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James L. Benedict a Revised Consent Model for the Transplantation of Face and Upper Limbs: Covenant Consent International Library of Ethics, Law, and the New Medicine

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James L. Benedict a Revised Consent Model for the Transplantation of Face and Upper Limbs: Covenant Consent International Library of Ethics, Law, and the New Medicine International Library of Ethics, Law, and the New Medicine 73 James L. Benedict A Revised Consent Model for the Transplantation of Face and Upper Limbs: Covenant Consent International Library of Ethics, Law, and the New Medicine Volume 73 Series editors David N. Weisstub, University of Montreal Fac. Medicine, Montreal, QC, Canada Dennis R. Cooley, North Dakota State University, History, Philosophy, and Religious Studies, Fargo, ND, USA Founded by Thomasine Kimbrough Kushner, Berkely, USA David C. Thomasma, Dordrecht, The Netherlands David N. Weisstub, Montreal, Canada The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, international health care and medicine. The 28 volumes that have already appeared in this series address aspects of aging, mental health, AIDS, preventive medicine, bioethics and many other current topics. This Series was conceived against the background of increasing globalization and interdependency of the world’s cultures and govern- ments, with mutual influencing occurring throughout the world in all fields, most surely in health care and its delivery. By means of this Series we aim to contribute and cooperate to meet the challenge of our time: how to aim human technology to good human ends, how to deal with changed values in the areas of religion, society, culture and the self-definition of human persons, and how to formulate a new way of thinking, a new ethic. We welcome book proposals representing the broad interest of the interdisciplinary and international focus of the series. We especially welcome proposals that address aspects of ‘new medicine’, meaning advances in research and clinical health care, with an emphasis on those interventions and alterations that force us to re-examine foundational issues. More information about this series at http://www.springer.com/series/6224 James L. Benedict A Revised Consent Model for the Transplantation of Face and Upper Limbs: Covenant Consent 123 James L. Benedict Center for Healthcare Ethics Duquesne University Pittsburgh, PA USA ISSN 1567-8008 ISSN 2351-955X (electronic) International Library of Ethics, Law, and the New Medicine ISBN 978-3-319-56399-2 ISBN 978-3-319-56400-5 (eBook) DOI 10.1007/978-3-319-56400-5 Library of Congress Control Number: 2017937723 © Springer International Publishing AG 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland The original version of the book was revised: Incorrect volume number of the book has been updated. The erratum to the book is available at 10.1007/978-3-319-56400-5_7 v Contents 1 Introduction.............................................. 1 1.1 The Challenge of Medical Advancement for Healthcare Ethics ............................................... 2 1.2 Vascularized Composite Allotransplantation .................. 2 1.2.1 Emergence of the Field and Special Demands on Patients ..................................... 2 1.2.2 Implications of VCA for Consent .................... 5 1.3 Covenant Consent...................................... 6 1.4 Structure of the Book ................................... 7 1.5 Conclusion ........................................... 7 2 Vascularized Composite Allotransplantation .................... 9 2.1 Introduction .......................................... 9 2.2 History and Development of Solid Organ Transplantation and Limb Replantation .................................. 10 2.2.1 Ancient Evidence ................................ 10 2.2.2 Developments in Transplantation Prior to 1954 ......... 11 2.2.3 Early Developments in Replantation .................. 13 2.2.4 Sixty Years of Successful Solid Organ Transplantation .................................. 14 2.2.5 Developments in Replantation....................... 15 2.3 History and Development of Vascularized Composite Allotransplantation ..................................... 15 2.3.1 Upper Extremity Transplantation..................... 17 2.3.2 Face Transplantation .............................. 20 2.3.3 Other VCA ..................................... 23 2.4 Similarities and Differences in VCA and SOT ................ 25 2.4.1 Similarities ..................................... 25 2.4.2 Unique Features of Solid Organ Transplants............ 26 2.4.3 Unique Features of Vascularized Composite Allotransplantation ............................... 28 vii viii Contents 2.5 Practical and Ethical Concerns in the Field of Vascularized Composite Transplantation ............................... 34 2.5.1 Immunological Concerns........................... 34 2.5.2 Psycho-Social Issues .............................. 40 2.5.3 Procurement and Allocation Concerns................. 47 2.5.4 Financial Costs .................................. 48 2.5.5 Ethical Issues ................................... 50 2.6 Conclusion ........................................... 71 3 The Ethics of Consent...................................... 73 3.1 History and Development of the Role of Consent in Health Care ........................................ 73 3.1.1 Pre-enlightenment Developments .................... 75 3.1.2 The Influence of Post-medieval Philosophy............. 79 3.1.3 Building on the Philosophical Foundation.............. 81 3.2 The Current Understanding of Consent ..................... 93 3.2.1 The Dominant Formulation ......................... 93 3.2.2 Critiques and Alternatives .......................... 94 3.3 A More Fundamental Critique ............................ 102 3.3.1 Historical Origins ................................ 103 3.3.2 Philosophical Origins ............................. 105 3.3.3 Atypical Contexts ................................ 109 3.3.4 Adapting Informed Consent for Treatment Contexts ....................................... 113 4 The Meaning of Covenant .................................. 115 4.1 Introduction .......................................... 115 4.2 Covenant in the Ancient Near East......................... 116 4.2.1 Etymological Roots............................... 116 4.2.2 The Structure of Covenants......................... 121 4.2.3 Covenants and Fictive Kinship ...................... 122 4.2.4 The Role of Shame and Honor in Covenantal Relations ....................................... 123 4.2.5 Durability and Flexibility .......................... 124 4.3 The Role of Covenant in Contemporary Religious Ethics........ 126 4.3.1 Jewish Ethics ................................... 126 4.3.2 Christian Ethics.................................. 128 4.4 The Role of Covenant in Health Care Ethics ................. 131 4.4.1 General Use of the Covenant Concept ................ 131 4.4.2 Paul Ramsey .................................... 135 4.4.3 William F. May.................................. 137 Contents ix 4.5 Covenant and Care Provider—Patient Relationships............ 140 4.5.1 Reciprocity, Loyalty and Disparities in Power .......... 142 4.5.2 Covenantal Relationships: Accompanying Characteristics ................................... 144 4.5.3 A Covenant Approach to Care Provider—Patient Relations ....................................... 146 5 Covenant Consent ......................................... 149 5.1 Introduction .......................................... 149 5.2 Informed Consent: Dynamic and Evolving ................... 153 5.3 Incongruity: VCA and Standard Antecedent Consent ........... 161 5.4 The Concept of Covenant as a Resource .................... 169 5.4.1 Covenant Consent and the Duration of Treatment in VCA ........................................ 174 5.4.2 Covenant Consent and the Burdens and Risks of VCA ........................................ 175 5.4.3 Covenant Consent and Long-Term Active Participation by the Recipient in VCA .......................... 176 5.4.4 Covenant Consent and the Role of Dignity and Vulnerability in VCA .......................... 179 5.5 Covenant Consent for VCA .............................. 182 5.5.1 Re-imagining Consent in Covenantal Terms ............ 183 5.5.2 Creating a Structure and Process for Covenant Consent .......................................
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