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[199]-239) and index. 327 $aMachine generated contents note: 1 Lifeboat Ethics and the Case of the William Brown -- Health Care -- The William Brown -- The Gulf Stream -- A Constructed Tale -- The Trial -- Lifeboat Ethics Redux -- The Titantic --2 The Scales of Justice: Principles and Practice -- Distributive Justice -- Scarcity -- Justice Rationales -- Critiques -- Transplantation -- A Geographical Approach -- 3 Scarce Goods: The Contexts of Solid Organ Transplantation -- Transplantation: The Early Years -- Cyclosporine: Transforming Scarcity -- A National System -- National Organ Transplant Act -- Regionalization -- An Example -- Discussion --4 The Scale of Justice: Theories and Realities -- Perspective and Scale -- Global/Interational Scales -- Hemispheric Perspective -- Justice and Scale --5 Disappearing States: The Scale of the Nation -- Regional Inequalities -- Centers of Excellence -- Distant Cities -- Redistricting -- Travel Time (Distance) -- Discussion --6 The Scale of the City: Distant Communities and the -- Problem of Supply -- Rural versus Urban Care -- OPO Performance -- Demographics and Membership -- Poverty and Race -- A Sense of the Game -- Application: Southern California -- Discussion --7 The Lifeboat's Choice -- Lifeboat Seats -- Results -- Q-Analysis -- Discussion --8 Justice in Ethic's Lifeboat -- Dimensionality -- Participation -- Philosophical Concerns -- Reasons and Persons -- The Scarcities We Create --Afterword -- Holmes' Legacy -- Abundance and Scarcity. 330 8 $aIn 1841 the American sailing ship William Brown struck an iceberg. About half of the passengers and all of the crew were saved in two small, open boats. The next night, half of the passengers in the larger long-boat were thrown overboard because the boat was overfull. This was the first case of lifeboat ethics, of hard choices in the face of scarcity. Since then the question has been who should die so that others, equally needy, might live? Both the case of the William Brown and the ethics it spawned have been used in recent years to describe the problem of health care rationing generally, and organ transplantation specifically. Koch reexamines and reinterpretes the paradigm case of lifeboat ethics, the story of the William Brown, not as an unavoidable tragedy, but as an avoidable series of errors. Its relation to more general issues of distributive justice are then considered. The lessons learned from both the historical review and its application to distributive principles are then applied to the problem of graft organ distribution in the United States. Through the use of maps, the problem of organ distribution is considered at a range of scales, from the international to the urban. The contextual issues become more evident as one moves from international to hemispheric, fron national to regional, and then local systems. Finally, Koch reviews the lessons in light of other problems of distribution in the face of scarcity. The central lesson-that scarcity is exacerbated where it is not in fact created by our distributive programs-is explored thoroughly. The result is no good choices for anyone and the continuation of the scarcity that for most seems inevitable, but, from the evidence provided, is itself an outcome of inequalities of distribution at different scales of society. Of particular interest to students, scholars, and policymakers involved with issues of planning and health care economics, medical geography, and concepts of justice. 606 $aTransplantation of organs, tissues, etc$xMoral and ethical aspects$zUnited States 606 $aTransplantation of organs, tissues, etc$xSocial aspects$zUnited States 606 $aTransplantation of organs, tissues, etc$xLaw and legislation$zUnited States 606 $aSocial justice$zUnited States 615 0$aTransplantation of organs, tissues, etc.$xMoral and ethical aspects 615 0$aTransplantation of organs, tissues, etc.$xSocial aspects 615 0$aTransplantation of organs, tissues, etc.$xLaw and legislation 615 0$aSocial justice 676 $a174/.25 700 $aKoch$b Tom$f1949-$01804823 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910966555503321 996 $aScarce goods$94353060 997 $aUNINA