medical law

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.

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp

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A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

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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

Can Liberals Support a Ban on Sex Selection?

Australia essentially bans sex selection, except to prevent babies being born with serious sex-linked disorders. The National Health and Medical Research Councils also prohibits it in its guidelines.

A couple in the state of Victoria is currently appealing to the Victorian Civil and Administrative Tribunal to allow them to access IVF and to deliberately have a girl. The couple have had three boys naturally and lost a daughter soon after birth. They recently had IVF which resulted in a twin pregnancy. The twins were boys. They aborted the pregnancy.

I argued over 10 years ago there are no good reasons to oppose sex selection in countries like Australia.

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