The article considers the objection to a commercial market in living donor organs for transplantation on the ground that such a market would be exploitative of the vendors. It examines a key challenge to that objection, to the effect that denying poor people the option to sell an organ is to withhold from them the best that a bad situation has to offer. The article casts serious doubt on this attempt at justifying an organ market, and its philosophical underpinning. Drawing, (...) in part, from the catalogued consequences of a thriving kidney market in some parts of India, it is argued that the justification relies on conditions which are extremely unlikely to obtain, even in a regulated donor market: that organ selling meaningfully improves the material situation of the organ vendor. Far from being axiomatic, both logic and the extant empirical evidence point towards the unlikelihood of such an upshot. Finally, the article considers a few conventional counter-arguments in favour of a permissive stance on organ sales. (shrink)

A prominent defence of a market in organs from living donors says that if we truly care about people in poverty, we should allow them to sell their organs. The argument is that if poor vendors would have voluntarily decided to sell their organs in a free market, then prohibiting them from selling makes them even worse off, at least from their own perspective, and that it would be unconscionably paternalistic to substitute our judgements for individuals' own judgements about what (...) would be best for them. The author shows that this ‘Laissez-Choisir Argument’ for organ selling rests on a mistake. This is because the claim that it would be better for people in poverty to sell their organs if given the option is consistent with the claim that it would be even better for them to not have the option at all. The upshot is that objections to an organ market need not be at all paternalistic, since we need not accept that the absence of a market makes those in poverty any worse off, even from their own point of view. The author goes on to argue that there are strong theoretical and empirical reasons for believing that people in poverty would in fact be harmed by the introduction of a market for live donor organs and that the harm constitutes sufficient grounds for prohibiting a market. (shrink)

This paper suggests that many of the pressing dilemmas of bioethics are global and structural in nature. Accordingly, global ethical frameworks are required which recognize the ethically significant factors of all global actors. To this end, ethical frameworks must recognize the rights and interests of both individuals and groups (and the interrelation of these). The paper suggests that the current dominant bioethical framework is inadequate to this task as it is over-individualist and therefore unable to give significant weight to the (...) ethical demands of groups (and by extension communal and public goods). It will explore this theme by considering the inadequacy of informed consent (the ‘global standard’ of bioethics) to address two pressing global bioethical issues: medical tourism and population genetics.Using these examples it will show why consent is inadequate to address all the significant features of these ethical dilemmas. Four key failures will be explored, namely,• That the rights and interests of those related (and therefore affected) are neglected;• That consent fails to take account of the context and commitments of individuals which may constitute inducement and coercion;• That consent alone does not have the ethical weight to negate exploitation or make an unjust action just (‘the fallacy of sufficiency’);• That consent is a single one-off act which is inappropriate for the types of decision being made.It will conclude by suggesting that more appropriate models are emerging, particularly in population genetics, which can supplement consent. (shrink)

This article focuses on ethical issues surrounding the selling and buying of human organs. The author argues that most people who sell their organs in India do so in order to pay already existing debts. The transaction is only temporarily an exchange of “life for life,” and most “donors” are back in debt soon after the operation. The author discusses the flexible ethics that reduce reality to dyadic transactions and the purgatorial ethics that collapse real and imaginary exploitation in the (...) service of complex interests. He also offers a sophisticated discussion of the ethics of publicity and public ethics. He emphasizes the lack of factual information, intentional manipulation of information, and the dissemination of kidney panics and kidney scandals, especially by the new developing bioauthorities and bioethical brokers. (shrink)

This paper takes the view that compensated donation and altruism are not incompatible. In particular, it holds that the arguments against giving compensation stand on weak rational grounds: the charge that compensation fosters “commodification” has neither been specific enough to account for different types of monetary transactions nor sufficiently grounded in reality to be rationally convincing; although altruism is commendable, organ donors should not be compelled to act purely on the basis of altruistic motivations, especially if there are good reasons (...) to believe that significantly more lives can be saved and enhanced if incentives are put in place, and offering compensation for organs does not necessarily lead to exploitation—on the contrary, it may be regarded as a necessity in efforts to minimise the level of exploitation that already exists in current organ procurement systems. (shrink)

Gillon is correct that the four principles provide a sound and useful way of analysing moral dilemmas. As he observes, the approach using these principles does not provide a unique solution to dilemmas. This can be illustrated by alternatives to Gillon’s own analysis of the four case scenarios. In the first scenario, a different set of factual assumptions could yield a different conclusion about what is required by the principle of beneficence. In the second scenario, although Gillon’s conclusion is correct, (...) what is open to question is his claim that what society regards as the child’s best interest determines what really is in the child’s best interest. The third scenario shows how it may be reasonable for the principle of beneficence to take precedence over autonomy in certain circumstances, yet like the first scenario, the ethical conclusion relies on a set of empirical assumptions and predictions of what is likely to occur. The fourth scenario illustrates how one can draw different conclusions based on the importance given to the precautionary principle. (shrink)

