Organ allocation and patient responsibility: Re-examining the concept of responsibility in light of the thought of Emmanuel Levinas.

Abstract

A persisting, unresolved debate in the bioethics literature was the impetus behind this work. The focus chosen was the need for replacement organs for those whose illnesses appear to be related to addiction to alcohol or tobacco. The initial section thus examines the more factual aspects of both addiction and organ transplantation. The history of organ transplantation is explored, focusing particularly on the attempts to frame criteria for reception of the scarce organs, and the concomitant attempts to increase the supply of donated organs; neither issue has been solved, although there is much research being focused on technical solutions in particular, for those awaiting scarce organs. Within the bioethics literature, the issue of criteria for the reception of scarce organs has tended to be viewed as a question of justice. Thus this work peruses the varying conceptions of justice which appear within that literature, in an attempt to ascertain whether their applications have involved differing results for the population in question. In fact, there appears to be little difference in the outcomes amongst those ascribing to one or other of the meta-ethical theories. In contrast to the extensive treatment of issues of justice within bioethics, the concept of responsibility is largely unexamined. This dearth suggested that an historical perusal of the concept of responsibility within a number of the disciplines to which bioethics turns would be appropriate. In the end, the thought of Emmanuel Levinas appeared to offer the most fruitful approach to the topic under consideration. His work appears to be a profound challenge to rethink our relationships to others, as well as our approach to justice. Central to that thought is what Levinas calls the relationship of the one-for-the-other; the philosopher suggests that a response of profound responsibility for the other before one is called forth by the visage of that "wounded" other. The question of justice does arise for Levinas, since in the eyes of the other before one are all the others; thus needs must be weighed and choices made. The benchmark for this justice, however, is the relationship of the one-for-the-other: real justice implies, not a faceless, objectified totality, but an attention to the needs of all---the very antithesis of the utilitarian approach so prevalent within much of North American bioethics. (Abstract shortened by UMI.)