Test 4 Bioethics
The Case for Allowing Kidney Sales- Some facts about organ transplants: The first organs to be transplanted were kidneys beginning
in the 1950s
Rule utilitarianism
Looks at the consequences of having everyone follow a particular rule and calculates the overall utility of accepting or rejecting the rule.
Organ Donation and Retrieval: Whose Body is it Anyway?-
1) Religious reasons 2) Psychological reasons 3) Lack of awareness or misinformation on organ donation
Whose body is it anyway?"- What are some reasons for people's reluctance to donate their organs?
1) Religious reasons 2) Psychological reasons 3) Lack of awareness or misinformation on organ donation
Organ Donation and Retrieval: Whose Body is it Anyway?- Other Solutions?
1) presumed consent legislation: laws that mandate the harvesting of organs after a person's death UNLESS people have explicitly stipulated that they do not wish to be organ donors 2) Organ donation as a supererogatory act that cannot be expected of all people The donor must give agreement during his or her lifetime OR, after donor's death, next of kin makes such an agreement
The Survival Lottery (John Harris)- Objection 4
It makes too high a demand on us. We don't have to be "saints" and give up our lives when we want to live. For example, we have the right to self-defense. Response: Yes, and by saying that Y and Z have a right to kill in self-defense, we can agree to the lottery, provided anyone they would kill has a equal right to kill Y and Z in similar circumstances
The Survival Lottery (John Harris) - Harris' Proposal: There are two fundamental objections to killing one to save two.
1) A doctor's choice of whom to kill will be arbitrary (within a range of suitable donors). It is simply not fair to the innocent person who is killed. 2) It will create "terror and distress to the victims, the witnesses, and society generally." - BUT (Harris argues) we can set up a rule (a social policy) that removes these problems, and then the benefits of the lottery will outweigh the "costs."
The Survival Lottery (John Harris) - Assumptions of the Lottery part 1
1) Each life (killed or allowed to die naturally) is of equal value. 2) Two lives saved are of more value than one life killed to save them
"The Survival Lottery"-What assumptions does the lottery depend on?
1) Each life (killed or allowed to die naturally) is of equal value. 2) Two lives saved are of more value than one life killed to save them. 3) Two lives saved would be completely cured, or be sufficiently cured as to show a quality of two lives greater than a healthy life killed to save them. 4) Two lives saved would be able to live sufficiently long enough on the transplanted organs (staving off rejection and the original sickness causing their need for replacement) as to show a quantitative gain over a completely healthy (and presumable longer) life randomly chosen to be killed.
The Survival Lottery (John Harris) - Argument for the Lottery: The argument for the survival lottery can be as follows:
1) Imagine that organ donation was perfect. 2) Imagine there is no moral difference between killing and letting die. Given 1 and 2, Harris argues that we should adopt the Survival Lottery.
SHOULD ALCOHOLICS COMPETE EQUALLY FOR LIVER TRANSPLANTATION?- SHOULD PATIENTS WITH ARESLD RECEIVE TRANSPLANTS?: The circumstances of liver transplantation differ from those of most other lifesaving therapies in three important respects:
1) Nonrenewable Resource 2) Comparison with Cardiac Transplantation 3) Expensive Technology
Organ Donation and Retrieval: Whose Body is it Anyway?- Arguments against selling organs:
1) People have such a close association with their bodies that making parts of their bodies be available for sale is tantamount to considering the people themselves as chattels 2) This would lead to exploitation of poor by the rich the poor would become walking organ banks
The Survival Lottery (John Harris)- General guidelines: part 1
1) Put everyone at equal risk of being sacrificed (e.g., use a computer to select someone at random from the population of compatible organ donors).
The Survival Lottery (John Harris)- General guidelines: part 2
2) Make sure that everyone becomes aware that their own chances of living are increased by this plan. Organ donation will no longer depend on the few people who become organ donors, and the many people who now die (due to scarcity of organs) can live. Those who object to being chosen in the lottery would be classified as murderers.
The Survival Lottery (John Harris) - Assumptions of the Lottery part 2
3) Two lives saved would be completely cured, or be sufficiently cured as to show a quality of two lives greater than a healthy life killed to save them. 4) Two lives saved would be able to live sufficiently long enough on the transplanted organs (staving off rejection and the original sickness causing their need for replacement) as to show a quantitative gain over a completely healthy (and presumable longer) life randomly chosen to be killed.
The Survival Lottery (John Harris)- Six Objections to the Lottery (and responses) : Objection 1
It reduces our security. Response: No, it doesn't, and people need better education in what does and doesn't make them secure.
