Emile Durkheim was a French philosopher who was born on 15 April, 1858. Durkheim acknowledged Comte as his master.

On a sociological perspective when Comte and Spencer were considered as the founding fathers of Sociology, Durkheim is considered as the grandfather and the systematic approach to study the society began with him. Durkheim's theory of 'suicide' is related in various ways to his study of the division of labour. It is also linked with the theory of 'social constraint'. Durkheim has established the view that there are no societies in which suicide does not occur. Rejecting most of the accepted theories of suicide, Durkheim on the basis of his monographic studies claims suicide as primarily a social phenomena in terms of the breakdown of the vital bond of life. Durkheim in his classical study of 'Le Suicide' which was published in 1897, demonstrates that neither psycho-pathic factor nor heredity nor climate nor poverty, nor unhappy love nor other personal factors motivate along form sufficient explanation of suicide. According to Durkheim, suicide is not an individual act nor a personal action. It is caused by some power which is over and above the individual or super individual. He viewed "all classes of deaths resulting directly or indirectly from the positive or negative acts of the victim itself who knows the result they produce" Having defined the phenomenon Durkheim dismisses the psychological explanation. Many doctors and psychologists develop the theory that majority of people who take their own life are in a pathological state, but Durkheim emphasises that the force, which determines the suicide, is not psychological but social. He concludes that suicide is the result of social disorganisation or lack of social integration or social solidarity. Types of Suicide Emile Durkheim classified different types of suicides on the basis of different types of relationship between the actor and his society. (1) Egoistic suicide: According to Durkheim, when a man becomes socially isolated or feels that he has no place in the society he destroys himself. This is the suicide of self-centred person who lacks altruistic feelings and is usually cut off from main stream of the society. (2) Altruistic suicide: This type of suicide occurs when individuals and the group are too close and intimate. This kind of suicide results from the over integration of the individual into social proof, for example - Sati customs, Dannies warriors. (3) Anomic suicide: This type of suicide is due to certain breakdown of social equilibrium, such as, suicide after bankruptcy or after winning a lottery. In other words, anomic suicide takes place in a situation which has cropped up suddenly. (4) Fatalistic suicide:

This type of suicide is due to overregulation in society. Under the overregulation of a society, when a servant or slave commits suicide, when a barren woman commits suicide, it is the example of fatalistic suicide Critical evaluation of Durkheim's theory: Although Durkheim's theory of suicide has contributed much about the understanding of the phenomenon because of his stress on social rather than on biological or personal factors, the main drawback of the theory is that he has laid too much stress only on one factor, namely social factor and has forgotten or undermined other factors, thereby making his theory defective and only one sided.

In vitro The Ethics of In Vitro Fertilization 1. Amnon Goldworth, PhD* +Author Affiliations 1. 2. *Senior Medical Ethicist-in-Residence, Lucile Packard Childrens Hospital, Stanford University School of Medicine, Stanford, CA. Next Section TOPICS FOR DISCUSSION 1. Is there a difference between being human and being a person? 2. Are there other ethical problems with the use of in vitro fertilization beyond those identified in this article? 3. Should an infertile couple be allowed to take the risk of harming their offspring if it is not known whether a serious harm is involved or it is known that a serious harm is involved? 4. Are there ways of possibly wronging the community by the use of in vitro fertilization other than financially? 5. Does the physician have an ethical if not a legal obligation to provide in vitro fertilization to infertile couples? Previous SectionNext Section

