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Medical practice, ethics and belief

Lancet owned by Edward Jenner, England, 1720-1800

Lancet owned by Edward Jenner, England, 1720-1800

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Different cultural or religious beliefs can have a profound effect on the way new medical techniques and technologies are received. An innovation that may be seen in a positive light in one setting may be highly controversial in another. For instance, when doctors in European countries began vaccination programmes in the 1800s, many religious groups were critical of the way it disfigured bodies that they believed were made in God’s image (vaccination was a much more painful and invasive procedure than it is today).

Organ transplantation is another example - a daring, dangerous procedure that has come to symbolise the power and impact of modern medical science. Bear in mind that successfully transferring body parts between people was seen as a miracle in the middle ages! But taking organs from people and putting them into the bodies of others often raises major concerns.

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The changing view on organ transplants

A good example of this is how different belief systems have taken time to accept the definition of ‘brain death’ that is central to organ transplantation. Today, a major supply of organs for transplants comes from individuals who are legally defined as brain dead. These people, whose organs are kept functioning by intensive care machines, have little or no brain activity. They offer an excellent source of transplant material because, apart from the brain, their other organs have a high chance of remaining healthy and functioning. With the consent of the individual’s family, organs can be removed and rapidly transplanted.

The legal acceptance of brain death

The definition of brain death was incredibly controversial when it was first introduced in the 1960s. Several doctors in Europe and the US were arrested after removing hearts from patients classified as brain dead. The definition was only written into law after a long legal and ethical debate in the 1960s and 1970s. Today the definition is accepted by most people in countries with a dominant Christian or secular culture - and brain-dead people are a major source of organs in these countries. This is because traditionally Christianity separated mind from body, making the former central to identity and reason.

The Japanese connection between mind and body

Brain death was accepted with far more difficulty in Japan, however, where cultural beliefs do not allow the separation of mind and body in the same way. Japanese culture locates spirit in a space in the thorax, or chest, known as kokoro. Unsurprisingly, then, the removal of beating hearts in Japan proved especially controversial. After a transplant surgeon was arrested in 1968, no heart transplants were attempted for over 30 years.

The acceptance of brain-dead donors in Japan, 1999

In the late 1990s, after much legal, ethical and public debate, the Japanese government decided to allow the removal of organs from people in an irreversible coma. From 1997, people could be recognised as brain dead if they had given their consent to organ donation before they fell into a coma. If they did not give consent, they were not recognised as brain dead - even if they had no brain activity. In 1999 the first heart transplant from a brain-dead donor in over 30 years took place in Japan.

 

Related links

Bibliography

G S Belkin, 'Brain-Death and the Historical Understanding of Bioethics', Journal of the History of Medicine and Allied Sciences, 58 (2003), pp 325 - 361

N Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853 – 1907 (Durham NC: Duke University Press, 2005)

M Lock, Twice Dead: Organ Transplants and the Reinvention of Death (Los Angeles: University of California Press, 2001)

S J Younger, R C Fox and L J O’Connell (eds), Organ Transplantation: Meanings and Realities (Wisconsin: University of Wisconsin Press, 1996)

R M Wolfe and L K Sharpe, ‘Anti-vaccinationists Past and Present', British Medical Journal, 325 (2002), pp 430-432

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