The Case for Allowing Kidney Sales- Some facts about organ transplants:
According to one estimate, between 6900 and 10,700 potential organ donors are available, but for various reasons only about 37 to 57 percent of potential donors become actual donors.
Two Types of Utilitarianism
Act utilitarianism and Rule utilitarianism
Objections to the Selling of Kidneys: Objections cont'd
Also, they are coerced by their economic condition, so their consent cannot be genuine Both these arguments appeal to the importance of autonomous choice BUT: to answer the first objection, counseling and education can be employed to remove ignorance of risks To answer the second objection, prohibition of sales will not help, only the removal of conditions of poverty will!
The Case for Allowing Kidney Sales- Some facts about organ transplants:
At a time when the need for donors is increasing, their actual number is decreasing. The number of live donors began to decline in 2004.
The Case for Allowing Kidney Sales- Acquiring Transplant Organs:
On the one hand, some argue that not allowing the person to do so is a violation of his autonomy (provided he has consented and understands the risks involved). The organ does, after all, belong to the person.
The Case for Allowing Kidney Sales- Acquiring Transplant Organs:
On the other hand, there are those who believe that, at best, the permissible circumstances should be severely circumscribed.
The Case for Allowing Kidney Sales- Some facts about organ transplants: Over the last twenty years the list of organs that are transplanted has grown to include
corneas, bone marrow, bone and skin, livers, lungs, pancreases, intestines, and hearts.
The Case for Allowing Kidney Sales- Some facts about organ transplants: People with one kidney are slightly more likely to
develop high blood pressure than those with two. No long-term studies of kidney donors have been done.
Objections to the Selling of Kidneys: Objections cont'd : It is often claimed that organ donation must altruistic to be acceptable, which rules out payment
BUT: there are two problems with this claim 1) altruism does not distinguish donors from vendors 2) nobody believes that unless some useful action is altrusitic, it ought to be prohibited altogether
Supererogatory
is the technical term for the class of actions that go "beyond the call of duty." Roughly speaking, supererogatory acts are morally good although not __________________________________________ beyond what's asked
Organ Donation and Retrieval: Whose Body is it Anyway?- Current problem with Informed Consent and Organ Retrieval
Consent of next of kin required EVEN IF deceased person has agreed to organ donation prior to death! Proposed solution: revoke right of veto from next of kin! This would protect the autonomy and informed consent of the deceased
Whose body is it anyway?"-According to Kluge, what is the problem of giving the deceased person's family a right to veto organ retrieval?
Consent of next of kin required EVEN IF deceased person has agreed to organ donation prior to death! Proposed solution: revoke right of veto from next of kin! This would protect the autonomy and informed consent of the deceased
Rule Utilitarianism
form of utilitarianism that says an action is right as it conforms to a rule that leads to the greatest good, or that "the rightness or wrongness of a particular action is a function of the correctness of the rule of which it is an instance."
The Case for Allowing Kidney Sales- Some facts about organ transplants:
Each year, 35,000-40,000 additional people register to get organs. For each organ transplanted, three more people sign up, and those on the waiting list die at a rate of 19 a day.
Act utilitarianism
Looks at the consequences of each individual act and calculates utility each time the act is performed.
The YouTube Video- What myths about organ donation are discussed in the video?
Myth: Organ Donors don't receive life-saving treatment in the hospital Fact: Doctors & Nurses are concerned with saving immediate patients' lives Myth: The donor's family pays the cost of donations Fact: There is no charge for organ donation Myth: some religions don't support organ donation Fact: Most religions support organ donation Myth: Open caskets aren't possible for donors Fact: Open caskets are possible for donors Myth: Older people & those with health issues can't donate Fact: People of all ages & medical conditions are accepted
"The Survival Lottery"-What are the six objections to the lottery and how does Harris answer them?
Objection 1 It reduces our security. Response: No, it doesn't, and people need better education in what does and doesn't make them secure. Objection 2 Objection: We should not "play God." Response: The same objection would make us stop doing transplants altogether. Objection 3 Objection: Killing is worse than letting die, so it's better to let Y and Z die. Response: But other cases of inaction are a type of killing, so why isn't a refusal to use the lottery a sort of killing? Objection 4 It makes too high a demand on us. We don't have to be "saints" and give up our lives when we want to live. For example, we have the right to self-defense. Response: Yes, and by saying that Y and Z have a right to kill in self-defense, we can agree to the lottery, provided anyone they would kill has a equal right to kill Y and Z in similar circumstances Objection 5 Objection: The lottery will create too much terror and distress. Response: Yes, in the short run, but time (and education) will get people used to it. Objection 6 Objection: Third parties cannot decide who to save and who to kill, so only those who "are going to die" soon should be put into the lottery. Response: This objection already assumes that people who are very ill have lives that are of less value than everyone else's.
