Arthur L. Caplan and Daniel H. Coelho
Recent advances in medical technology and research have made possible an unprecedented level of health care for those living in economically advanced nations like the United States. Antibiotics, chemotherapy, functional imaging, telemedicine, reproductive technology, artificial organs, and transplantation are just a few of the weapons in our medical arsenal today that simply did not exist only fifty years ago. Not coincidentally, the field of bioethics has also grown over the same time span. Much of the concern about ethics is driven by the power of our new technological medical prowess. All too often it seems as though medicine asks "Can we?" before asking "Should we?" and thus many Americans are doubtful that ethics can ever keep pace with rapidly changing technologies.
However, technology need not be our master. If we think hard about the ethical implications of what a particular technology might permit us to do, if thinking about the ethical consequences of technological innovation becomes an essential part of research in biomedicine, and if we realize that as citizens and patients it is up to each of us to attend to the ethical and social ramifications of what biomedicine does to our lives, our pocketbooks, and our society, then we may be able to shape biomedical progress to best suit our values. Organ transplantation is one area where progress has been astounding but where ethical reflection has done a reasonably good job of keeping pace.
Ever since its inception in the 1950s, organ transplantation has been accompanied by many hard questions about the ethics of taking organs from the dead and the living and giving them to others. It has been one of the most fertile sources of discussion among physicians, ethicists, policy makers, and lay people. Some go so far as to claim that bioethics was born out of the