Written by a sociologist and a biologist and science historian, this text considers the social aspects of organ transplantation and chronic hemodialysis. Their research, begun in 1968, focused on the experience of research physicians engaged in this work, the "gift- exchange" social dimensions of these practices, and the impact of these technologies on society as a whole. This reprint of the 1978 edition includes a new introduction by the authors. c. Book News Inc.

In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)

The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to American bioethics.

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval.

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

Enth.: De quoi faut-il s'étonner / par René Thom. Du point de vue du tiers... / par Claire Lejeune. Géométriser la signification / par Jean-Pierre Duport.

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

They have watched, as insiders, the first fumbling attempts to transplant kidneys, then hearts, then live‐donated lobes of liver and lung. Now the two sociologists most closely identified with organ transplantation have concluded that they must leave the field.

“Bioethics is not just Bioethics.” This is the aphoristic way in which I have recurrently expressed my historical and social perspective on the significance of bioethics, whose import I regard as extending beyond the emergence, development, and establishment of an intellectual field that is primarily concerned with advances in biology and medicine, their relationship to illness and health, and their ethical concomitants. In my view, although they are expressed through the medium of medicine, some of the value and belief questions (...) with which bioethics has been preoccupied since its inception are connected with broad and deep moral issues that are integral to what the illustrious French sociologist Émile Durkheim... (shrink)

In the expanding repertoire of practices designed to increase the supply of organs for transplantation, non-heart-beating cadaver organ donation has generated an ongoing debate in the literature. The continuing stream of articles is disquieting in part because it documents a troubling "trial-and-error ethics" approach to the formulation of organ procurement policy, and because it raises serious questions about the reasons that the development of this policy is being mediated by published communication. In the light of concerns about the implicit support (...) and credibility that professional publications give to organ procurement policies, restraint in publishing articles about non-heart-beating organ donation as well as in devising such policies is strongly advocated. (shrink)

Twelve narratives written by surgeons on ethical decision-making are analyzed in this commentary. Several major themes in their narratives are discussed: the preponderance of end-of-life issues; the struggle to be inclusively empathetic, even under emotionally alienating circumstances; social justice; and the disagreement among colleagues about how to deal with patients in situations of medical uncertainty. The commentary not only discusses the areas of stress that the surgeons identify in their accounts. It also highlights phenomena and themes that are missing from (...) them, and calls for more work to be done gathering stories from surgeons to explore and explain the “gaps” in this narrative collection. (shrink)

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

We are sad to say that Advisory Board member Renée Fox died on September 23rd. Renée was an extraordinary friend of Perspectives in Biology and Medicine, celebrating and contributing to its uniqueness over many years.Renée was a pioneer in medical sociology who spent most of her career at the University of Pennsylvania. Her research used participant-observation to explore the work of physicians. In Experiment Perilous, she examined troubling practices of doctors who conducted research on their own patients (...) at the Peter Bent Brigham Hospital in Boston. In The Courage to Fail, written with Judith Swazey, she focused on dangers to patients as their physicians used them as experimental subjects to develop... (shrink)

Religion has become a vital resource for attempts to rethink the meaning of the political. This article rehearses the efforts of two recent figures, René Girard and Giorgio Agamben, to transform the political by renewing its connection to religion. Both thinkers struggle to escape politics as defined by Carl Schmitt's friend/enemy distinction. Girard and Agamben do clash ideologically, but their inquiries into sacrifice and messianism take similar courses. Regarding origins, Girard argues for the sacrificial crisis as the common parent to (...) religion and politics. Conversely, for Agamben, the Roman figure of homo sacer distinguishes politics from religion. With respect to the future, Girard's messianism installs Christian belief as the only way to move beyond violence. By contrast, Agamben steers Pauline messianism toward the efforts to displace sovereignty and reopen the political. I conclude that Agamben breaks with Schmitt while Girard reinscribes his politics at a higher level. Key Words: Giorgio Agamben • Rey Chow • Christianity • René Girard • homo sacer • messianism • politics • sacred • sacrifice • Carl Schmitt. (shrink)

