Receiving the Gift of Life: Stories from Organ Transplant Recipients.

This symposium includes thirteen personal narratives from people who have received at least one organ transplant from a living or deceased donor. These narratives foster better understanding of the experiences of life-saving organ recipients and their families, including post-transplant difficulties experienced-sometimes requiring multiple transplants. This issue also includes three commentaries by Macey L. Levan, Heather Lannon, and Vidya Fleetwood, Roslyn B. Mannon & Krista L. Lentine. Dr. Levan is a living kidney donor and associate professor of surgery and population health. She writes and teaches on organ transplant and has expertise and experience in governance at the federal level as a member of the board of directors for the U.S. Organ Procurement and Transplantation Network. Dr. Lannon is a social worker and transplant advocate. Her work and interest in the topic were inspired by her husband who needed a heart transplant. Dr. Fleetwood is a surgeon specializing in liver transplantation, pancreas transplantation, kidney transplantation, as well as living donor nephrectomy. Dr. Mannon is a nephrologist and professor of medicine, pathology and microbiology. Her work focuses on understanding and improving long-term kidney transplant outcomes for patients, donors, and caregivers. Dr. Lentine is a nephrologist specializing in treatment of adult patients with kidney disease. She is a researcher and co-chaired the international work group that developed guidelines for living donor kidney transplantation.

Disability, Enhancement, and Flourishing.

Recent debate among bioethicists concerns the potential to enhance human beings' physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between "transhumanists," who argue for unreserved enhancement of human capabilities, and "bioconservatives," who warn against any non-therapeutic manipulation of humanity's natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of "normal function"? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one's flourishing, could the enhancement of one's cognitive capacities through biotechnological means enhance one's flourishing.

The many metaphysical commitments of secular clinical ethics: Expanding the argument for a moral-metaphysical proceduralism.

The rich moral diversity of academic bioethics poses a paradox for the practice of giving moral recommendations in secular clinical ethics: How are ethicists to provide moral guidance in a pluralistic society? The field has responded to this challenge with a "procedural approach," but defining this term stirs debate. Some have championed a contentless proceduralism, where ethicists work only to help negotiate resolutions among stakeholders without making any moral recommendations. Others have defended a moral proceduralism by claiming that ethicists should make moral recommendations that are grounded in bioethical consensus (e.g., relevant law, policy, professional consensus statements, and bioethics literature), which is secured using moral principles such as respect for persons or justice. In contrast, we develop a moral-metaphysical proceduralism by identifying many metaphysical commitments in points of secular bioethical consensus. The moral-metaphysical view of secular clinical ethics is important because it challenges the discipline to accept the substantive philosophical foundations required to support giving moral recommendations in a pluralistic context, which may lead to further insights about the nature of the field.

Losing One's Head or Gaining a New Body?

A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue living. HEAVEN putatively actualizes a thought-experiment long debated by philosophers concerning the definition of personhood and criterion of personal identity through time and change. HEAVEN's advocates presume to preserve the identity of the person whose head is transplanted onto another's living body, leaving one's previous body behind as one would their corpse. Various classical and contemporary theories of personhood and personal identity would support this presumption, while others would contest it as providing an accurate or complete view of what is essential for a human person to persist through this procedure. This paper brings such theories to bear in analyzing whether HEAVEN can indeed deliver on its promise of complete ontological survival for the person whose head is transplanted.

Catholic Perspective on Decision-Making for Critically Ill Newborns and Infants.

In this paper, we discuss the foundational values informing the Catholic perspective on decision-making for critically ill newborns and infants, particularly focusing on the prudent use of medical technologies. Although the Church has consistently affirmed the general good of advances in scientific research and medicine, the technocratic paradigm of medicine may, particularly in cases with severely ill infants, lead to decision-making conflicts and breakdowns in communication between parents and providers. By exploring two paradigm cases, we offer specific practices in which providers can engage to connect with parents and avoid common technologically mediated decision-making conflicts. By focusing on the inherent relationality of all human persons, regardless of debility, and the Christian hope in the life to come, we can make decisions in the midst of the technocratic paradigm without succumbing to it.

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

BACKGROUND: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies. OBJECTIVE: To characterize the development of ventilator triage policies and compare policy content. DESIGN: Survey and mixed-methods content analysis. SETTING: North American hospitals associated with members of the Association of Bioethics Program Directors. PARTICIPANTS: Program directors. MEASUREMENTS: Characteristics of institutions and policies, including triage criteria and triage committee membership. RESULTS: Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations. LIMITATION: The results may not be generalizable to institutions without academic bioethics programs. CONCLUSION: Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation. PRIMARY FUNDING SOURCE: None.