Organ Transplants Acknowledges all the rational arguments for doing - - PDF document

Organ Transplants and Larger Issues Medical Ethics 1

Organ Transplants

Symbolic of Larger Ethical Issues

Two Concrete Questions Raised

Should ability to pay matter in getting a

transplanted organ?

Should contributing to one’s disease (e.g.,

through alcoholism) matter?

Main Concepts and Themes

Liberal-rational vs “sentiment” Capitalism and medicine “Benefits everyone and violates no one’s rights”

(revisited)

Leon Kass, “wisdom of repugnance,” and “neomorts” Commodification” Anticipates issues we will discuss later: genetic

improvement, cloning, stem cells, other new reproductive technologies.

Callahan’s “Defense of Sentiment”

Earlier article (not read in class): Callahan

• pposes ending feeding of dying patients

Acknowledges all the rational arguments

for doing it, but argues “in defense of sentiment”

But it’s not quite just an appeal to

feelings…

Ways to Get More Organs

Required request Presumed consent Living unrelated donor Make prior permission for posthumous transplant a

requirement for being a recipient

Create a new child (see Ayala case, pp. 744-745 and many web sites; e.g.,

http://bmt.cityofhope.org/succ_ayala.htmhttp://bmt.cityofhope.org/succ_ayala.htm)

(Later) Stem cells and cloning Free enterprise: buying and selling organs?

The Case for Buying and Selling

Makes more organs available Allows people to exercise freedom Meets this test: “if a policy or practice

benefits everyone concerned and violates no one’s rights, it is morally acceptable”

Organ Transplants and Larger Issues Medical Ethics 2

The Case Against: Kinsley

Kinsley: “Some things money shouldn’t be allowed to buy.” A just society is one where influence of money doesn’t

dominate everywhere.

And yet…

The poor Turk is worse off if he can’t sell his kidney to pay for

his daughter’s surgery

We don’t stop people from risking their lives for money by

working in a coal mine

When protect people from exploitation without changing the

system, we make them worse off.

Protecting People in Whose Interest?

“Euthanasia would be unnecessary if everyone

received good end-of-life care.”

What if everyone doesn’t? Is person better off if denied choice to die?

Even severely handicapped child can be spared

“injury of continued existence” with loving care”

What if the loving care is not available? Is child better off being kept alive?

Protecting People from Exploitation

“In a just society no one would have to take

a dangerous, health-destroying job in a coal mine.”

What if a person’s only choice is that job or no

job?

Do we protect that person by denying choice?

“In a just world, no one would have to sell a

body part to survive or save child’s life.”

Leon Kass

Chairman, President’s Council on Bioethics

Leading conservative bioethicist, author of

numerous works; e.g., Toward a More Natural Science

Recently well known for opposition to “therapeutic

cloning.” Ban just passed in House of Rep.

Essay: “The Wisdom of Repugnance” raises

similar issues to this one

Why does Kass discuss neomorts?

Kass’s Case Against Organ Sales

Should “repugnance” be respected as

ethical argument?

“Man gets used to everything, the beast”

Raskolnikov in Dostoevsky’s Crime and Punishment

We’ve overcome emotional resistance to…

[see long list of things, p. 784, column 2]

Kass Treats Some Subtle Challenges

The body is our property

Well, the body is different. My body is me, not my property

like an object.

Yet I must have a property right to it (or at least parts) if I

can give (not sell) parts of it away

Liberty and liberal ideal would seem to support

choice to sell organ.

Capitalism based on free exchange, using money “If a policy or practice benefits everyone concerned…”

Organ Transplants and Larger Issues Medical Ethics 3

Limits to Economic Liberty

Money and free exchange have as purpose

“the satisfaction of natural human needs…to encourage the full flowering of human possibility” (p. 783-2)

Can we base ethics on some conception of

the natural or on natural human needs?

Kass: Commodification

Repugnance may teach us something. Think of

example of neomorts.

Beyond just feeling of repugnance: it is wrong to

make some things commodities (even if “benefits everyone…”)

Comes up in other issues; e.g., surrogate

motherhood.

Is health care itself (in danger of becoming) a

commodity?

Alcoholics and Liver Transplants

Raises larger issue of whether one’s past

behavior causing disease affects one’s claim to health care.

Cohen-Benjamin reject two kinds of

arguments

Alcoholics morally disqualify themselves Alcoholics medically disqualify themselves

Moral argument

Inconsistent with how we treat other conditions:

accident victim without seatbelts, smokers, etc.

If alcoholism a disease, no reason to bar We don’t exclude people for other moral failings Would require great intrusiveness to monitor

Medical argument

Not clear that prognosis for alcoholics is

worse

Even if lower survival rate, still would be

inconsistent with how we treat other groups

Might the combination of arguments be sound?

Principle: people should not be excluded from treatment if they cause their disease

• r if their prognosis is somewhat worse

But Combination of the two a reason to exclude? (Just asking)