The American Society of Nephrology (ASN), the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA) and the International Society of Nephrology (ISN) have formed a Joint Working Group on Ethical Issues in Nephrology to facilitate collaboration on efforts to address current and emerging challenges for nephrologists; this paper represents the first part of this project. Ten broad areas of ethical concern in nephrology are described in order to highlight the need for ethical analysis of specific issues, and for training and development of guidance tools to support clinicians in practicing ethically and in contributing to ethical policy making. Collaborative action on these challenges is advocated to achieve equity in access to ESKD care, avoid futile dialysis, safely reduce costs of dialysis, facilitate shared decision-making in ESKD care, support donor evaluation and decision-making in living kidney donation, encourage priority setting in kidney disease prevention and care, address the ethical implications of genetic kidney diseases, advocate responsibly for kidney health, and to manage conflicts of interest in nephrology.
Purpose:
To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution.
Methods:
Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America–accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions.
Results:
Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking.
Conclusions:
Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.
This article offers a new theory about how using lotteries to distribute scarce benefits satisfies beneficiaries' claims. In the first section of the article I criticize John Broome's view and on the basis of these criticisms set out four desiderata for a philosophically adequate account of claim satisfaction by lottery. In section II I propose and defend a new view called the dual structure view, so called because it posits that claimants have two types of claims in the relevant scarce benefit distribution cases under discussion. This view meets all the desiderata set out in section I. Section III draws out the practical implications of my view for a variety of temporally extended cases, including the distribution of corneas to patients who have suffered corneal degeneration.
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