The commercial trading of human organs, along withvarious related activities (for example, advertising)was criminalised throughout Great Britain under theHuman Organ Transplants Act 1989.This paper critically assesses one type of argumentfor this, and similar, legal prohibitions:commodification arguments.Firstly, the term `commodification' is analysed. Thiscan be used to refer to either social practices or toattitudes. Commodification arguments rely on thesecond sense and are based on the idea that having acommodifying attitude to certain classes of thing(e.g. bodies or persons) is wrong. The commodifyingattitude consists (...) of three main elements: denial ofsubjectivity, instrumentality, and fungibility.Secondly, in the light of this analysis, the claimthat organ sale involves commodifying the human bodyis examined. This claim is found to be plausible butinsufficient to ground an argument against organ sale,because the very same commodifying attitude is likelyto be present in cases of (unpaid) organ donation. Itis also argued that commodifying bodies per semay not be wrong.Thirdly, the view that organ sale involvescommodifying persons is examined. Although this andthe claim that it is wrong to commodify persons areprobably true, there is – it is argued – littlereason to regard organ sale as worse in this respectthan other widely accepted practices, such as thebuying and selling of labour.The conclusion is that although commodification is auseful ethical concept and although commodificationarguments may sometimes be successful, thecommodification argument against organ sale is notpersuasive. This is not to say, though, that thereare no arguments for prohibition – simply that thisparticular justificatory strategy is flawed. (shrink)

BackgroundSocial media has globalised compassion enabling requests for donations to spread beyond geographical boundaries. The use of social media for medical crowdfunding links people with unmet healthcare needs to charitable donors. There is no doubt that fundraising campaigns using such platforms facilitates access to financial resources to the benefit of patients and their caregivers.Main textThis paper reports on a critical review of the published literature and information from other online resources discussing medical crowdfunding and the related ethical questions. The review (...) highlighted the benefits of crowdfunding as well as the under-exploration of the risk of having patients’ desires and human rights undermined during online fundraising campaigns. Majority of these campaigns get initiated on behalf of the patients, especially the very sick and dependant. The ethical questions raised relate to the voluntariness of informed consent and the possibility of patients being used as a means to an end. Vulnerability of patients may expose them to coercion, undue influence, manipulation, and violation of their human rights. The success of these campaigns is influenced by the digital skills, pre-existing social networks and, the emotional potency. Healthcare is a public good, and online market forces should not determine access to essential health services. The benefits of crowdfunding cannot be subverted, but it can perpetuate unintended injustices, especially those arising from socio-economic factors.ConclusionsPolicymakers ought to monitor the utilisation of crowdfunding sites to identify policy failures and unmet essential health care needs responsible for driving individuals to use these platforms. The upholding of human rights and the fundamental respect of the individual’s wishes is a moral imperative. The need for an ethics framework to guide different stakeholders during medical crowdfunding needs further examination. (shrink)

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

Since its origins in the mid-1980s, DNA profiling has become the most powerful tool for identification in contemporary society. Practitioners have deployed it to determine parentage, verify claims to identity in various civil contexts, identify bodies in wars and mass disasters, and infer the identity of individuals who have left biological traces at crime scenes. Thus DNA profiling can be used to implicate or exonerate individuals from participation in particular social relations and activities; this affords it a growing importance in (...) major social institutions such as the family, the criminal justice system, immigration services, and health services. There are key state, security, civil liberty, personal, and commercial considerations surrounding the reliability and social implications of DNA profiling in establishing the identities of “family members,” “claimants,” “customers,” “suspects,” and “citizens.”Given that DNA profiling is increasingly influential in forensic inquiries, the recently-developed practice in the UK of “familial searching” of DNA databases has the potential to become a significant aspect of investigations. (shrink)

This article explores the socio-ethical concerns raised by the familial searching of forensic databases in criminal investigations, from the perspective of family and kinship studies. It discusses the broader implications of this expanded understanding for wider debates about identity, privacy and genetic databases.

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve (...) medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“. (shrink)

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve (...) medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“. (shrink)

This special volume of Health Care Analysis is dedicated to a consideration of the status of body parts and products and the roleof law in regulating them. We argue that such a discussion is timely giventhe conflation of technological and academic concerns posed by thecomplex legal framework within which these issues are currentlyaddressed and in the light of debates such as those regardingthe storage of children's organs addressed by inquiries atAlder Hay and Bristol, United Kingdom. The contributors addressspecific legal problems (...) which have been brought before the courts in the UK and other jurisdictions, something which wesuggest is likely to occur with increasing regularity oncethe Human Rights Act 1998 comes into force in October 2000.The issues are also considered on a more theoretical level with papers exploring the role of concepts such as property, donation, commodification and kinship in these debates.While the volume focuses principally upon the manner inwhich these issues have arisen in a UK context, though withreference to certain comparative examples, the concepts discussed here are of more general application acrossother jurisdictions. (shrink)

Should face transplants be undertaken? This article examines the ethical problems involved from the perspective of the recipient, looking particularly at the question of identity, the donor and the donor’s family, and the disfigured community and society more generally. Concern is expressed that full face transplants are going ahead.

