The global shortage of organs for transplantation and the development of new and better medical technologies for organ preservation have resulted in a renewed interest in non-heart-beating donation (NHBD). This article discusses ethical questions related to controlled and uncontrolled NHBD. It argues that certain preparative measures, such as giving anticoagulants, should be acceptable before patients are dead, but when they have passed a point where further curative treatment is futile, they are in the process of dying and they are unconscious. (...) Furthermore, the article discusses consequences of technological developments based on improvement of a chest compression apparatus used today to make mechanical heart resuscitation. Such technological development can be used to transform cases of non-controlled NHBD to controlled NHBD. In our view, this is a step forward since the ethical difficulties related to controlled NHBD are easier to solve than those related to non-controlled NHBD. However, such technological developments also evoke other ethical questions. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

Brian Clark's drama, Whose Life Is It Anyway?, explores the difficulties of applying the principle of respect for autonomy to real-life circumstances. In the play a permanently disabled patient, who wishes to be allowed to die, raises moral questions about the adequacy of the autonomous agent, respect for the autonomy of others, the authority of the law, the allocation of society's resources, and the intrinsic value of human life. After a brief review of the story and definition of respect for (...) autonomy, this paper cites passages from the play that dramatize the tension between respect for autonomy and these other moral concerns. There follows a review of relevant commentary from the classicists Kant and Mill and the modernists Childress and Gillon. The study concludes that although classical and contemporary philosophers have clarified and elaborated upon the relationship between ethical principles, they have not provided definitive guidelines. (shrink)