INTRODUCTION After the Flood, God blessed Noah and his sons, and said unto them, Be fruitful and multiply, and replenish the earth. (Genesis 9:1) Humankind, notwithstanding war, famine, and disease, has heeded this call with natural exuberance and global consequences that challenge the planets resources today. Over the many centuries since Gods injunction, children have been born by natural means. However, among the estimated 40 million couples of childbearing age who live in the United States, 8.5% are involuntarily infertile. Obviously, many more infertile couples around the world can be added to this more than 3 million in the United States. For these couples, in vitro fertilization (IVF) offers new promise. This promise is not without its critics. Social pressure, especially on women, is at the heart of much of the drive for biologic parenthood. Nevertheless, the fact that many infertile couples are willing to spend thousands of dollars and risk the physical and mental demands of IVF rather than adopt a child suggests a strong emotional need for biologic offspring that is not influenced by social pressures. Previous SectionNext Section THE IVF PROCEDURE Unlike in vivo fertilization, IVF requires the intervention of a medical team. This intervention begins by taking a history of the couple. This is followed by physical and laboratory examinations that include a test for the sperm count of the male partner and a pelvic examination, cervical culturing, and staining of cervical secretions for the presence of Chlamydia for the female partner. Once these tests are completed, fertility drugs are administered to the woman to stimulate her ovarian follicles to produce as many healthy eggs as possible. This is necessary because a single fertilized egg or pre-embryo has only a small chance of survival. Eggs are retrieved 27 to 36 hours by a specific stimulation technique such as ultrasonographically guided aspiration or laparoscopy, and as many eggs as possible are obtained per single retrieval attempt. The harvested eggs are inseminated by a sample of semen that contains sperm of good quality and are prepared by washing to induce capacitation. Each harvested egg has a 60% to 70% chance of being fertilized. Once cleavage occurs, the pre-embryos are transferred to the womans uterus. Sperm of poor quality reduces the chances for a couple to have sufficient embryos available for assisted fertilization. This problem has been addressed with intracytoplasmic sperm injection, in which a single captured sperm is injected directly into the egg. Previous SectionNext Section THE ETHICAL LANDSCAPE Bernard Williams has observed that we have a conception of the ethical that understandably relates to us and our actions the demands, claims, desires, and especially the lives of other

people. Four distinguishable ethical problems are involved with IVF: 1) the relationship of the physician and the infertile couple to the pre-embryo, 2) the relationship of the physician to the infertile couple and the affected offspring, 3) the relationship of the infertile couple to the expected offspring, and 4) the relationship of the physician and the infertile couple to the general community. My conception of ethically permissible behavior is based on the view that any decision is ethically permitted if it is voluntary and does not cause gratuitous harm to others. This is congruent with the early ethical stricture in medicine, Primum non nocere, First, do no harm. However, our perception of harm must be qualified. A living being can be harmed without being harmed in a moral sense. I harm a mosquito when I swat it, but I do not harm it in a moral sense unless I assign a moral absolute value to the mosquitos well-being. To be harmed in a moral sense is to be wronged. Thus, my concern is with behavior that does or does not wrong another. Previous SectionNext Section THE ETHICAL ISSUES ISSUE 1: THE POSSIBLE WRONG DONE TO THE PRE-EMBRYO The number of pre-embryos that are transferred to the womans uterus is determined by the chances of fertilization, and this varies with the womans age. A sufficient number of preembryos are needed to increase the likelihood of pregnancy. Those that are not needed usually are frozen. Embryos that are not transferred to a womans uterus ultimately may be used for research purposes or destroyed. Embryos in the uterus may be destroyed by selective pregnancy reduction. In these instances, further embryonic development has been halted by the action of a physician with the likely consent of the couple. Can the destroyed embryo be said to have been wronged? The answer to this question is contingent on the perceived ontologic status of the embryo. If the embryo is viewed as a human being with the rights normally associated with personhood, arresting its development will be considered a wrong because it constitutes an act of murder. On the other hand, if the embryo is perceived as a bit of protoplasm, neither freezing nor destroying it is inherently unethical. Personhood Considering the human pre-embryo or embryo to be protoplasm overlooks the fact that it differs from every cell in a womans body and can be identified as human by its DNA. Thus, science supports the view that human life begins at conception. Some conclude from this that the pre-embryo is a person who possesses rights from the moment of conception. However, personhood is a social construct that is shaped not only by an understanding of objective nature but also by community needs and values. It is not surprising that different concepts of personhood have been adopted at different times and places. Aristotle indicated that ensoulment (personhood) occurs 40 days after conception for the male fetus and 80 days after conception for the female fetus. Muslims believe that personhood occurs 14 days after conception. From the 17th century onward, European common law recognized personhood

