Solving the Organ Crisis Ethically

Julian Savulescu and William Isdale

An editorial in the Lancet earlier this month report on the first fall in UK organ transplants in a decade.

Key statistics included that “the number of people who chose or were able to donate their organs in 2014 fell, and that 224 fewer people in the UK received an organ transplant than the year before”

Amongst the factors restricting donations is family consent: “no appreciable rise has occurred in the proportion of families who gave consent to organ retrieval following the death of a relative, which continues to hover “stubbornly below 60%”.

The Lancet also points to inefficiencies in the use of those organs that are donated.

Australia’s #DonateLife week has just been completed, a week dedicated to promoting organ donation, Australia is seeking to improve its own rates, which lag behind the UK, US and other comparable nations.  The government is already undertaking  a review into the current organ and tissue donation and transplantation programme.

One quote from the Lancet is perhaps timely:

As Rafael Matesanz, Director of Spain’s world-leading Organización Nacional de Trasplantes, recently reminded us, we should “…never blame the population. If people donate less, it must be something we have done wrong””

William  Isdale and I recently proposed Three Ethical Ways to Increase Organ Donation: no longer allowing a family veto where a patient has consented; financial incentives to consent; and non financial incentives to consent (such as higher priority as a recipient for those who are on the transplant list).

On August 25, Peter Singer, Neera Bhatia William Isdale, Julian Koplin, and myself will be participating in a public event in Melbourne, Solving the Organ Crisis Ethically, where we will critically discuss the ethics of a range of options available to increase the organ supply in Australia.

There are 1500 people waiting for an organ in Australia. Some of those will die, or become too ill to be an organ recipient, before an organ becomes available. How far should we go to address the organ shortage?

Guest Post: ‘I don’t want to die, but I am too scared to be anything different’: The role of identity in mental illness

Anke Snoek
Macquarie University

If you break a leg or have a cold, it probably wouldn’t affect your identity at all. But when you have an invasive, chronic illness, it will probably change your way of being in the world, and the way you perceive yourself. Our body is the vehicle with which we interact with the world. There are many personal accounts in the disability bioethics literature on how a chronic illness affects one’s sense of being. For example, in the work of Kay Toombs, who was diagnosed with multiple sclerosis, or Havi Carel, who was diagnosed with lymphangioleiomyomatosis (LAM), a rare lung disease. Both describe how their illnesses gradually changed their identities, their senses of being.

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Guest Post: Agree to disagree? Why not?

Pedro Jesus Perez Zafrilla.
(University of Valencia)

In a previous post on this blog, David Aldridge questions the social convention of ending arguments by “agreeing to disagree.”, arguing that doing so “ends the dialogue at precisely the point where what is really at issue is beginning to emerge” . He also questions the motivations of those who seek to end an argument by offering to “agree to disagree” However, I think agreeing to disagree is a good idea and I will try to argue why.

Debating could be characterized by three features: a context of disagreement, open-minded participants, and an expectation that one can rationally convince his/her interlocutor. Then, people who debate do so because they believe that agreement is possible. The achievement of agreement is the aim of  dialogue.

Nevertheless, the desire to reach agreement shouldn’t lead us to forget that debate is fruitful only under certain conditions. Some of them include limitations of time and the number of participants, because the decision must be made, or agreement reached, within a reasonable span of time. But there are also other limitations in the debating process. We might begin with the expectation that one can rationally convince one’s interlocutor about the rightness of one’s position but we reach difficulties when incommensurable views are confronted. Some examples are found in debates on taxes, euthanasia or models of education. Here what is morally significant for some persons is not so for others. So, concepts such as “a dignified life” or “quality of education” have different meanings for each side of the debate. Accordingly, the arguments one side presents will not be convincing to the other side. In these cases, the expectation that one can rationally convince one’s interlocutor will generate polarization processes toward antagonist positions (see Haidt, J. “The Emotional Dog and its Rational Tail. A Social Intuitionist approach to Moral judgement”, Psychological Review, 108, 2001, p.823). Even more, each person will think that his/her interlocutor is not morally motivated (Schulz, Kathryn. Being wrong. Adventures in the margin of error. London: Portobello Books, 2010, pp.107-110).

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Doping in Hollywood

For his role in the new movie Southpaw, Jake Gyllenhaal gained 45 lbs (20 kgs) of muscle in six months. Many praised Gyllenhall for his dedication in undergoing this remarkable physical transformation. Few have questioned whether this achievement was aided by the use of performance enhancing drugs (PEDs). Some in the bodybuilding community claim that such massive weight gain would be nearly impossible without the use of steroids. For experienced bodybuilders, it is considered an accomplishment to gain 7-10 pounds of muscle in a year “naturally”. Training in combination with taking human growth hormone (HGH) can add 4.6 pounds of lean muscle mass, in three weeks.

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Pinker Bioethics: What Should We Learn?

Julian Savulescu 
Twitter @juliansavulescu

Steven Pinker has recently written an op-ed questioning the contribution of bioethics to the safe and efficient regulation of research. This has been widely misinterpreted and criticised, though Alice Dreger has written a recent accurate blog in support of Pinker. Pinker provocatively said that bioethics should get out of the way of research. This has been interpreted to mean that we should give up ethics review of research. Nobody, not me, and not Steven Pinker, thinks we should abandon ethical review of research. He actually says, ” Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.” Pinker is objecting to the unnecessary, unproductive obstruction that much bioethics represents to good research and regulation.

