224 G. O’Brien
transplantation experience were relatively straightforward for them.
Based on the findings of my research, the experiences of heart recipi-
ents most closely adhere to the gift-of-life experience prescribed by gift
rhetoric.
Dissent: The Experience of Liver Transplantation
The context in which organ transplantation is experienced may differ in
a number of ways; influenced not only by personal circumstances but
also by the broader social milieu within which it occurs. Healthism (i.e.
the moralisation of health) has become a dominant ideology in contem-
porary Western societies, comprising a framework within which individ-
uals are held to be responsible for their health status (Crawford 2006 ).
The choices we make regarding what we eat and drink, how much we
exercise, and general health maintenance (e.g. regular pap smears, or
colonoscopies) are associated with health outcomes, and those who expe-
rience poor health or illness are seen to have failed to engage in respon-
sible self-management. Cheek ( 2008 : 976) noted the intense focus on
‘health as an ideal’ and ‘ideal health’ that exists within healthism and
the use of language that denotes transgression (e.g. sin, bad, weak) when
one fails to live up to this ideal. She argued that health has become a
civic duty; and good health is seen to be ‘a badge of honor by which we
can claim to be responsible and worthy both as citizens and individuals’
(Cheek 2008 : 974). As Galvin ( 2002 : 110) points out, however, under-
standing good health to be the consequence of making the ‘right’ choices
slides easily into blaming individuals for ill health and can be ‘devastat-
ing’ for the chronically ill, leading to guilt and self-recrimination.
In the context of liver transplantation, the public appears particularly
judgemental and willing to discriminate against those who are consid-
ered to be responsible for their illness (Neuberger et al. 1998 ). In sce-
nario-based studies of preferences in the allocation of donated livers for
transplant, most participants agreed that preference should be given to
those with naturally occurring liver disease before those with alcoholic
liver disease (Ratcliffe 2000 ; Ubel et al. 2001 ; Wittenberg et al. 2003 ).
These findings in specific relation to liver transplantation reflect more