Descartes est, dans le fait, le vrai fondateur de la philosophie moderne, en tant qu'elle prend la pensée pour principe. L'action de cet homme sur son siècle et sur les temps nouveaux ne sera jamais exagérée. C'est un héros ; il a repris les choses par les commencements, et il a retrouvé de nouveau le vrai sol de la philosophie, auquel elle est revenue après un égarement de mille ans. 1637, c'est la date de la publication du Discours de la (...) méthode, de René Descartes - véritable déclaration des droits et des pouvoirs de la Raison sur un monde qu'elle domine et organise. Toute la pensée moderne est née de cet ouvrage dont la langue, dense mais toujours claire, n'a pas vieilli. (shrink)

Écrites entre 1628 et 1629, avant le Discours de la Méthode, les Règles pour la Direction de l’Esprit sont le premier des grands ouvrages philosophiques de Descartes et sont donc, à plusieurs égards, un texte fondateur. Descartes y expose sa méthode par une énumération de règles qu’il convient de suivre pour guider l’esprit dans la recherche de la vérité. Ce texte, certes inachevé, permet déjà de saisir l’importance et la portée de la méthode de Descartes, qui dessine, en opposition à (...) la scolastique, une nouvelle conception de la science dans laquelle tout objet est traité selon l’ordre et la mesure. Cette science moderne sera définie comme la Mathématique Universelle, science une, fondée sur l’entendement, dont il importe de dégager précisément les procédés, induction et déduction.Cet ouvrage décisif, en posant les fondements de la méthode et de la philosophie de Descartes, permet de comprendre comment est pensée la science en sa modernité et de souligner le pouvoir conféré à l’entendement. Ce que cherche à montrer Descartes, c’est que la science doit être le fruit d’une pensée ordonnée, qui ne conserve rien qui ne soit clair et distinct, et que l’entendement doit pouvoir ne compter que sur lui seul. (shrink)

Rereading Renée C. Fox's “A Sociological Perspective on Organ Transplantation and Hemodialysis,” published in 1970, one is likely to be struck more by continuity than by change. The most pressing of the social, policy, and ethical concerns that Fox raised remain problematic fifty years later. We still struggle with scientific and clinical uncertainty, with the boundary between experimentation and therapy, and with the cost of organ replacement therapies and disparities in how they are allocated. We still have an imperfect (...) understanding of transplant immune responses. We still debate when a potential donor “actually” dies, and we still seem to think better empirical criteria could harmonize the diverse religious, cultural, and socioeconomic values of patients, providers, third‐party payers, and policy‐makers. Organ transplantation was for Fox both a particular case unfolding in time and an entryway for discussing the difficult moral questions presented by many new medical technologies in a context of high demand and limited resources. (shrink)

This book brings together contributions from scholars across the humanities. A wide-ranging exploration of the interface between performance and nature. Examines the use and usefulness of ideas of ‘performance’ for understanding human-nature relationships. Draws on different disciplines and intellectual traditions and on different conceptions of ‘performance’ and ‘nature’. Contributions are rooted in real-world contexts and problems, explored through detailed ethnographic work. Explores domains as diverse as allotments and bioinvasion, fox hunting and green politics. Makes a distinctive contribution to the ‘cultural (...) turn’ in environmental research. (shrink)

J’ai rencontré Marie-Jeanne Bérère à Lyon en 1994. C’était une petite femme vive, à la parole claire et précise, avec un bel accent bourguignon. Elle avait accepté une interview, à son domicile lyonnais, le 23 mars 1995. Je souhaitais la revoir pour ce numéro de CLIO, Histoire, Femmes et Sociétés sur les Chrétiennes mais elle est décédée dans l’été 2000, à 73 ans, sans avoir eu le temps de rédiger ses mémoires. Son itinéraire de femme engagée dans l’Église catholique (...) est celui d’une chrétienn... (shrink)

