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PubMed2003

Organ donation: a communitarian approach.

Recently, various suggestions have been made to respond to the increasingly great shortage of organs by paying for them. Because of the undesirable side effects of such approaches (commodification, injustice, and costs), a communitarian approach should be tried first. A communitarian approach to the problem of organ shortage entails changing the moral culture so that members of society will recognize that donating one's organs, once they are no longer of use to the donor, is the moral (right) thing to do. This approach requires much greater and deeper efforts than sharing information and making public service announcements. It entails a moral dialogue, in which the public is engaged, leading to a change in what people expect from one another. Among the devices that could help change the moral culture are a public statement, endorsed by community members and leaders, that expresses the community sense that donation "is what a good person does" and a community-specific web page that lists those who have made the commitment. A change in law so that a person's wishes in the matter are recognized as final and binding are also desired. This position paper deals only with cadaver organs and not living donors.

Altruism↗
PubMed2001

Commodified kin: death, mourning, and competing claims on the bodies of organ donors in the United States.

A pronounced disjunction characterizes symbolic constructions of the cadaveric donor body in the United States, where procurement professionals and surviving donor kin vie with one another in their desires to honor this unusual category of the dead. Of special concern is the medicalized commodification of donor bodies, a process that shapes both their social worth and emotional value. Among professionals, metaphorical thinking is key: death and body fragmentation are cloaked in ecological imagery that stresses renewal and rebirth. Such objectification also obscures the origins of transplantable organs, renders individual donors anonymous, and silences kin who mourn their dead. In response, donor kin have grown increasingly assertive, generating alternative public mortuary forms that exclude professional mediators. In so doing, they challenge the medical assumption that anonymity is central to transplantation's continued success. Through donor quilts and Web cemeteries, they proclaim the personal identities of donors who, at times, may speak beyond the grave, offering critiques of donation as socio-medical process in the United States.

Anthropology, Cultural↗
PubMedDate not supplied

Can a purchaser be a partner? Nursing education in the English universities.

Since the early 1990s, public sector management in England has been exhorted to follow the example of the private sector, and 'quasi-markets' have been established, for example in the health service. A quasi-market also exists between the NHS and higher education for the purchasing (or procurement) of nursing education. This paper uses policy documents such as the National Health Service Executive Circular (March 1999) on 'Good Contracting Guidelines' for Non-Medical Education and Training, plus other relevant literature on the commodification of higher education, quasi-markets and contract theory to examine this market, and the confusion of two rhetorics, those of competition and partnership. Nursing occupies a marginal place in higher education in England, having only recently become part of it. The emphasis of the quasi-market on the output of a trained 'fit for purpose' labour force combines with professional attempts to create an academic discipline, in complex ways which are as yet underanalysed.

Education, Nursing↗
PubMed2003

[Basic ethical aspects of living organ donation].

A characteristic feature of transplanting organs from living donors is that not only patients in need for treatment but also healthy individuals are submitted to medical interventions. Ethical considerations in this field have to deal with the question of property attributes of the human body and conflicts with traditional medical principles. Altruistic organ donation, appreciated by Christianity as a sign of charity, is indeed contradictory to the classic maxim of medical ethics "primum nihil nocere, " meaning "first of all, do not harm." The autonomous choice of a potential donor has to be balanced thoroughly against his personal physical and psychological risks. Apart from organ donation with altruistic motives, commercial incentives or payment for organ donation, which are increasingly under discussion in many nations, need profound ethical reflection. Organ selling does not lead to long-term economic benefit for individual donors in developing countries and is associated with a decline in health. A market system of organ sales would foster exploitation of the poor, and it is substantially doubtful whether autonomy and self determination are valid under circumstances of poverty and coercion. Commodification of the human body risks viewing persons as marketable objects. The human body,however, is an integral element of an individual's personality and not a resource to be removed. It is therefore fundamental that the social good of altruism is preserved as the major principle in organ donation.

Altruism↗
PubMed1988

Holistic health and the critique of Western medicine.

The holistic view of health has been accurately criticized in the literature for its individualistic, victim-blaming ideology that obscures the social origins of illness. The paper explains how the contrasting view of the body and illness provided by the holistic model can help to show how Western medicine reflects the capitalist system in which it is promoted. It shows how evaluation of holistic therapies is problematic insofar as it is based on the analytical, reductionist criteria of the Western model. It suggests that one reason why holistic practices are not more fully accepted by Western medicine may be the challenge they pose to the Western model, and to the commodification of health needs promoted by this model.

