abstract This paper examines, from a philosophical point of view, the ethics of the role of the family and the deceased in decisions about organ retrieval. The paper asks: Who, out of the individual and the family, should have the ultimate power to donate or withhold organs? On the side of respecting the wishes of the deceased individual, the paper considers and rejects arguments by analogy with bequest and from posthumous bodily integrity. It develops an argument for posthumous autonomy based (...) on the liberal idea of self‐development and argues that this establishes a right of veto over donation. It claims, however, that whether the family's power to veto would conflict with posthumous autonomy rights depends on how it comes about. On the side of respecting the family's wishes, the paper first considers an argument from family distress. This supports a contingent, non‐rights‐based reason for the family's power that is trumped by the deceased's rights. It then outlines and criticises an argument based on family autonomy. The conclusion is that the individual has the right to veto the family's wish to donate and that, while the family has no right to veto the individual's wishes to donate, it can legitimately acquire this power and has done so in practice. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

This is a major new study of Kant's ethics that will transform the way students and scholars approach the subject in future. Allen Wood argues that Kant's ethical vision is grounded in the idea of the dignity of the rational nature of every human being. Undergoing both natural competitiveness and social antagonism the human species, according to Kant, develops the rational capacity to struggle against its impulses towards a human community in which the ends of all are to harmonize and (...) coincide. The distinctive features of the book are twofold. First, it focuses for the first time on the central role played in Kant's ethical theory by the value of rational nature as an end itself. Second, it shows the importance of Kant's systematic theory of human nature and history, and its implications for the structure, formulation, and application of Kant's moral principles. This comprehensive study will be of critical importance to students of moral philosophy, the history of ideas, political theory, and religious studies. (shrink)

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria, there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, (...) the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients. (shrink)

The Pareto argument for inequality holds that any change from a position of equality to one of inequality is justified so long as everyone benefits from the change. G.A. Cohen criticizes this argument (which he attributes to Rawls) on the ground that changes can normally be found which preserve both equality and Pareto‐efficiency. However, this does not resolve the basic conflict between the two desiderata. Strong egalitarians hold that Pareto changes are not for the better if they increase inequality too (...) greatly. Thus if the Pareto argument holds, then strong egalitarianism is unsustainable. I argue that egalitarians need not be troubled by the Pareto argument for inequality. The Pareto criterion would not be widely accepted unless it takes account of moral harms; but if it does take account of moral harms then there is no reason to doubt that egalitarian concerns can be incorporated into the Pareto argument. (shrink)