only after quickening. Within this historical context, any attempt to decide when protoplasm is endowed with rights by merely resorting to a scientific examination of biologic processes is bound to fail. A broadly accepted view in todays world is that the human organism becomes a person at the moment of birth. A competing position is that personhood begins at the moment of conception. Adopting this latter view weighs against selective pregnancy reduction and research on embryos and might require that all embryos be implanted. The Catholic Church is the major proponent of the view that the life of a new human being begins at the moment the ovum is fertilized. According to Catholic teaching, viewing a human individual as a person dictates recognition of the rights of the pre-embryo as a person. Is a pre-embryo a person from the moment the ovum is fertilized? According to Thomas Shannon (1997), the answer is no. He states that not until totipotency gives way to specialized cellular development, which occurs approximately 3 weeks after formation of the zygote, can we correctly speak of the pre-embryo as an individual. Before this time, the pre-embryo is not an individual and, therefore, cannot be a person. Although science cannot provide a concept of personhood, it appears, in this context, to have provided a necessary condition for human individuality without which personhood is not possible. However, Shannon acknowledges that the biology of the pre-embryo will eventuate in an individual who is a person. Focusing on the argument from totipotency results in the conclusion that human individuality and, therefore, human personhood does not begin until some weeks after the ovum is fertilized. If we emphasize the fact that the fertilized ovum normally will develop into a person, then the argument from potentiality may lead us to conclude, along with the Catholic Church, that the embryo is a person from the moment of conception. Because the existence of personhood bars us from abusing or killing a person, the logical conclusion is that pregnancy reduction and embryo research are immoral. The Church would like us to believe that personhood occurs at the moment of conception, and Shannon would like us to believe that prior to 3 weeks gestation, the pre-embryo falls short of being a person. As already noted, personhood is a social construct based on community needs and interests as well as on biology. These needs and values find their expression in the way we see things. For example, one person looking at the softly rolling hills of California might react by seeing God as the invisible landscape architect who made the beautiful placements of the live oak trees, while another might see these placements as the effect of soil conditions, wind, and rain. William Werpehowski sees the human face in the pre-embryo when he says, Following fertilization, the human zygote is a genetically unique, individual human organism that in its immediate appearance displays to us the human countenance. However, many do not see a human countenance in the pre-embryo. For them, personhood is conferred on human organisms with whom human interactions are possible or occur. We can cuddle a baby; we cannot cuddle a zygote. We coo at an infant and he or she responds by smiling; zygotes do not smile. An infant grasps a proffered finger; a zygote cannot. Babies have personalities and embryos do not. That is why babies are persons and embryos are not.

Prima Facie Demands Nevertheless, some have argued that although a pre-embryo is not a person, it does have special status and, therefore, is to be treated with special respect. Richard McCormick cites these considerations to support his belief that the potential of the pre-embryo for person-hood makes powerful prima facie demands on us not to interfere with that potential. A prima facie demand is one that cannot be interfered with unless it is overridden or trumped by more powerful ethical considerations. However, identification of a more powerful ethical consideration is determined partly by the perceived ontologic status of the pre-embryo. As McCormick has pointed out, there is broad moral and legal recognition that the pre-embryo is too primitive to have any interests or rights. Thus, its use in research or its elimination in pregnancy reduction, which either directly or indirectly satisfies the needs or interests of human beings, is a more powerful ethical consideration than treating the pre-embryo with special respect. Indeed, unless the pre-embryo is viewed as having rights from the moment of conception, interference in its development to benefit persons is warranted ethically. Unfortunately, any discussion about the special status of or special respect for the pre-embryo, which may have symbolic value, does not contribute to resolving the question of whether its destruction is a wrong. ISSUE 2: THE POSSIBLE WRONG DONE TO THE INFERTILE COUPLE OR THE EXPECTED OFFSPRING BY THE PHYSICIAN IN USING IVF The success of IVF depends on the number of embryos transferred to the uterus. Because the chance of survival of an embryo in conventional IVF is small, the more transfers made, the greater the chance of pregnancy. However, this increases the likelihood of multiple pregnancy, with the greatest chance occurring among women younger than age 35 and the least chance among those older than 40. Multiple pregnancy presents a threat to the physical and mental health of the mother. She may suffer from high blood pressure or uterine bleeding or from complications associated with delivery by cesarean section. Accompanying these physical problems are possible emotional difficulties that might be experienced by both the pregnant woman and her male partner. In addition, the couple will have to bear the medical costs of IVF as well as the costs of medical care for their offspring should there be ongoing medical problems. Because iatrogenesis commonly is associated with medical interventions, the appropriate question to ask is not simply whether an intervention produces harm, but whether the harm so produced is outweighed by acknowledged benefits. The willingness of infertile couples to undertake IVF is a sufficient sign that the perceived benefits to them outweigh the burdens of financial costs and physical and mental risks. ISSUE 3: THE POSSIBLE WRONG DONE TO THE OFFSPRING BY THE INFERTILE COUPLE WHO USES IVF Multiple pregnancies also present a threat to the well-being of the offspring. There are problems associated with low birthweight and with preterm birth. The few comparative studies that have been undertaken suggest that children born of IVF have a significantly greater risk for

