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Contents

• Letter from the Editor Andrew Rosenthal
  
• Interview: Francis Delmonico, MD (Massachusetts General Hospital; OPTN/UNOS)
• Interview: David J. Undis (LifeSharers)
  

Articles

• Psychedelic Psychotherapy: The Ethics of Medicine for the Soul by Brian Anderson, University of Pennsylvania Read Abstract

  Psychedelic drugs like LSD and MDMA (Ecstasy) are known to have profound psychological effects on people. These substances are now being evaluated in clinical trials in the US as aids to psychotherapy. The use of these substances in Transpersonal Psychology is thought to help patients by inducing spiritual experiences that lead to improved mental health. Some people challenge the claim that authentic spiritual experiences can be induced by drugs and still others question whether spirituality have any place in medicine at all. The potential emergence of the use of psychedelics in medicine calls for a consideration of these and many other concerns.

• Ethical Considerations on Organ Transplantation in China by Changmin Jiang, Peking University Health Science Center Read Abstract

  Although organ transplantation in China began almost 10 years later than in western countries, it’s undergoing a rapid change these years. Now, Chinese hospitals are witnessing that they can operate almost all kinds of organ transplantations, clinically or experimentally. Take kidney transplantation as an example. By the end of 2000, China had performed 34,832 kidney transplantation operations. In the year of 2001 alone, 5,561 transplantations were done (Nanyan, 2004). While technology is no longer a major problem, it is still not an easy topic. It is a perfect example to show that sociological and ethical considerations often lag behind science and technology. Nowadays, organ transplantation is facing a lot of social and ethical problems which are quite complicated and related to many areas of social life. In this paper, I would like to share some phenomena surrounding organ transplantation in China and my considerations on ethical issues about organ resources and allocation.

• Selling with Dignity: Organ Selling and the Safeguarding of Human Dignity by Julia Josepha, University of Toronto Read Abstract

  With increasing wait times to receive an organ transplant, there is a rising need to institute a more efficient organ procurement system. As an incentive for organ donation, it has been suggested that money be given to donors. Yet many maintain that human dignity, as characterized by Immanuel Kant, would be destroyed should organ selling become legalized. This assertion, one interpretation of Kant’s conception of dignity, further claims that a monetary amount could never compensate for the loss of dignity. However, an alternative interpretation of Kant’s definition insists that dignity would not be destroyed during an organ sale, and argues that a price does not always denote something’s entire worth. This paper explores these two opposing interpretations of Kant’s characterization, ultimately arguing that accepting the latter interpretation would lead to both a reduced occurrence of preventable, unwanted deaths and a preservation of human dignity.

• Critical Objections to Michael Steinberg’s Opt-In System for Kidney Transplantation by Matthew Kelly, Brown University Read Abstract

  The growing realization that kidney diseases are a significant contributor to morbidity and mortality in this nation has prompted discussion regarding the availability of kidneys for transplant operations. However, the current dearth of donated kidneys keeps the number of transplant operations low. David Steinberg rejects current kidney transplant practice and, instead, proposes an “Opt-In” model for donated kidneys to attempt to remedy the low availability for donated kidneys. Here, I argue that the Opt-In model (i) inappropriately privileges merit over need for medical resource allocation decisions, and (ii) needlessly privileges like-reciprocation in the construction of a system that forces a comparison of two incomparable rights. The use of this meritbased resource distribution paradigm presents individuals with a contract that effectively coerces them into unfairly sacrificing one right for the sake of another.

• The Medicated Self: Implications of Prozac on Selfhood, Embodiment and Identity by Cara Rabin, University of Pennsylvania Read Abstract

  As knowledge about molecular neurobiology and genetics has grown and as biotechnology is increasingly able to modify and moderate what was once considered permanently determined by our biological and genetic fate, selective serotonin reuptake inhibitors, particularly Prozac, have been pushed to the forefront of bioethical debates. The use of Prozac and other pharmacological interventions in the brain raises concerns that other aspects of biotechnology have not. The brain is considered the seat of mind and consciousness: Therefore, interventions in the brain have a unique set of ethical implications. Though today we can alter many things about ourselves with great ease, the use of Prozac has broadened the scope of changes we can make to our moods, temperaments and feelings. This article aims to open an essential dialogue about Prozac’s impact on identity and selfhood.

• Transplantation of Ovarian Tissue by Alix Rogers, University of Pennsylvania Read Abstract

  New transplantation procedures such as the transplantation of ovarian tissue raise especially complex ethical and legal questions associated with organ transplantation. This paper discusses two ways that ovarian tissue transplants could be performed, namely re-implantation and transplantation from donor to recipient. Focusing on issues of reproduction, this paper then examines these two procedures under the light of concerns over the medicalization and commodification of reproduction, interpretations of reproductive rights and safety. I conclude with the expectation that ovarian tissue transplantation will become ethically and legally acceptable in the distant future.

• Assessing the Ethicality of Pre-implantation Genetic Diagnosis beyond the Discourse of Eugenics by Faraz Siddiqui, University of Toronto Read Abstract

  Pre-implantation genetic diagnosis (PGD) is often seen as the inevitable return of eugenics “through the back-door”. Recent advances in genetics have certainly resurrected the prospects of human artificial selection, but fundamental differences between the two in aims and ideology as well as methods and potentials render this label tenuous. This paper highlights these differences to challenge commonly applied similarities and calls for a re-examination of PGD beyond the nostalgic paranoia of eugenics. Referring to PGD as eugenics is doubly disadvantageous. Firstly, the reminiscence it provokes of the Eugenics Movement restricts our discourse* when we assess the ethicality of the use of PGD and unnecessarily compromises an otherwise beneficial tool against genetic diseases. Secondly, only after we see beyond this discourse can we recognize and tackle the more realistic ethical issues of PGD. Such issues are assessed in this paper and their implications for bioethics are explored.

• Emergency Contraception: Balancing a patient’s right to medication with a pharmacist’s right of conscientious objection by Hannah Shacter, University of Pennsylvania Read Abstract

  Emergency Contraception (EC) is a safe and effective way to prevent pregnancy after having unprotected sex. Plan B, a form of EC, is 95% effective at preventing pregnancy when taken up to 24 hours after unprotected sex. Therefore, timely access to Plan B is key to its efficacy. Many pharmacists, however, refuse to fill prescriptions for EC due to their moral or religious beliefs. There is a growing conflict between the right of patients to receive timely access to their medications and the right of pharmacists to refuse to fill prescriptions to which they are morally opposed. Recent legislation on the state level has attempted to deal with the problem, but has not mitigated the conflict. Future policies must ensure that patients have access to their medications while still respecting the ethical concerns of pharmacists.

• Person in PVS: An Oxymoronic Bioethical Issue? by Noah T. Sugerman, University Of Pennsylvania Read Abstract

  The 2005 legal battle over the fate of Terri Schiavo garnered intense media coverage and sparked a nation-wide debate over the so-called “right to life” of patients in a persistent vegetative state (PVS). This paper explores the ethical side of the PVS issue. After presenting the medical definition of PVS, as well as the diagnosis and prognosis of the condition, I investigate possible definitions of personhood and death in an attempt to discover whether or not Ms. Schiavo deserved full rights as a person. I then look at the arguments and reasons on all sides of the issue and examine the implications of choosing various definitions of personhood and death. Finally, I propose a possible solution to the ethical dilemma of PVS patients and analyze the effects such a solution would have on our society and morals.

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