René Descartes (1596-1650)?: un classique de la philosophie, père du rationalisme, disciple du dualisme platonicien et inventeur du cogito. 0Il existe pourtant un autre Descartes, méconnu?: l’observateur de ce qui, en l’homme, se situe à la limite du rationnel et de l’irrationnel. Bref, en cette partie qu’est, aux confins de l’âme et du corps, le non-rationnel?: la sensibilité ou, mieux, l’affectivité. D’où le sens du titre de ce livre?: le clair-obscur de la conscience, réunissant les idées claires et distinctes de (...) l’âme et les idées obscures et confuses du corps. 0C’est donc, chronologiquement, le troisième et dernier Descartes, le moins étudié mais le plus authentique, que l’on analysera ici?: après le savant du Discours de la Méthode, puis le métaphysicien des Méditations, le psychologue des Passions de l’âme. Ainsi est-ce un Descartes original et inédit, réévalué et actualisé à la lumière de la philosophie contemporaine, que le lecteur découvrira en ces pages. (shrink)

Boucs émissaires, violences sacrificielles, désir mimétique, autant de thèmes que René Girard (1923-2015) n'a cessé d'explorer et qui sont devenus des ressources essentielles pour notre compréhension des sociétés. L'anthropologie mimétique, dont il a posé les bases, a en effet eu des échos multiples dans les sciences humaines et les religions. Avec ce livre, Bernard Perret offre une présentation éloquente de ce vaste chantier théorique. Il éclaire notamment la fonction et la signification de la violence dans les rapports humains, des origines (...) à nos jours, tout en explorant les liens et les différences entre la pensée de Girard et celle d'autres grands auteurs du XXe siècle (Lacan, Lévi-Strauss, Mauss...). Le lien particulier de Girard aux Écritures juives et chrétiennes, le sens à la fois novateur et controversé qu'il donne à la passion et à la mort du Christ, ne sont pas éludés, tout comme sa vision apocalyptique du politique. En exposant la cohérence profonde et la fécondité d'une pensée majeure de notre temps, ce livre permet de ressaisir tous les débats passionnants auxquels elle a donné et donne toujours lieu."--Page 4 of cover. (shrink)

Contemporary bioethics has evolved over the past 40 years predominantly as a “Western” construct drawing fundamental inspiration for its conceptual and methodological frameworks from secular, Anglo-American philosophical traditions. American bioethicists can be credited with playing a defining role in the globalization of this new discipline to the developing countries of the world, but in this process, in the words of LaFleur, “Bioethics has become international without becoming internationalized.” Among the criticisms leveled against the dominant American model of bioethics is that (...) in its focus on universalism it ignores local cultural and religious influences that are vital to the comprehension of the moral life in many societies. Medical sociologist Renée C. Fox and historian Judith P. Swazey have termed this as a form of “cultural myopia.”. (shrink)

Since the early 1970s, Marcel Mauss’s Essai sur le Don, translated into English as The Gift in 1954, has been a standard reference in the social science and bioethical literature on the use of human body parts and substances for medical and research purposes. At that time, three social scientists—political scientist Richard Titmuss in the United Kingdom and sociologist Renée C. Fox working with historian Judith Swazey in the United States—had the idea of using this concept to highlight the (...) fundamental structure of the biomedical practices they were studying, respectively, blood donation, and hemodialysis and organ transplantation. The fact that these first applications of Mauss’s essay should emerge in English- rather than in French-speaking countries raises the question of what the translation of the essay, and notably of the word don as gift, may have to do with this fact. Reading Mauss in translation undoubtedly inspired a seminal approach to interpreting medical and research practices based on bodily giving. This article posits that something may have also been lost: a much broader concept of giving with unquestionable links to the Durkheimian concept of solidarity, which Mauss conceptualizes not only as an obligation but also as a liberty to give. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pittsburgh protocol as “disquieting” because the display “trial-and-error (...) ethics.” To dismiss “trial-and-error ethics” implies that we antecedently possess all the moral knowledge we need to evaluate and regulate developments in medicine. Should we summarily reject experimentation in ethics, particularly with respect to complex issues involving scientific and technological changes? For if we need to reconsider and possibly revise what counts as moral knowledge, the proposing an experimental approach to the ethics of a novel practice, which is presented publicly and made open to revision, as in the Pittsburgh protocol, may be precisely the best way to proceed.Fox and Christakis resort to invidious insinuation in their criticism of ethicists who have written, and journals that have published, articles about non-heart-beating organ donation. Publication on this issue has given ethicists the opportunity of “adding numerous items to their vitae.” Their appraisal of the vitae-boosting behavior represents an interesting rhetorical specimen: “Although there is nothing inherently dishonorable about this it does create tension between two motives: conviction about the importance of perfecting ethical conduct, on the one hand, and the desire to advance one’s professional career, on the other” (p. 340). I am not sure what the authors mean by “perfecting ethical conduct.” Yet they suggest that a group of reputable scholars, who have taken diverse positions on the ethics of non-heart-beating organ donation, have come perilously close to venality.Finally, in order to avoid further legitimating what they consider to be an ethically objectionable practice, the authors advocate that journals exercise “restraint” in publishing articles about this topic. Perhaps in a future pronouncement they will enlighten us about how enforcing a publication policy that avoids the vice of “unduly iterative ethical review” might work without compromising freedom of discussion. Moral dogmatism and censorship have a long history of association.Franklin G. MillerCenter for Biomedical Ethics University of Virginia Charlottesville, VACopyright © 1996 The Johns Hopkins University Press... (shrink)