spina bifida and transposition of the great vessels and that some of the drugs administered to women to stimulate the production of eggs increase the risk of serious birth defects. Given these results and the scanty evidence, some argue that those who use IVF have an obligation to prove that the technologies employed are safe and that IVF not be used until further evidence of its comparative safety is forthcoming. John Robertson has argued against this position by observing that the increased incidence of defects does not justify banning the technique to protect the offspring, because without these techniques these children would not have been born at all. He reasons that being alive is better than not existing and, therefore, the benefit of existence outweighs the harm of birth defects. Interests in Existing The previously used comparison for weighing the benefits and harm to the infertile couple is not legitimate in this context. As Cynthia Cohen noted, The interests in existing argument assumes that children with an interest in existing are waiting in a spectral world of nonexistence where their situation is less desirable than it would be were they released into the world. In other words, an individual has to exist to be better or worse off. Therefore, it is meaningless to attribute such existential states to what does not exist. Safety of Technology Although I reject Robertsons approach, I also find that opposition to the use of IVF is not well-grounded. It sounds reasonable to reject use of a technology until there is evidence of its safety, but no technology is perfectly safe. Perhaps it is more reasonable to assure that the safety of the new technology approximates the safety of more conventional methods. Thus, IVF would be considered safe if the expected rate, for example, of pre-maturity was the community standard rather than being much higher. Cohen commented, It would be wrong to have children if it were known before conception that the means used to bring this about could inflict serious or devastating harm on those very children. Of course, this also can be said of conception by coital means because serious or devastating harm may be inflicted in these circumstances as well. To knowingly conceive a child who will suffer serious disorders is to wrong that child. However, people do not do this knowingly. Statistics provide information about a given population, but not about any particular individual in that population. Thus, this admonition not to have children by IVF is not well supported. Tansmitting a Serious Disorder Suppose a couple who uses IVF unknowingly produce a child who suffers from a serious disorder? Has this couple wronged their child? Before answering this question, let us consider the transmission of Huntington chorea. We can identify clearly all those who transmit the disease (the parents of each of the diseases victims), and we know the precise risk factor of developing the disease (50%), when the disease is likely to develop (between the ages of 30 and 40), and the fact that the disease terminates in death approximately 15 years after its onset. Opinions differ concerning the morality of fertile couples who have the genetic predisposition

