability to clarify the donor’s wishes. (shrink)

Plain Anabaptists are a small but rapidly growing ethnoreligious society with significant concentrations of population in a number of regions in North America. Among the most widely known of the various groups of Plain Anabaptists are the Amish and the Old Order Mennonites. It is the purpose of this article to provide insight into the culture and values of the Plain Anabaptists so that those who may be called upon to address ethical conflict involving Plain Anabaptists can do so with (...) appropriate knowledge and sensitivity. The discussion of the culture and values of the Plain Anabaptists will be organized as follows: first we will explore the implications of Plain Anabaptist culture and values for applying the ethical principles of respect for autonomy and beneficence/nonmaleficence. Second, a brief description of several elements of Plain Anabaptist culture will be discussed with attention to the potential they create for ethical conflict in the healthcare setting. (shrink)