The paper reviews the discussion within transplantation medicine about the organ supply and demand problem. The focus is on the evolution of attitudes toward compensation plans from the early 1980s to the present. A vehement rejection on ethical grounds of anything but uncompensated donation—once the professional norm—has slowly been replaced by an open debate of plans that offer financial rewards to persons willing to have their organs, or the organs of deceased kin, taken for transplantation. The paper asks how this (...) shift has occurred and what it tells us about the dynamics of bioethical debates, both within professional circles and in wider public arenas. (shrink)

Altruistic donation of organs from living donors is widely accepted as a virtue and even encouraged as a duty. Selling organs, on the other hand, is highly controversial and banned in most countries. What is the Jewish legal position on these issues? In this review it is explained that altruistic donation is praiseworthy but in no way obligatory. Selling organs is a subject of rabbinic dispute among contemporary authorities.

Effective altruism is a growing philosophical and social movement, whose members design their lives in ways aligned with doing the most good that they can do. The main focus of this paper is to explore what effective altruism has to say about the moral obligations people have to do good with their organs, in the face of an organ-shortage problem. It is argued that an effective altruism framework offers a number of valuable theoretical and practical insights relevant to ongoing debate (...) about how to resolve the organ-shortage problem. Its recommendations constitute a plausible and promising strategy for increasing the supply of, and decreasing the demand for, human organs, in a way that protects the global poor. And, many of its recommendations can be implemented into policy without requiring that citizens actually become effective altruists themselves. (shrink)

It is often maintained that, since the buying and selling of organs—particularly the kidneys—of living people supposedly constitutes exploitation of the living vendors while the so-called “altruistic” donation of them does not, the former, unlike the latter, should be a crime. This paper challenges and rejects this view. A novel account of exploitation, influenced by but different from those of Zwolinski and Wertheimer and of Wilkinson, is developed. Exploitation is seen as a sort of injustice. A distinction is made between (...) justice and fairness. To exploit someone is to take advantage of him or her unjustly. Exploitation pertains to the nature of actions, interactions, and transaction rather than to their outcomes or to how they are perceived by exploitees. Desperation on the part of one or other of the parties to a transaction does not preclude the giving of valid consent to the transaction. Disparities of power or wealth between the parties to a transaction do not indicate or entail that the transaction will be exploitative. A disparity in the benefits that arise from a transaction between the parties does not indicate or entail that exploitation has taken place. (shrink)

Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, (...) that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide. (shrink)

Supporting the view that ethics can be taught, this paper will explore the frequent lack of a philosophical foundation in scientific training and its impact on a course on ‘Science and ethics.’ The incidence of cases of misconduct by scientists engaged in basic research led the United States to establish the Office of Research Integrity. Their publication, “Introduction to the Responsible Conduct of Research” covers the ethical conduct of research and defines misconduct as fabrication, falsification and plagiarism. Concern for breach (...) of public trust with repercussions in scientific funding has led to mandates courses in ethics for students training for scientific research careers. Having concentrated their course work in laboratory-based science, these students have less familiarity with philosophy and consequently struggle with the ethical reasoning aspects of a course in science and ethics. Discovery of a therapeutic drug or device opens a complex web of regulations by Food and Drug Administration for the ethical use of human subjects. Again the ethical system is one of rules and conduct based norms without foundational philosophical support for the ethical principles used in the guidelines. Rules of law reflect corrective action. Engaging students in case studies helps alert them to potential ethical dilemmas and invites them to explore why one action is right, good or better than an alternative. Narrative ethics provides a human presence to competing and compelling claims, the intersection of which is the ethical issue and concept. Dissection narratives help students explore how ethics can be taught and learned in a pluralistic society and remain relevant to the field of expertise they have chosen. The challenge lies in finding the best methods for teaching ethics in a particular discipline. Is there a code of ethics that applies crossculturally and across disciplines? Early and often should be the mantra of teaching ethics throughout the development of the individual and emergent professional. (shrink)

Living organ donation is developing increasingly into an important therapeutic option in transplantation medicine. In spite of the existence of a normative-legal frame, medico-ethical questions remain open. Among these are in particular 1) who should be taken into consideration as a donor, 2) how information concerning the possibility of living organ donation should be passed on, and 3) what an adequate medical-psychosocial evaluation of potential donors should look like. The paper presents the results of a survey based on questionnaires, which (...) addresses the current practice in German transplantation centers as well as the opinions of clinical practioners regarding these three topics. The empirical data form the context for the formulation of medico-ethical ideas and suggestions concerning living organ donation in Germany. (shrink)