I largely agree with him and have said as much myself over the years. I recently wrote a piece for the anniversary issue of the JME arguing as much. I applaud him for trying to generate some self-reflection in the field.

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Left, Right, and Belief Formation.

A recent article by Jeff Sparrow on the Australian writer Helen Dale/Darville/Demidenko has left me pondering the way that we form beliefs. Under the penname ‘Helen Demidenko’, Dale published a novel that told the story of a Ukrainian family, members of whom were perpetrators of crimes against Jews during the Holocaust. The novel was instantly successful, winning major awards, and equally controversial. It was described as anti-Semitic in its sympathetic depiction of ordinary Ukranians and its (alleged) caricatures of Jews. The book gained an aura of authenticity from the author’s claims that she based much of it on interviews with members of her own family, who had lived through the events depicted. Demidenko’s bubble burst when it was revealed she was born Helen Darville, and had no Ukrainian relatives to recount these tales. Continue reading

Guest Post: The Moral Imperative for Bioethics

By Daniel K. Sokol
Daniel Sokol, PhD, is a bioethicist and lawyer at 12 King’s Bench Walk, London. He has sat on several ethics committees, including the UK’s Ministry of Defence’s Research Ethics Committee.

In a recent Opinion piece in the Boston Globe, Professor Steven Pinker made the surprising suggestion that the primary moral goal of today’s bioethics should be to “get out of the way”. “A truly ethical bioethics”, he argued, “should not bog down research in red tape, moratoria or threats of prosecution”.

This bold assertion no doubt echoes the thoughts of many scientists whose research requires the approval of an ethics review committee before springing to life. As a PhD student many years ago, I experienced first hand the frustrations of the tedious review process. I spent hours drafting the protocol, revisions and responding to the Committee’s questions, time I would have preferred to spend conducting research. While a popular sentiment, getting out of the way is not the goal of bioethics.

The goal of bioethics is to allow potentially beneficial research while ensuring that the risk of harm to participants and others is proportionate, reduced to the lowest practicable level, and within morally acceptable limits. The risk of harm can never be eliminated, but it can usually be reduced with minimal effort or cost. It may be as simple as testing a new piece of equipment one more time in a laboratory before attaching it to a human for testing.

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Guest Post: Caring for Our Home

Darlei Dall’Agnol
Professor of Ethics, Federal University of Santa Catarina.

Many nations are already preparing for the 2015 UN Climate Change Conference to be held in Paris in December. One of the main goals of the Conference is to reach an agreement on climate change, especially on greenhouse gas emissions in order to limit the global temperature increase to 2 degrees Celsius above pre-industrial levels. Following Rio-92 and after more than 20 years of negotiations, the Conference has a unique opportunity to enact the first legally binding document for all the nations of the world. This is certainly a significant step in caring more for our little planet, which is after all our home. As citizens and philosophers concerned with environmental issues, we should support and try to help bring about such an agreement. However, there are also signs that some countries are evading their responsibilities. Earlier this month, in her first visit to the United States since Wikileaks revealed in 2013 the US’ spying , the Brazilian President Dilma Rousseff announced that Brazil’s goal is to bring illegal deforestation down to zero over the next few years. Moreover, the country will work towards reforestation of 12 million hectares. According to some North-American newspapers, this announcement was below what was expected by the White House, which had hoped for higher targets in cutting greenhouse gas emissions. This is one of the President Obama’s priorities for his legacy. He is trying to influence China, India, Brazil and other developing countries to get a satisfactory outcome at the climate Conference later this year. Is this a sign of what is going to happen at the Conference? Will the US just press other developing countries to cut down gas emissions? What about the US’ own environmental responsibilities?

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ASMR and Absurdity

by Hannah Maslen and Rebecca Roache

In the past five years or so, a new phenomenon has emerged on the internet. ASMR videos allow you to spend around 40 minutes watching someone carefully unpack and repack a box, or listen to a detailed demonstration of ten different notebooks, or observe the careful folding of several napkins. If you think this is something that almost nobody would want to do, think again: a search on the term ‘ASMR’ on YouTube returns over 1.4 million videos, the most popular of which has been viewed 11.7 million times.

What is ASMR?

Autonomous sensory meridian response, or ASMR, is the pseudo-scientific name of a phenomenon that, according to thousands of anecdotal reports, various news reports, and a recently published academic survey, loads of people experience. ASMR refers to a pleasant tingling sensation in response to certain visual and/or auditory stimuli. Common triggers include the kind of close personal attention you get when someone cuts your hair, certain sounds like tapping or brushing, and perhaps most bizarrely of all, observing someone doing something trivial very carefully and diligently.

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Stripping Addicts of Benefits – Coercion, Consent, and the Right to Benefits

The UK government has announced plans to review the possibility of stripping drug addicts, alcoholics and obese individuals of benefits if they refuse treatment for their conditions. In support of the review, a consultation paper claims that the review is intended to “. . . consider how best to support those suffering from long-term yet treatable conditions back into work or to remain in work.”

One concern that has been raised against the plans is that stripping these individuals of their benefits is unlikely to be effective in getting them to seek treatment, with the Mirror reporting one campaigner as suggesting that “(this strategy) didn’t work in the Victorian times, (and) it’s not going to work now”.

In this post, I shall consider a challenge to the lawfulness of the proposals that is based on the claim that they would coerce individuals into accepting treatment. This is in fact a challenge that Sarah Woolaston, chair of the Health Select Committee has herself raised.

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