for Huntington chorea having children. Optimists point out that these children have a 50% chance of not having the disease and even those who do may enjoy approximately 30 years of healthy life. Pessimists believe that a 50% risk is too high and point to the terrible effects of the disease once it develops. Notwithstanding these conflicting perspectives, there is agreement on both sides about which facts are material and many, if not all, of these provide accurate information. This exactness of relevant information in the case of Huntington chorea dissolves when applied to IVF. Someone in the population of IVF users will have a child or children who will suffer from a serious disease. As is sometimes the case with coital conception, however, neither can we identify the parents in question nor can we tell which child will be affected by a serious disease and what that disease will be. All that we can say at present is that there is some evidence to suggest an increase in the number of serious disorders in this population compared with the frequency of these disorders among coitally produced children. A reasonable conclusion from these observations is that a severely damaged child has been harmed as a result of IVF technology, but has not been wronged. Nevertheless, Cynthia Cohens advice to infertile couples who are contemplating the use of IVF is well taken when she says, Would be parents who consider resorting to the new reproductive technologies must be informed about the risks these technologies would present to the children as a result of their use, the means available for ameliorating deficits these children might experience, and what social support would be available should they lack the resources to address such defects on their own. Only then can they decide whether they ought to proceed with those technologies. ISSUE 4: THE POSSIBLE WRONG DONE TO THE COMMUNITY BY THE USE OF IVF ON THE PARTS OF THE PHYSICIAN AND THE INFERTILE COUPLE Although the use of IVF may harm but not wrong the infertile couple or their offspring, the aggregate effect of IVF is an increase in harm compared with the effects of coital pregnancy. Does this indicate that the use of IVF wrongs the community? One might argue that the community is wronged because the financial resources needed to support the individuals who are made ill by IVF are best spent elsewhere. However, this does not take account the fact that distributive justice, albeit an important moral requirement, is in competition with other moral demands. These include the autonomy of the individual in attempting to overcome infertility, the obligation of the physician to try to rescue the sick infant, and the need for medical research to refine the technologies of IVF to eliminate or reduce the effects of illness and disease. Society has adopted the rescue mentality even when such efforts are extremely expensive and, in terms of the number of individuals affected, could be used more effectively in other medical arenas. Interest in allocating scarce resources ultimately may foreclose on expensive technologies such as IVF. However, until that day arrives, it is difficult to support the contention that IVF wrongs society. Previous SectionNext Section

CONCLUSION There are numerous problems concerning the implementation of IVF, including whether there is a right to this technology, whether such access should be funded by health insurance, and whether access should be limited to women of a specified age group. However, these problems take on meaning and importance only if IVF is perceived to be sanctioned ethically. This essay was an effort to demonstrate that it is sanctioned by arguing that neither the pre-embryo, the infertile couple, nor the community is wronged by the use of IVF.

Cloning Several years ago, a new animal was discovered in Australia that appeared to be a kosher pig. While the animal was previously unknown, the rules governing its status as kosher or treif are as old as the Torah. After much debate, a decision was rendered that it was indeed nonkosher. Today, cloning presents us with our own new creation, a baby with no parents. While the world stretches its concepts of morality and ethics to encompass this new reality, the Jewish world also endeavors to decide if human cloning is permitted. There is no clear consensus yet in Jewish law regarding cloning. Since the technology to clone people is not yet a reality, the issue is an academic one, not a practical one. For this reason Jewish law, which relies strongly upon precedent (much like secular law), has no actual cases that have been decided. Scholarly analyses are still being published by prominent rabbis. Already, the two chief rabbis of Israel are reported to disagree. At least one prominent American halachic authority has ruled that cloning is permitted in certain instances. Many technical issues of Jewish law will have to be resolved before a final consensus is reached. In addition, many deep philosophical concepts in Judaism will also have to be applied to cloning before the final decision is reached. Nevertheless, many of the issues involved have been dealt with in detail regarding artificial insemination, surrogate motherhood, and ovary transplants. In Jewish law, family relationships are very important. For example, the Torah lists multiple illicit familial relationships such as a son marrying his mother and a nephew marrying his aunt. In traditional Judaism, religious status is passed down through the mother and tribal designation (Cohen, Levi, Israel) is passed down through the father. The first serious challenges to the traditional view of family relationships came about with the advent of surrogate motherhood and ovary transplants. Who is the mother- the genetic mother (egg donor) or the birth mother (gestational mother)? In addition to the legal issues raised, such as inheritance and obligation to support the child, there are fascinating religious ramifications. For instance, when the Torah commands: honor your father and mother, who is the mother?

