medical ethics

Organ donation is not all about the donors

Another article discusses the morality of different methods of organ transplant. Strangely absent from the discussion, is any indication of the scale of the problem – something that should be front and centre. The numbers are strangely hard to find, but seem to lie between 400 and 1000 deaths per year, with many more suffering from pain and reduced quality of life because of the lack of available organs.

That should be the main focus of the discussion – those people who would now be living, breathing, enjoying life, contributing to the world and spending time with their friends and family, had they got the organ they needed. It matters not whether our ‘system of organ donation [is] based on generosity and compassion’ – the point is not to show personal virtue for the donor, but to save lives. It is truly bizzare to argue that we must ensure, on compassionate grounds, that more people must die. If you truly want to show generosity and compassion, there are no lack of methods to do so.

As for the argument that changing systems would make our bodies become the property of the state – it’s important to ignore the appeal to emotion, and focus on what’s happening here. We are talking about allowing doctors to take organs from people who are already dead, and using them to keep living people alive. That’s it. Nothing more. And it all happens under a system of presumed consent, so that if you really felt strongly about it, you could opt out entirely.

Remember – if your organs aren’t the property of the state after your death, then they’re usually the property of the worms.

Autonomy: amorphous or just impossible?

By Charles Foster

I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.

This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.

The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise. Continue reading

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