Several bioethical topics received a great deal of news coverage here in Scotland in 2009. Three important issues with transatlantic connections are the swine flu outbreak, which was handled very differently in Scotland, England and America; the US debate over healthcare reform, which drew the British NHS into the controversy; and the release to Libya of the Lockerbie bomber, which at first glance might not seem particularly bioethical, but which actually hinged on the very public discussion of the prisoner’s medical (...) records. On a national level, there have been attempts in both Scotland and England to change the law on assisted suicide, where success looks more likely than ever. This paper will discuss each of these issues, and hopefully raise awareness of how these issues were dealt with in the UK and its component countries. (shrink)

Disputes over brain death and euthanasia are used to illuminate the question whether there really is a Japanese way of thinking in bioethics. In Japanese thought, a person does not exist as an individual but as a member of the family, community or society. I describe these features of Japanese society as ‘mutual dependency’. In this society, an act is ‘good’ and ‘right’ when it is commonly done, and it is ‘bad’ and ‘wrong’ when nobody else does it. Thus, outsiders (...) to this ring of mutual dependency encounter ostracism. One feature of this society is a lack of open discussion which leads to the existence of multiple standards. This Japanese morality even prevails over written laws. In Japan, there is a public stance that euthanasia does not exist. On the other hand, there are certain decisions which have permitted euthanasia. Similarly, organ transplants were performed from brain dead donors, while that procedure was not accepted officially by the medical profession. In this situation, there is a danger that human rights will be neglected. So far bioethical approaches have not helped to work out these problems. This may be because Japanese think that bioethics is subordinate to morality. The current dispute over brain death involves a struggle for the establishment of a rational society in Japan. Overcoming mutual dependency and ostracism is essential to resolve this struggle and to lead Japan into a society of mutual respect where all individuals, families and communities are esteemed. (shrink)

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.

Genetic information about one individual often has medical and reproductive implications for that individual’s relatives. There is a debate about whether policy on transmitting genetic information within the family should change to reflect this shared aspect of genetic information. Even if laws on medical confidentiality remain unchanged, there still remains the question of professional practice and whether, to what extent and by what means professionals should encourage disclosure within a family. The debate so far has tended to focus on who (...) has a right to genetic information, or has a right to decline genetic information, frequently drawing on the notion of individual autonomy. There are significant divergences within this debate, and difficulties with the use of autonomy in this context have been noted. This paper draws on theoretical considerations as well as on qualitative empirical data to show that shifting from talk of autonomy to talk of integrity will greatly enrich and illuminate the issues. It becomes possible to gain deeper insights into the ethical significance of the timing and the manner of such communication, the character of recipients of knowledge, and the nuanced nature of communication and different levels of understanding within a family. (shrink)

This paper challenges the view, commonly held inbiolaw and bioethics, that there can be no proprietaryrights in our own bodies or body parts. Whether thestarting point is the post-intervention informedconsent regime of Article 22 of the Convention ofHuman Rights and Biomedicine or the traditional(exclusionary) understanding of private property it isargued that property in our own bodies or body partsis presupposed. Although these arguments do notdemonstrate that there is property of this kind (forthat, a full-scale justification of the institution ofprivate property (...) would be required), they suggestnevertheless that the commonly held view has animmanent property logic that has not yet been drawnout or appreciated. (shrink)

ABSTRACT This essay is an attempt to examine the idea that a professional code of practice can entail ethical conduct. It is focused around two differing perspectives on ethics. It will be argued that the professions have, perhaps too hastily, adopted one theory without considering the merits, or the objections offered by the alternative account. This alternative, a ‘cognitivist’ theory, is sketched, and the possible advantages of such an approach are discussed. Such a perspective means adopting a radically different approach (...) to the nature of ethics and what it is to be a moral agent, and could have interesting consequences for professional practice. Even if a cognitivist account is ultimately unconvincing, it does provide a number of worrying arguments for those professionals who believe that ethical conduct is generated by following a code of practice, and these arguments need to be addressed. (shrink)