The case of cloning adds the following fascinating twist- in the case of cloning a woman, is there a father? There is an issue raised by cloning that is not present in most reproductive technology questions. All prior technological advances have only enhanced the ability to conceive and bring a fetus to term. Egg and sperm donations allow otherwise sterile men and women to conceive, in vitro fertilization treats ovulatory dysfunction (among other problems), and surrogate motherhood allows women who lack the ability to sustain gestation to have children. Nevertheless, the basic mechanics of conception, gestation, and childbirth are not affected. Cloning interferes with the basic process of procreation itself. The normal sequence of egg and sperm uniting and forming a new life is abolished and the egg becomes a vehicle for the parasitic parental DNA. Basically, sexual reproduction is replaced by a new version of parthenogenesis! The Torah tells us that originally man and woman were one being, but that G-d separated them after creation. When a man and woman marry, they come together to form the original whole. Does cloning unduly interfere with the deeply held belief that G-d created the world such that a man and woman would unite to be fruitful and multiply, (Genesis 1:28) creating new life together. Or, alternatively, is cloning just another leap forward in the quest for better technology, as the Torah commands in the same verse: fill the earth and master it? The issue of cloning touches many areas of Jewish law, but it also raises many exciting challenges to our Jewish world view. It should be very interesting to see how the consensus of Jewish law develops if human cloning ever becomes a reality.

Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can selfrenew to produce more stem cells. In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adult organisms, stem cells andprogenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells (these are called pluripotent cells), but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues. There are three accessible sources of autologous adult stem cells in humans: 1. Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest), 2. Adipose tissue (lipid cells), which requires extraction by liposuction, and 3. Blood, which requires extraction through pheresis, wherein blood is drawn from the donor (similar to a blood donation), passed through a machine that extracts the stem cells and returns other portions of the blood to the donor.

Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one's own body, just as one may bank his or her own blood for elective surgical procedures. Highly plastic adult stem cells are routinely used in medical therapies, for example in bone marrow transplantation. Stem cells can now be artificially grown and transformed (differentiated) into specialized cell types with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture. Embryonic cell lines and autologous embryonic stem cells generated through therapeutic cloning have also been proposed as promising candidates for future therapies.[1] Research into stem cells grew out of findings by Ernest A. McCulloch and James E. Till at the University of Toronto in the 1960s

Organ donation Most organs for transplantation come from cadavers, but as these have failed to meet the growing need for organs, attention has turned to organs from living donors. Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient. Transplantation surgeons have therefore been cautious in tapping this source. As surgical techniques and outcomes have improved, however, this practice has slowly expanded. Today, according to the United Network for Organ Sharing (UNOS), almost half of all kidney donors in the United States are living. In 2004, living organ donors also provided a lobe of the liver in approximately 320 cases and a lobe of a lung in approximately 15 cases. Three categories of donation by living persons can be distinguished: directed donation to a loved one or friend; nondirected donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; and directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection. Each type of donation prompts distinct ethical concerns. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced. In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the person can bow out gracefully.1 Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves. In one instance, both parents of a child who was

dying of respiratory failure insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life.2 Such a sense of compulsion is not unusual. In cases like these, simply obtaining the informed consent of the relative is insufficient physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large. Nondirected donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life-threatening sacrifice for a stranger calls for careful scrutiny. One recent case involved a man who seemed pathologically obsessed with giving away everything, from his money to his organs, saying that doing so was as much a necessity as food, water, and air.3 After donating one kidney to a stranger, he wondered how he might give away all his other organs in a dramatic suicide. Other psychologically suspect motivations need to be ruled out as well. Is the person trying to compensate for depression or low self-esteem, seeking media attention, or harboring hopes of becoming involved in the life of the recipient? Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern.1 Directed donation to a stranger raises similar ethical questions with a few additional wrinkles. This type of donation usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising is not illegal, but it has been strongly discouraged by the transplantation community. Two central objections are that the practice is unfair and that it threatens the view that an organ is a gift of life, not a commodity to be bought and sold. Some argue that just as we have a right to donate to the political parties and charities of our choice, so should we be able to choose to whom to give our organs. In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs rather than those most in need. This strikes some ethicists as unfair. Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals. Hence, the argument goes, these donations are legitimately subject to societal requirements of fairness, and transplantation centers should refuse to permit the allocation of organs on the basis of anything but morally relevant criteria.4 The most ethically problematic cases are those in which the recipient is chosen on the basis of race, religion, or ethnic group. In one case, for example, the family of a brain-dead Florida man agreed to donate his organs but insisted that because of the man's racist beliefs, the recipients must be white. Although the organs were allocated accordingly, Florida subsequently passed a law prohibiting patients or families from placing such restrictions on donation.5