Legal Justice in Organ Allocation. A Legal Perspective on the Failure of the German Organ Allocation System
The German organ allocation system is out of joint. In July 2012, the medical community as well as the broader public got alarmed by several high-profile transplantation scandals, which meanwhile have resulted in a significant decrease in the number of organ donations. Several physicians at different university hospitals have been accused of altering data related to their patients to make them appear sicker than they actually were in order to place them in front of other patients that were on the waiting list for liver donations. The scandal sheds light on the essential normative nature of prioritization decisions and raises the question of ethical and legal justice in public health. The article argues that the regulatory framework of organ allocation in Germany is not in accordance with the constitutional requirements for a state organized allocation order, which directly affects the most fundamental rights of patients. The lack of legitimacy of the current allocation system, which is essentially determined by guidelines of the German Medical Association, makes it impossible to find a satisfactory legal answer to the problem of individual manipulations of the prioritization process by doctors, who arbitrarily try to advantage their own patients.
Manipulationen in der Transplantationsmedizin. Ein Fall von organisationaler Devianz?
ZusammenfassungDie Manipulationen der Wartelisten für ein Organ durch Transplantationsmediziner haben in den letzten Jahren in Deutschland Aufsehen erregt. Der Artikel behandelt die Frage, wie sich diese Manipulationen erklären lassen. Er tut dies mittels der Analyse von Gerichtsakten und Prüfberichten sowie der Durchführung von Interviews. Er legt die theoretische Perspektive organisationaler Devianz zugrunde und prüft, inwiefern sich die Manipulationen durch individuelle und/oder organisationale Devianz erklären lassen. Dazu werden die inhaltsanalytisch gewonnenen Strukturdaten mit den in einer Deutungsmusteranalyse herausgearbeiteten Deutungs- und Handlungsregeln in diesem Feld verbunden. Er kommt zu dem Ergebnis, dass Häufigkeit und Art der Manipulationen für ein organisiertes Handeln sprechen, das sich mittels des medizinischen Wettbewerbsdrucks, der straffen fachautoritären Hierarchien und der Sozialisation in einem Pionierfeld der Medizin etablieren konnte. Dazu waren nach bisherigem Kenntnisstand keine persönliche Bereicherung und keine kriminelle Energie notwendig. Diese Form organisationaler und „professioneller“ Devianz kann stattdessen durch organisationale Anreizstrukturen und professionsbezogene Autonomie und Reputationsorientierungen erklärt werden. Sie unterscheidet sich maßgeblich von der Wirtschaftskriminalität, weil der ökonomische Nutzen nur eine untergeordnete Rolle spielt und die tragische Wahlsituation unter der Bedingung der Organknappheit dafür sorgt, dass sowohl bei Regeleinhaltung als auch bei Regelabweichung bestimmte Patienten sterben.AbstractIn recent years, the frequent manipulation of the waiting lists for an organ transplant by physicians caused a stir in Germany. This article deals with the question of how to explain these manipulations. It does so, by analyzing court records, audit reports and interviews. The authors make a case for applying the theoretical perspective of organizational deviance, and they examine empirically to what extent the individual and/or organizational deviance accounts for the manipulations. To this end, they combine the content analysis of structural data with the collective mindset analysis of interview data, which links the deviant behavior to the rules that guide cognition and action in this particular field. They conclude that the frequency and nature of the manipulations indicates an organized action that was established due to the medical competitive pressure, the tight hierarchies of authority and expertise, and the socialization of the pioneers in an innovative field of medicine. According to present knowledge, neither personal enrichment nor criminal energy was necessary to manipulate. This form of organizational and “professional” deviance may instead be explained by organizational incentive structures and the dominance of professional autonomy and reputation. Thus, it differs significantly from economic crime, because the economic benefits only play a minor role. Instead, the tragic choice situation that is structured by the relative scarcity of organs implies that in both cases, be it regulatory compliance or organizational deviance, certain patients die.
The laws of Cnut and the history of Anglo-Saxon royal promises
The ‘first’ and ‘second’ law codes of Cnut are the last surviving codes issued in the name of an Anglo-Saxon king.They are the final fruit of the interest in kingship and law and in the inter-relationship of the two which characterized the period following the monastic revival in England and which is especially associated with the name of Wulfstan, archbishop of York. Although they are far from being complete codifications of Anglo-Saxon law, they draw extensively on earlier legislation. They are different in kind from much tenth-century law, which is usually more limited and administrative in content and character, and their nature and purpose invite further consideration.