In Saudi Arabia in 2000 the world's first human uterus transplant was attempted with some success. In 2011 the second successful human uterus transplant took place in Turkey. Doctors in the United Kingdom have recently announced that uterus transplants will be carried out in the UK if doctors can raise enough funds to complete their research. As scientists continue to make progress in this domain this is anticipated to be the next breakthrough in the arena of assisted reproductive technologies. The (...) procedure is designed to restore fertility in women unable to gestate due to an abnormal, damaged, or absent uterus. At present, the only other option for such women to achieve genetic motherhood is via surrogacy, which in Islam is widely regarded as haram or forbidden. This article examines the benefits of this technology so as to facilitate discourse between Islam and the West. It argues for Islamic scholars to consider these advances so as to ensure Muslims living as minorities in Western countries, such as the United Kingdom, are able to utilize such technology (if indeed regarded as permissible) should the government move to enact legislation to permit this procedure. (shrink)

The main theme of the article is the tension between the obligation to preserve life, and the value of timely death. This tension is resolved by distinguishing between precipitating death, which is prohibited, and merely removing an impediment to it, which is permitted. In contemporary Jewish law, a distinction is made between therapy, which may be discontinued, and life-support, which must be maintained until the establishment of death. Another theme is that of “soft” patient autonomy, and its role in dealing (...) with the dying in both traditional Jewish law and Israel’s Terminal Patient Law, 2005. Preventing suffering in relation to a dying person, and praying for his or her death are also discussed in the article. (shrink)

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical (...) profession that address problems of conflict of interest. (shrink)

What relationship between investigators and subjects of clinical research would best meet the needs and wants of both – and of society, which has an interest not only in clinical research being done but also in its being done well? This series of articles argues that investigators and subjects should work together in a partnership based in shared aims. Other relationships are possible, however, and here I examine two.

If patients are to be partners rather than subjects, contributing effectively to clinical research in which they have an interest, both they and investigators must change their ways. The case is argued here that the conduct of clinical research fulfils an essential need of society and that, therefore, in the interests of society, there is a moral imperative that it be done. Further essays will develop this theme, questioning along the way whether consent is a redundant concept.

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical (...) profession that address problems of conflict of interest. (shrink)

The quest for effective medicines is very old. In modern times two important tools have been developed to evaluate efficacy of drugs: superiority and non-inferiority types of clinical trials. The former tests the null hypothesis of μ (the difference between a tested drug and comparator) ≤ 0 against μ > 0; the latter tests the null hypothesis of μ ≤ - Δ against, μ > - Δ, where Δ is the clinical difference from the comparator. In a superiority trial, a (...) new drug is tested against a placebo; in a non-inferiority trial, a new drug is tested against active treatment. In this paper, arguments are presented to show that a superiority trial against a placebo is scientifically sound but ethically unacceptable, whereas a non-inferiority trial against active treatment is ethically sound but scientifically not reliable. Switching from a superiority type of trial with placebo to a non-inferiority trial with an active-control — following the latest revision of Declaration of Helsinki — is in practice switching from the violation of the uncertainty principle to uncertainty of results. Given human and financial resources, it appears an academic question as to which is more unethical: to violate patients’ rights or to produce results without scientific value. All presented considerations lead to the conclusion that the use of a superiority trial of design with an active control instead of placebo will satisfy scientific needs, expectation of patients, and the ancient quest for effective medicines. In the era of Good (Clinical, Laboratory, Manufacture) Practice, the attention of those performing clinical trials is focused on the procedure, not always on its essence. However even the excellent performance of a trial which is not worth doing is fruitless. (shrink)

This series of articles argues for a different relationship between investigators and subjects of clinical research based on partnership in shared aims and recognition, by each, of their duties within this partnership. This second essay describes how those duties arise and explores the basis on which, and by and to whom, they are owed. The conclusion that patients have duties in research raises a number of moral issues which, ultimately, question the concept of consent. Discussion of these will be continued (...) in future articles. (shrink)

In a series of articles, I set out my belief that investigators and subjects of research should work together in a partnership based in shared aims. Such a relationship – quite different from what is usual today – would impose duties on both partners. In earlier papers I explored the origin and nature of the duties that would fall on patients; here I examine their limits.

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

In these articles I have so far explored the set of duties that call upon patients to participate in clinical research as subjects of it. Here I consider whether they acquire a set of rights in consequence of participation, and what these rights may be.

In the first five of these articles I have questioned the justice, and effectiveness, of total dependence in clinical research on willing volunteers. I have explored ways that might better and more equitably spread the burden of participating in clinical research as subjects of it. Here I consider this question: if consent is the barrier, must we regard consent as indispensable?