Doctors Without Borders/Médecins Sans Frontières is among the most emblematic nongovernmental organizations in the field of medical humanitarian assistance. Since its creation in 1971 in the wake of the Biafran War, MSF has grown to be admired for its outstanding boldness and often disliked for its fierce arrogance. Although best known publicly as a large organization that operates in the world’s most ravaged places and that is supported by millions of individual donors, internal staff and field workers typically identify with (...) MSF more as an association of individual members than as an international organization. Renee C. Fox’s 2014 book, Doctors Without Borders:... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pittsburgh protocol as “disquieting” because the display “trial-and-error (...) ethics.” To dismiss “trial-and-error ethics” implies that we antecedently possess all the moral knowledge we need to evaluate and regulate developments in medicine. Should we summarily reject experimentation in ethics, particularly with respect to complex issues involving scientific and technological changes? For if we need to reconsider and possibly revise what counts as moral knowledge, the proposing an experimental approach to the ethics of a novel practice, which is presented publicly and made open to revision, as in the Pittsburgh protocol, may be precisely the best way to proceed.Fox and Christakis resort to invidious insinuation in their criticism of ethicists who have written, and journals that have published, articles about non-heart-beating organ donation. Publication on this issue has given ethicists the opportunity of “adding numerous items to their vitae.” Their appraisal of the vitae-boosting behavior represents an interesting rhetorical specimen: “Although there is nothing inherently dishonorable about this it does create tension between two motives: conviction about the importance of perfecting ethical conduct, on the one hand, and the desire to advance one’s professional career, on the other” (p. 340). I am not sure what the authors mean by “perfecting ethical conduct.” Yet they suggest that a group of reputable scholars, who have taken diverse positions on the ethics of non-heart-beating organ donation, have come perilously close to venality.Finally, in order to avoid further legitimating what they consider to be an ethically objectionable practice, the authors advocate that journals exercise “restraint” in publishing articles about this topic. Perhaps in a future pronouncement they will enlighten us about how enforcing a publication policy that avoids the vice of “unduly iterative ethical review” might work without compromising freedom of discussion. Moral dogmatism and censorship have a long history of association.Franklin G. MillerCenter for Biomedical Ethics University of Virginia Charlottesville, VACopyright © 1996 The Johns Hopkins University Press... (shrink)

Conversion to sound at the close of the 1920s ushered in a decade-long period of French film production that standard accounts by Alan Williams and Colin Crisp cast as all but unparalleled in aesthetic impact and thematic scope. Despite chronic underfunding and structural disarray in an industry that never fully rebounded after the Great War, French audiences enjoyed a robust domestic culture of stars, screenwriters, and directors whose concern for richly detailed narratives and moody “atmospherics” laid the foundations for the (...) classic French cinema. Key to an understanding of this period that saw René Clair, Jean Renoir, and Julien Duvivier rise to international prominence alongside—or... (shrink)