The Survival Lottery (John Harris)- Objection 3
Objection: Killing is worse than letting die, so it's better to let Y and Z die. Response: But other cases of inaction are a type of killing, so why isn't a refusal to use the lottery a sort of killing?
The Survival Lottery (John Harris)- Objection 5
Objection: The lottery will create too much terror and distress. Response: Yes, in the short run, but time (and education) will get people used to it.
The Survival Lottery (John Harris)- Objection 6
Objection: Third parties cannot decide who to save and who to kill, so only those who "are going to die" soon should be put into the lottery. Response: This objection already assumes that people who are very ill have lives that are of less value than everyone else's.
The Survival Lottery (John Harris)- Objection 2
Objection: We should not "play God." Response: The same objection would make us stop doing transplants altogether.
Organ Donation and Retrieval: Whose Body is it Anyway?-Facts/Problems with Organ Transplantation
Organ transplantation saves lives and it cost-effective BUT there is a severe shortage of available organs -One proposal: To allow people to sell their organs
Whose body is it anyway?" What are some arguments against selling organs?
People have such a close association with their bodies that making parts of their bodies be available for sale is tantamount to considering the people themselves as chattels 2) This would lead to exploitation of poor by the rich the poor would become walking organ banks
The Case for Allowing Kidney Sales- Some facts about organ transplants: The immunosuppressive drugs needed to prevent rejection of a transplanted organ cost
from $10,000 to $20,000 a year, and they must be taken for the remainder of the patient's life.
Acquiring Transplant Organs-
he primary worry here is that, although the sale of organs is prohibited in all countries, promoting the idea that the decision to donate is primarily up to the donor encourages the view that transplant organs are simply commodities which can be bought and sold on the open market. This can lead to the exploitation of the poor and degrades human dignity.
The Case for Allowing Kidney Sales- Some facts about organ transplants:
The 1984, National Organ Transplantation Act made the sale of organs for transplant illegal in the United States. At least twenty other countries, including Canada, Britain, and most of Europe, have similar laws.
"The Survival Lottery"- What is Harris' argument for the lottery? Does he believe there is a moral difference between killing and letting die?
The argument for the survival lottery can be as follows: 1) Imagine that organ donation was perfect. 2) Imagine there is no moral difference between killing and letting die. Given 1 and 2, Harris argues that we should adopt the Survival Lottery. The basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference. -On this basis, we have a STRICT obligation not to kill. - Harris wants to challenge this assumption.
The Case for Allowing Kidney Sales -
The authors argue that although some may feel disgust at the idea of selling kidneys, this is not a sufficient reason to deny people a necessary treatment.
The Case for Allowing Kidney Sales- Acquiring Transplant Organs:
The major ethical question concerns whether the fact that a person wants to have an organ harvested is sufficient justification for granting his wish.
The Survival Lottery (John Harris) - Rule Utilitarianism to the Rescue!
The typical modification is rule utilitarianism, which asks us to follow the rules, which, if generally followed, would maximize utility (happiness). Harris is proposing that if the rule is properly formulated, we could endorse killing one person to save two
"The Survival Lottery"- What ethical theory does Harris follow in his proposal?
There are two fundamental objections to killing one to save two. 1) A doctor's choice of whom to kill will be arbitrary (within a range of suitable donors). It is simply not fair to the innocent person who is killed. 2) It will create "terror and distress to the victims, the witnesses, and society generally." - BUT (Harris argues) we can set up a rule (a social policy) that removes these problems, and then the benefits of the lottery will outweigh the "costs."
"The Survival Lottery"- What is Harris' proposal, i.e., what is the "survival lottery"? How is it supposed to work? What main example does Harris give to illustrate the proposal?
There are two fundamental objections to killing one to save two. 1) A doctor's choice of whom to kill will be arbitrary (within a range of suitable donors). It is simply not fair to the innocent person who is killed. 2) It will create "terror and distress to the victims, the witnesses, and society generally." -BUT (Harris argues) we can set up a rule (a social policy) that removes these problems, and then the benefits of the lottery will outweigh the "costs."
The Case for Allowing Kidney Sales- Acquiring Transplant Organs
While in the future, vital human organs might be grown in a non-human organism or "in vitro", at the present time all organs must be procured from other humans, either alive or recently dead.
