Shifting ethics: debating the incentive question in organ transplantation.

The paper reviews the discussion within transplantation medicine about the organ supply and demand problem. The focus is on the evolution of attitudes toward compensation plans from the early 1980s to the present. A vehement rejection on ethical grounds of anything but uncompensated donation--once the professional norm--has slowly been replaced by an open debate of plans that offer financial rewards to persons willing to have their organs, or the organs of deceased kin, taken for transplantation. The paper asks how this shift has occurred and what it tells us about the dynamics of bioethical debates, both within professional circles and in wider public arenas.

Studying the quality of life after organ transplantation: research problems and solutions.

Studies assessing the quality of life after organ transplantation proliferated in the 1980s after improved immunosuppression led to higher survival rates. Despite severe critiques of the methods employed in this research, as well as more general criticisms of the financial motives behind it, medical journals have continued to publish reports which almost uniformly conclude that transplant recipients enjoy a high quality of life. This paper revisits the critiques, asks why they have had so little impact, and suggests a new approach.

Organ wars: the battle for body parts.

Transplantation surgeries contribute to conceptions of the body as a collection of replaceable parts and of the self as distinct from all but its neural locus. There remains substantial cultural resistance to these conceptions, which leads the medical community to attempt to link the surgeries to social values that are sufficiently powerful to minimize the sense of a disjuncture between traditional concepts of personhood and those consistent with transplantation. The controversy over how to increase the supply of transplantable organs reveals two diametrically opposed sets of values invoked by advocates of transplantation: altruism and individual rights. The article analyzes these as the ideological equivalents of immunosuppressant drugs, designed to inhibit cultural rejection of transplantation and its view of the body.

The performing patient in ritual healing.

A Peruvian curandero carries out curing rituals in two distinct coastal communities. The unprogrammed component of patient ritual involvement differs between the two settings, while the formal ritual 'script' is identical. The contrast, between active engagement and passive participation, is attributed to the social context from which patients are drawn in each ritual location. This evidence suggests that patients as well as specialists contribute to the modification of folk healing practices in changed social and cultural circumstances.

The role of hallucinogenic drugs and sensory stimuli in Peruvian ritual healing.

On Peru's north coast, curanderos perform night-long curing ceremonies in which the mescaline-bearing cactus San Pedro is used. The concept of autonomic nervous system tuning is presented as the best explanation for the overall physiological effect of the ritual. An assessment of the possible therapeutic impact of this condition is provided. Organic response and symbolic message are seen to resonate in the purificatory connotations of the ritual.

New World depopulation and the case of disease.

PIP: The decline of the indigenous population of the Americas after the European conquest is examined. In particular, the impact of epidemic diseases is evaluated, and a methodology is offered that blends ethno-historical accounts with medical information and data on analogous outbreaks. The method is illustrated using smallpox data for the Andean region at the end of the sixteenth century.^ieng