Economics, Medical↗
PubMed1993

(Over)eating success: the health consequences of the restoration of capitalism in rural China.

This paper reviews and evaluates some of the changes that have occurred in the Chinese health care system during the reform era associated with Deng Xiaoping (1978-1993). The reforms have helped to enrich the long suffering peasants in the Chinese countryside, and in many areas the peasants have experienced a significant improvement in the quality of their lives, including greater access to health care facilities, and better diets. The paper also considers some of the potentially negative side effects of the reform era, including the increasing income inequality between urban and rural areas; the commodification of Chinese medicine; declining access to health care for peasants in the poorest regions; and a concern about the changing patterns of diet and nutrition in the newly enriched parts of the Chinese countryside.

Cause of Death↗
PubMed1996

Smoking prevalence among women in the European community 1950-1990.

The paper reviews trends in tobacco use among women in the European Community (EC) between 1950 and 1990. The data suggest that EC countries occupy different points on what appears to be a common prevalence curve. Southern EC countries are represented in the early phases of this curve, marked out by sharply rising prevalence. In northern EC countries, female smoking prevalence appears to have peaked. Across the EC, the commodification of tobacco use, and the production and promotion of manufactured cigarettes in particular, underlies this prevalence curve. Young women in higher socio-economic groups have led the way into cigarette smoking in both northern and southern Europe, with smoking prevalence declining first among women who are privileged in terms of their education, occupation and income. Because the decline in prevalence has yet to be repeated among women in more disadvantaged circumstances, cigarette smoking among women in the EC is likely to become a habit increasingly linked to low socio-economic status.

Adolescent↗
PubMed2001

The Icelandic genome debate.

Three of the central issues in contemporary debates about the commodification of the human body are those of property, ownership, and access. This article uses the case of the central medical database on Icelanders to discuss contesting claims about the ownership of the human genome, with respect to the rapid development of biotechnology, human genome projects and DNA collections. We emphasize the contrast between commercial and communitarian perspectives and to illustrate our argument we explore debates about the Icelandic database. These debates have been intense, focusing on a range of issues, including ethics, academic freedom, public health and, last but not least, the control and ownership of medical records, genetic information and genealogical data. This article should be seen primarily as an anthropological commentary on ongoing developments.

Bioethics↗
PubMed1999

Purchasing a quick fix from private pharmacies in the Gaza Strip.

Increasingly, it is recognised by health planners and social scientists that self medication with drugs bought over the counter in private pharmacies is extremely widespread. Some anthropologists see this trend as an aspect of the 'commodification of health'. In this study, group interviews with health service users and providers in Gaza revealed many health service users reporting an inadequate supply of drugs resulting in the purchasing of drugs in private pharmacies. As a result, a survey of the pattern of utilization of three private pharmacies in three contrasting urban areas within the Gaza Strip was undertaken. Using a questionnaire, data were collected from all customers buying drugs. The results show that variations in the patterns of health seeking behaviour were associated with socioeconomic status. Adult males were the most frequent customers of all three pharmacies. They were buying medicines for members of their nuclear family more often than for themselves. Overall, pain and influenza were the most commonly reported conditions. The drugs purchased most frequently for women were for reproductive health problems, particularly infertility. Customers of the pharmacy in the relatively prosperous area more commonly purchased drugs which were prescribed by a private doctor.

Adult↗
PubMed1998

Quantitative health research in an emerging information economy.

This paper is concerned with the changing information environment in the U.K. National Health Service and its implications for the quantitative analysis of health and health care. The traditionally available data series are contrasted with those sources that are being created or enhanced as a result of the post-1991 market-orientation of the health care system. The likely research implications of the commodification of health data are assessed and illustrated with reference to the specific example of the geography of asthma. The paper warns against a future in which large-scale quantitative health research is only possible in relation to projects which may yield direct financial or market benefits to the data providers.

Asthma↗
PubMed2000

Regulating human body parts and products.

