Scarce Goods

by Koch, Tom

• ISBN13: 9780275974329
• ISBN10: 0275974324
• Format: Hardcover
• Copyright: 2001-11-01
• Publisher: Praeger Pub Text

Summary

In 1841 the American sailing ship William Brown struck an iceberg. About half of the passengers and all of the crew were saved in two small, open boats. The next night, half of the passengers in the larger long-boat were thrown overboard because the boat was overfull. This was the first case of "lifeboat ethics," of hard choices in the face of scarcity. Since then the question has been "who should die so that others, equally needy, might live?" Both the case of the William Brown and the ethics it spawned have been used in recent years to describe the problem of health care rationing generally, and organ transplantation specifically. Koch reexamines and reinterpretes the paradigm case of lifeboat ethics, the story of the William Brown, not as an unavoidable tragedy, but as an avoidable series of errors. Its relation to more general issues of distributive justice are then considered. The lessons learned from both the historical review and its application to distributive principles are then applied to the problem of graft organ distribution in the United States. Through the use of maps, the problem of organ distribution is considered at a range of scales, from the international to the urban. The contextual issues become more evident as one moves from international to hemispheric, fron national to regional, and then local systems. Finally, Koch reviews the lessons in light of other problems of distribution in the face of scarcity. The central lesson-that scarcity is exacerbated where it is not in fact created by our distributive programs-is explored thoroughly. The result is "no good choices" for anyone and the continuation of the scarcity that for most seems inevitable, but, from the evidence provided, is itself an outcome of inequalities of distribution at different scales of society. Of particular interest to students, scholars, and policymakers involved with issues of planning and health care economics, medical geography, and concepts of justice.

Author Biography

TOM KOCH is a writer and bioethicist specializing in medical ethics. A frequent contributor to newspapers, magazines, and the CBC Radio, he is the author of 11 books.

Table of Contents

Tables and Figures	ix
Preface	xi
Acknowledgments	xv
Lifeboat Ethics and the Case of the William Brown	1	(22)
Health Care	5	(3)
The William Brown	8	(2)
The Gulf Stream	10	(5)
A Constructed Tale	15	(2)
The Trial	17	(1)
Lifeboat Ethics Redux	18	(1)
The Titantic	19	(4)
The Scales of Justice: Principles and Practice	23	(26)
Distributive Justice	25	(3)
Scarcity	28	(4)
Justice Rationales	32	(9)
Critiques	41	(3)
Transplantation	44	(1)
A Geographical Approach	45	(4)
Scarce Goods: The Contexts of Solid Organ Transplantation	49	(24)
Transplantation: The Early Years	50	(2)
Cyclosporine: Transforming Scarcity	52	(2)
A National System	54	(3)
National Organ Transplant Act	57	(4)
Regionalization	61	(3)
An Example	64	(6)
Discussion	70	(3)
The Scale of Justice: Theories and Realities	73	(22)
Perspective and Scale	75	(3)
Global/International Scales	78	(7)
Hemispheric Perspective	85	(7)
Justice and Scale	92	(3)
Disappearing States: The Scale of the Nation	95	(30)
Regional Inequalities	99	(8)
Centers of Excellence	107	(2)
Distant Cities	109	(4)
Redistricting	113	(2)
Travel Time (Distance)	115	(8)
Discussion	123	(2)
The Scale of the City: Distant Communities and the Problem of Supply	125	(26)
Rural versus Urban Care	126	(2)
OPO Performance	128	(3)
Demographics and Membership	131	(9)
Poverty and Race	140	(5)
A Sense of the Game	145	(1)
Application: Southern California	146	(3)
Discussion	149	(2)
The Lifeboat's Choice	151	(24)
Lifeboat Seats	153	(4)
Results	157	(9)
Q-Analysis	166	(4)
Discussion	170	(5)
Justice in Ethic's Lifeboat	175	(18)
Dimensionality	177	(3)
Participation	180	(3)
Philosophical Concerns	183	(6)
Reasons and Persons	189	(2)
The Scarcities We Create	191	(2)
Afterword	193	(2)
Holmes' Legacy	195	(1)
Abundance and Scarcity	196	(3)
Notes	199	(24)
Bibliography	223	(18)
Index	241