The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. (...) We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse. (shrink)

This is a major work in moral philosophy, the long-awaited follow-up to Parfit's 1984 classic Reasons and Persons, a landmark of twentieth-century philosophy. Parfit now presents a powerful new treatment of reasons and a critical examination of the most prominent systematic moral theories, leading to his own ground-breaking conclusion.

By contributing a few hundred dollars to a charity like UNICEF, a prosperous person can ensure that fewer poor children die, and that more will live reasonably long, worthwhile lives. Even when knowing this, however, most people send nothing, and almost all of the rest send little. What is the moral status of this behavior? To such common cases of letting die, our untutored response is that, while it is not very good, neither is the conduct wrong. What is the (...) source of this lenient assessment? In this contentious new book, one of our leading philosophers argues that our intuitions about ethical cases are generated not by basic moral values, but by certain distracting psychological dispositions that all too often prevent us from reacting in accord with our commitments. Through a detailed look at how these tendencies operate, Unger shows that, on the good morality that we already accept, the fatally unhelpful behavior is monstrously wrong. By uncovering the eminently sensible ethics that we've already embraced fully, and by confronting us with empirical facts and with easily followed instructions for lessening serious suffering appropriately and effectively, Unger's book points the way to a compassionate new moral philosophy. (shrink)

Two potentially lifesaving protocols, emergency preservation and resuscitation and uncontrolled donation after circulatory determination of death, currently implemented in some U.S. emergency departments, have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations (...) and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. (shrink)

The ordinary concept of death is analysed and compared with revisionary medical definitions, especially those based on irreversible loss of brain function. Prior critics of revisionary definitions have focused on the locus, the brain; I am concerned with the irreversibility condition. I argue that 1) the irreversibility condition is ambiguous, 2) it has unacceptable epistemic and other consequences on any plausible construal, and 3) irreversibility is not part of the ordinary concept of death. I conclude that recent medical definitions seek (...) illegitimately to obtain the certainty of a weak construal of 'irreversible' along with the freedom from moral obligation of the strong construal. (shrink)