Transplantation is a medically successful and cost-effective way to treat people whose organs have failed--but not enough organs are available to meet demand. T. M. Wilkinson explores the major ethical problems raised by policies for acquiring organs. Key topics include the rights of the dead, the role of the family, and the sale of organs.

This paper examines the ethical difficulties of organ donation from living donors and the problem of causing harm to patients or research subjects at their request. Graham Greene explored morally similar questions in his novella, The Tenth Man.

The principle that physicians should always act in the best interests of the present patient is widely endorsed. At the same time, and often within the same document, it is recognised that there are appropriate exceptions to this principle. Unfortunately, little, if any, guidance is provided regarding which exceptions are appropriate and how they should be handled. These circumstances might be tenable if the appropriate exceptions were rare. Yet, evaluation of the literature reveals that there are numerous exceptions, several of (...) which pervade clinical medicine. This situation leaves physicians without adequate guidance on when to allow exceptions and how to address them, increasing the chances for unfairness in practice. The present article considers the range of exceptions, illustrates how the lack of guidance poses ethical concern and describes an alternative account of physician obligations to address this concern. (shrink)

Since its publication in 1965, Brian Barry's seminal work has occupied an important role in the revival of Anglo-American political philosophy. A number of ideas and terms in it have become part of the standard vocabulary, such as the distinction between "ideal-regarding" and "want-regarding" principles and the division of principles into aggregative and distributive. The book provided the first precise analysis of the concept of political values having trade-off relations and its analysis of the notion of the public interest has (...) also been significant. (shrink)

In a recent article in this journal, we argued that living organ donation from a parent to a child should be described as a beneficent rather than an altruistic act. Emotional relationships can generate an obligation of beneficence to help those with whom we have these relationships. This may involve an obligation for a parent to donate an organ to a child, even though it entails some risk to the parent. The parent's donation is not altruistic because altruistic acts are (...) not obligatory but optional, and they are motivated solely or primarily by other-regarding concerns. In contrast, donor parents' other-regarding concerns are inseparable from their own self-regarding concerns. An individual who donates to a stranger is acting altruistically. She may choose to help others to whom she is not emotionally related for a variety of reasons—sympathy, compassion, generosity, or a desire to give something back to humanity. But she does not have an obligation to do so. Although she may benefit as a consequence of donating, this is not her reason for donating. Instead, her action is motivated by a concern for the recipient's own sake. This is what makes the donation altruistic, and it can be justified without any expectation of benefit to the donor. However, although the potential competent donor decides whether the donation is in her best interests, physicians have the right to refuse to perform a transplant if the risks to the donor are too great or the potential benefits to the recipient are too small. (shrink)

Spurred by a severe shortage of cadaveric organs, there has been a marked growth in living organ donation over the past several years. This has stimulated renewed interest in the ethics of this practice. The major concern has always been the possibility that a physician may seriously harm one person while trying to improve the well-being of another. As Carl Elliott points out, this puts the donor's physician in a difficult predicament: when evaluating a person who volunteers to donate an (...) organ, “a doctor is in the position of deciding not simply whether a subject's choice is reasonable … but whether he [the doctor] is morally justified in helping the subject accomplish it.”1 This question has become even more difficult since the introduction of living donor operations that are more risky than living kidney donation and the suggestion that volunteers at added risk may sometimes be acceptable.2 So, how can we decide when the risk is too much? (shrink)

According to Glannon and Ross, for an act to be considered altruistic, it cannot be obligatory nor motivated by expectation of self-reward. Given that parents are obligated to help their children and stand to benefit greatly from donating, the authors conclude that parent to child organ donation is not altruistic. Are they correct? I am not sure. In my view, this is a semantic question and the answer depends upon how one defines altruism. Altruism is a complex subject that means (...) different things to different people. If we say that an altruistic act is one that is performed voluntarily, is risky or costly to the actor, and is designed only to benefit others with no expectation of self-reward, then it may be difficult or impossible to identify any such acts. When one risks her own life to save a stranger, others may ask: “Did she really act solely to benefit another or was she motivated, at least in part, by a need to satisfy her conscience or a desire to feel good about herself?” This question is relevant to the motivation of living organ donors. In contrast to the authors' answer that strangers who donate organs do so only out of concern for other people, Carl Fellner argued that many living organ donors, even those who are not related to their recipients, act to benefit themselves. If Fellner is correct, and if organ donation by parents is not altruistic because of the possibility of self-reward, perhaps the same is true of organ donation by strangers. (shrink)