Objections to the Selling of Kidneys: Objections cont'd
he vendors' choice is not genuine: they are likely to be too uneducated to understand the risks, which precludes informed consent.
"The Survival Lottery"- Who does Harris think should get to decide whose organs are harvested?
Third parties cannot decide who to save and who to kill, so only those who "are going to die" soon should be put into the lottery.
The Lottery: A Utilitarian Approach
Traditionally, utilitarians have faced the challenge that maximizing good consequences seems to imply that, if 2 people are facing death and could be saved by killing one other person, we should go ahead and kill the person. BUT: this is contrary to our moral intuitions (our deepest moral beliefs). So there's something wrong with utilitarianism unless we modify it further.
The Case for Allowing Kidney Sales- Some facts about organ transplants:
Transplant centers have been reluctant to intrude on a family's grief by asking that a deceased patient's organs be donated. Even if a patient has signed an organ donation card, the permission of the immediate family is required, in most cases, before the organs can be removed.
Objections to the Selling of Kidneys: - Conclusion
We are not arguing for the positive conclusion that organ sales must be acceptable, let alone that there should be an unfettered market. Our claim is only that none of the familiar arguments against organ selling works."
The Case for Allowing Kidney Sales- Some facts about organ transplants:
Worldwide, more than 200,000 kidney transplants have been performed, and about 94 percent of the organs are still functioning one year later.
The Survival Lottery (John Harris) -The Main Example
Y and Z are dying. One needs a heart transplant. One needs a lung transplant. If a recently deceased person were a donor, Y and Z can be saved. Why, ask Y and Z, don't we just kill a suitable donor? The medical procedures to save Y and Z are available, and in OTHER medical treatments, a doctor's failure to provide the service would be regarded as equivalent to killing the two patients. So, by not killing an innocent "donor" for the necessary heart and lungs, the doctor chooses to kill Y and Z.
SHOULD ALCOHOLICS COMPETE EQUALLY FOR LIVER TRANSPLANTATION?- 3) Expensive Technology
a unique aspect of liver transplantation is that it is an expensive technology that has become a target of cost containment in health care. I
SHOULD ALCOHOLICS COMPETE EQUALLY FOR LIVER TRANSPLANTATION?- 2) Comparison with Cardiac Transplantation
allocational decisions for cardiac transplantation differ from those for liver transplantation. In liver transplantation, ARESLD causes more than 50 percent of the cases of ESLD; in cardiac transplantation, however, no one predominant disease or contributory factor is responsible. Thus, the allocational decisions for heart transplantation differ from those for liver transplantation in two ways: a) determining a cause for end-stage heart disease is less certain, and b) patients with a history of alcoholism are usually rejected from heart transplant programs.
SHOULD ALCOHOLICS COMPETE EQUALLY FOR LIVER TRANSPLANTATION?- 1) Nonrenewable Resource
although most lifesaving therapies are expensive, liver transplantation uses a nonrenewable, absolutely scarce resource -- a donor liver.
"The Survival Lottery"- What is the "Conventional Doctrine"?
basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference. - On this basis, we have a STRICT obligation not to kill. -Harris wants to challenge this assumption
The Case for Allowing Kidney Sales- Some facts about organ transplants: Kidney donors face odds of 1 in 20,000 of dying from surgical complications, but the risk of dying as a result of having only one
kidney is extremely small.
The Survival Lottery (John Harris) - The Conventional Doctrine: The basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between
killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference. -On this basis, we have a STRICT obligation not to kill. -Harris wants to challenge this assumption.
Whose body is it anyway?"- What is presumed consent legislation?
laws that mandate the harvesting of organs after a person's death UNLESS people have explicitly stipulated that they do not wish to be organ donors
Act Utilitarianism
the idea that the calculation of the utility of a particular choice of action is sometimes made relative to the particular situation and thus, particular individual(s)
Whose body is it anyway?"- What is the main argument of the article?
there is a severe shortage of available organs- should selling organs be a solution?
The Case for Allowing Kidney Sales- Acquiring Transplant Organs: This fact raises the question
under what circumstances is it ethically acceptable to harvest a person's organs? Where the donor has recently died the answer may seem simple: if the deceased or an authorized family member has consented, then harvesting is unobjectionable.
Objections to the Selling of Kidneys- Most common objection: vendors are usually poor and in danger of being exploited BUT:
vendors are themselves very eager to sell and this might the best option open to them -The prohibition of sales may do even more harm than it prevents because it harms both vendors AND recipients
Objections to the Selling of Kidneys: Objections cont'd : Slippery Slope
we would move from selling kidneys to selling hearts BUT: this argument could equally apply to unpaid donations