In theory, a commercial market for kidneys could increase the scarce supply of transplantable organs and give impoverished people a new way to lift themselves out of poverty. In‐depth sociological work on those who opt to sell their kidneys reveals a different set of realities. Around the town of Sarghoda, Pakistan, the negative social and psychological ramifications of selling a kidney affect not only the vendors themselves, but also their families, communities, and even the country as a whole.

abstract The possibility that organ sales by living adults might be made legal is morally distressing to many of us. However, powerful arguments have been provided recently supporting legalisation (I consider two of those arguments: the Consequentialist Argument and the Autonomy Argument). Is our instinctive reaction against a market of organs irrational then? The aim of this paper is not to prove that legalization would be immoral, all things considered, but rather to show, first, that there are some kinds of (...) arguments, offered in favour of legalisation, that are, in an important sense, illegitimate, and second, that even if legalisation might not be wrong all things considered, there are good reasons for our negative moral intuitions. Moreover, identifying these reasons will help highlight some features of moral decisions in non‐ideal situations, which in turn might be relevant to some other moral or policy choices. (shrink)

The right to buy and sell human organs is challenged by the authors within the framework of a broad Christian perspective. Opposition to organ sales is argued in the light of the developing underclass of poor organ donors throughout the world who sell their organs to the rich. Very often neither the donors nor the recipients are fully informed about the medical risks involved in the procedure of organ transplantation.

While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)

There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this ‘reasonable compensation’ in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors (...) if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors’ motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits. (shrink)

Whereas previous discussions on ownership of biological material have been much informed by the natural rights tradition, insufficient attention has been paid to the strand in liberal political theory represented by Felix Cohen, Tony Honoré, and others, which treats property relations as socially constructed bundles of rights. In accordance with that tradition, we propose that the primary normative issue is what combination of rights a person should have to a particular item of biological material. Whether that bundle qualifies to be (...) called “property” or “ownership” is a secondary, terminological issue. We suggest five principles of bodily rights and show how they can be applied to the construction of ethically appropriate bundles of rights to biological material. (shrink)

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)

Drawing on a social construction theory of ownership in biological material this paper discusses which differences in biological material might motivate differences in treatment and ownership rights. The analysis covers both the perspective of the person from whom the material originates and that of the potential recipient. Seven components of bundles of rights, drawing on the analytical tradition of Tony Honoré, and their relationship to various types of biological material are investigated. To exemplify these categories the cases of a heart, (...) a kidney, stem cells and hair are used. (shrink)

Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear (...) that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it. (shrink)

While organ transplantation has been established in the medical imagination since the 1960s, this technology is currently undergoing a popular re-imagination in the era of global capitalism. As transplantation procedures have become routine in medical centers in non-Western and developing nations and as organ sales and transplant tourism become increasingly common, organs that function as a material resource increasingly derive from subaltern bodies. This essay explores this development as represented in Korean filmmaker Park Chan-wook’s 2002 Sympathy for Mr. Vengeance, focusing (...) on the ethnic and class characteristics of the global market in organs and possible modes of counter-logic to transplant technologies and related ethical discourses. (shrink)

The paper argues that the idea of gift-giving and its associated imagery, which has been founding the ethics of organ transplants since the time of the first successful transplants, should be abandoned because it cannot effectively block arguments for (regulated) markets in human body parts. The imagery suggests that human bodies or their parts are transferable objects which belong to individuals. Such imagery is, however, neither a self-evident nor anthropologically unproblematic construal of the relation between a human being and their (...) body. The paper proposes an alternative conceptualization of that relation, the identity view according to which a human being is identical with their living body. This view, which offers a new ethical perspective on some central concepts of transplant medicine and its ethical and legal standards and institutions, supports widely shared intuitive ethical judgments. On this proposal, an act of selling a human body or one of its parts is an act of trade in human beings, not in owned objects. Transfers of human body parts for treatment purposes are to be seen as sharing in another human being’s misfortune rather than as giving owned objects. From the perspective of policy-making, the proposal requires, first, that informed consent for removal of transplant material be obtained from the potential benefactor. Secondly, explicit consent by the prospective benefactor is obligatory in the case of removal of transplant material from a living benefactor. Thirdly, in the case of posthumous retrieval, informed consent by the potential benefactor during their life is not ethically indispensable. Additionally, while refusal of posthumous retrieval expressed by a potential benefactor during their life must be respected, such a refusal needs ethical justification and explanation. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and (...) patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)