Risk disclosure after Montgomery: Where are we going?

•The new standard of disclosure following Montgomery v Lanarkshire is arguably more patient-centred but has introduced uncertainty•In an increasingly litigious culture, we expect that the standard of disclosure will become even higher, contrary to the interests of patients.

Living kidney donation and masked nationalism in Israel.

This paper draws attention to a current trend of masked conditional-nationalist living kidney donation in Israel, to which the local transplant system has been turning a blind eye. The paper seeks to make the international transplant and bioethics communities aware of this disturbing trend. It also explains why it is wrong and suggests how to tackle it. Finally, it calls on the Israeli system to bring the practice to a halt for the benefit of all parties involved.

Caution: deceased donor organ commercialism!

In the past 3 years there have been attempts to counter the international campaign against a market in organs from the living. In parallel to these attempts, support for a market in organs from the deceased has gained some traction. In this article we describe the various forms of this phenomenon, analyze its implications, and call upon policy makers to take steps to halt its progress.

Generic and therapeutic substitutions: are they always ethical in their own terms?

Cost containment-driven drug substitution, whether generic or therapeutic, is defined as switching to another drug because it is cheaper. So far, such substitutions have drawn their public legitimacy from the general belief that they would not compromise the clinical interests of patients and certainly not violate their right to decline them if they did. This article does not enter the debate on whether or not such substitutions must give exclusive priority to the patient's interests and choices in order to be ethical. Indeed, it acknowledges the plurality of views on this matter. It simply argues that when such substitutions involve a cheaper drug that is known to have different effects and side effects, or even a drug whose effects and side effects are unknown, they are potentially deleterious to the patient, and that no competent and well-informed patient would ever consent to them. Such substitutions are thus unethical in their very own terms.

How will the economic downturn affect academic bioethics?

An educated guess about the future of academic bioethics can only be made on the basis of the historical conditions of its success. According to its official history, which attributes its success primarily to the service it has done for the patient, it should be safe at least as long as the patient still needs its service. Like many other academic disciplines, it might suffer under the present economic downturn. However, in the plausible assumption that its social role has not been exhausted yet, it should recover as soon as the economy does. But if, as this paper tries to argue, the success of academic bioethics should be attributed first and foremost to the service it has done for the neoliberal agenda, then its future would have to depend on the fate of the latter. The exact implications of the downturn for the neoliberal agenda are obviously impossible to predict. Among the various options, however, the one of going back to 'normal' seems to be the least likely. The other options suggest that the future of academic bioethics, as we have known it, is bleak.

Sociological and ethical issues in transplant commercialism.

PURPOSE OF REVIEW: 'Global transplant commercialism' (practices and policies involving international trade in organs from living vendors, e.g., 'transplant tourism') is currently subjected to unprecedented criticism. In parallel, the debate around 'local transplant commercialism' (practices and policies that confine trade in organs from living vendors to national markets or economic unions) is heating up. In an attempt to assess the potential outcomes of these trends, this article reviews and discusses some sociological and ethical issues, ending with a proposal for a reinvigorated anticommercialist strategy. RECENT FINDINGS: The current international campaign against global transplant commercialism is conducted by an ad hoc alliance between strange bedfellows, proponents of local transplant commercialism on the one hand and opponents of any transplant commercialism on the other. Disparities in the rigor of the respective ethical discourses, the expanding list of precedents of legitimized commerce in the human body, and the political economy of transplantation, all suggest that the former have the upper hand. SUMMARY: Recent achievements in the struggle against international organ trafficking may not herald the abolition of transplant commercialism but rather presage its reconfiguration in deglobalized forms. In light of such a prospect, those who wish to prevent the pervasive commodification of the human body from entering the gates of transplant medicine should consider devising a new, perhaps more radical, strategy.

The political economy of death and the history of its criteria.

This paper argues for a constitutive link between ecologies of social interests and the social receptivity, if not also the formation, of some recent criteria of death. It maintains that these criteria have been embraced by ecologies that have been dominated by certain economic interests in pronouncing some patients dead. Moreover, the very same ecologies have also embraced philosophical representations of those criteria, but only such that were able to conceal these interests and thereby legitimize and reaffirm their hegemony. Based on this observation, the paper concludes that the current criteria of death and their philosophical representations are ideological constructs in the strict Marxian sense. They may or may not be 'really' true, but they are 'necessarily false' in one respect: they owe their social status to the fact that their self-professed role-pronouncing dead those who are dead-is not in accord with their objective, i.e., social, role-pronouncing dead those who should be dead.