This special volume of Health Care Analysis is dedicated to a consideration of the status of body parts and products and the role of law in regulating them. We argue that such a discussion is timely given the conflation of technological and academic concerns posed by the complex legal framework within which these issues are currently addressed and in the light of debates such as those regarding the storage of children's organs addressed by inquiries at Alder Hay and Bristol, United Kingdom. The contributors address specific legal problems which have been brought before the courts in the UK and other jurisdictions, something which we suggest is likely to occur with increasing regularity once the Human Rights Act 1998 comes into force in October 2000. The issues are also considered on a more theoretical level with papers exploring the role of concepts such as property, donation, commodification and kinship in these debates. While the volume focuses principally upon the manner in which these issues have arisen in a UK context, though with reference to certain comparative examples, the concepts discussed here are of more general application across other jurisdictions.

Government Regulation↗
PubMed1999

Status, sale and patenting of human genetic material: an international survey.

Following a decade of debate, the European Directive on the Legal Protection of Biotechnological Inventions was adopted by the European Parliament and the Council of the European Union on July 6, 1998. The Directive constitutes a legal and social policy landmark in biotechnology, taking an explicit position on the contentious issue of the patentability of higher life forms. It fails, however, to provide definitive statements on the legal status of human genetic material or the possibility of personal financial gain in relation to such material. An overview of the international, regional and national positions (as found in laws and official policy statements) on the status, commodification and patentability of human genetic material indicates that, although the Directive represents a consolidation of opinions, many issues remain unresolved.

Commerce↗
PubMed2003

Deconstructing risk assessment and management in mental health nursing.

RATIONALE: Risk assessment and management have a taken a central position in the delivery of contemporary mental health services. However, these concepts are generally taken-for-granted as necessary and unavoidable aspects of mental health nursing practice. This deconstructive analysis explores some of the assumptions and values that underpin these concepts. AIMS: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. DESIGN: This paper takes a deconstructive approach to the exploration of the historical, clinical, cultural, political and economic context of the concept of risk and its assessment and management. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. FINDINGS: The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organization. CONCLUSION: The mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.

Delivery of Health Care↗
PubMed2003

"Just trying to relax": masculinity, masculinizing practices, and strip club regulars.

This article explores customers' understandings of their visits to heterosexual strip clubs and the ways in which those visits become meaningful to them in relation to cultural discourses around masculinity, sexuality, leisure, and consumption, as well as in relation to their everyday lives and relationships. Not every man finds strip clubs pleasurable, yet understanding why some men frequent these venues can inform us more generally about the links between sexuality, gender, and the marketplace. This article focuses on regular male customers' stated motives for visiting strip clubs and examines those visits as touristic and masculinizing practices. It also explores gender, sexuality, and power in the men s performances of desire in the clubs, taking up issues of visibility, virility, youthfulness, and commodification.

Adult↗
PubMed1996

Feminist critiques of new fertility technologies: implications for social policy.

This essay aims to show how feminist theoretical and practical perspective have enriched and deepened debate about moral and social issues generated by the proliferation and commodification of new reproductive techniques. It evaluates alternative feminist appraisals beginning with the first group to organize a collective response to the medicalization of infertility and explores several weaknesses working within their assessment: objectification of infertile women, naturalizing constructions of motherhood, hostility to technology, and an overly simplistic conception of power relations. Next, it shows how subsequent feminists have reframed the issues to overcome these weaknesses, drawing on themes prominent in recent theoretical debates: the need to reclaim women's agency, to revalue mothering, and to reappraise power relations. Lastly, it weighs the prospects for a collaborative politics that is sensitive to the social marginalization of vulnerable women and suggests practical strategies for responding to mounting pressures to procreate at any price.

Dehumanization↗
PubMed2001

Competition, race, and professionalization: African healers and white medical practitioners in Natal, South Africa in the early twentieth century.

The licensing of African healers in the province of Natal, South Africa combined with urbanization, medical commodification, and an overcrowded biomedical market led to ideological and commercial competition between White biomedical practitioners and African healers in the early twentieth century in southeastern Africa. This article examines the historical antecedents of this competition and focuses on the role that competition, race, and gender played in the construction of local biomedical and African ideas of medical authority. Adopting the idea that medicine is an important site of power, contestation, and cultural exchange, I aim not only to document these historical changes in African therapeutics, but to problematize current ideas of biomedicine's colonial hegemony.

Economic Competition↗
PubMed1999

Managed medical education?

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managed medical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the temple of those who clamor, 'I can name that tune in four notes.'"

Cost Control↗