Organ Transplants Acknowledges all the rational arguments for doing - PDF document

Organ Transplants and Larger Issues Callahan’s “Defense of Sentiment” � Earlier article (not read in class): Callahan opposes ending feeding of dying patients Organ Transplants � Acknowledges all the rational arguments for doing it, but argues “in defense of Symbolic of Larger Ethical Issues sentiment” � But it’s not quite just an appeal to feelings… Two Concrete Questions Raised Ways to Get More Organs � Required request � Should ability to pay matter in getting a � Presumed consent transplanted organ? � Living unrelated donor � Make prior permission for posthumous transplant a � Should contributing to one’s disease (e.g., requirement for being a recipient through alcoholism) matter? � Create a new child (see Ayala case, pp. 744-745 and many web sites; e.g., http://bmt.cityofhope.org/succ_ayala.htmhttp://bmt.cityofhope.org/succ_ayala.htm ) � (Later) Stem cells and cloning � Free enterprise: buying and selling organs? Main Concepts and Themes The Case for Buying and Selling � Liberal-rational vs “sentiment” � Makes more organs available � Capitalism and medicine � Allows people to exercise freedom � “Benefits everyone and violates no one’s rights” (revisited) � Meets this test: “if a policy or practice � Leon Kass, “wisdom of repugnance,” and “neomorts” benefits everyone concerned and violates � Commodification” no one’s rights, it is morally acceptable” � Anticipates issues we will discuss later: genetic improvement, cloning, stem cells, other new reproductive technologies. Medical Ethics 1

Organ Transplants and Larger Issues The Case Against: Kinsley Leon Kass � Chairman, President’s Council on Bioethics � Kinsley: “Some things money shouldn’t be allowed to buy.” ( http://www.bioethics.gov/) � A just society is one where influence of money doesn’t � Leading conservative bioethicist, author of dominate everywhere. numerous works; e.g., Toward a More Natural � And yet… Science � The poor Turk is worse off if he can’t sell his kidney to pay for � Recently well known for opposition to “therapeutic his daughter’s surgery cloning.” Ban just passed in House of Rep . � We don’t stop people from risking their lives for money by working in a coal mine � Essay: “The Wisdom of Repugnance” raises � When protect people from exploitation without changing the similar issues to this one system, we make them worse off. � Why does Kass discuss neomorts ? Kass’s Case Against Organ Sales Protecting People in Whose Interest? � “Euthanasia would be unnecessary if everyone received good end-of-life care.” � Should “repugnance” be respected as � What if everyone doesn’t? ethical argument? � Is person better off if denied choice to die? � “Man gets used to everything, the beast” � Even severely handicapped child can be spared Raskolnikov in Dostoevsky’s Crime and Punishment “injury of continued existence” with loving care” � We’ve overcome emotional resistance to… � What if the loving care is not available? [see long list of things, p. 784, column 2] � Is child better off being kept alive? Protecting People from Exploitation Kass Treats Some Subtle Challenges � “In a just society no one would have to take � The body is our property a dangerous, health-destroying job in a � Well, the body is different. My body is me , not my property coal mine.” like an object. � Yet I must have a property right to it (or at least parts) if I � What if a person’s only choice is that job or no can give (not sell) parts of it away job? � Liberty and liberal ideal would seem to support � Do we protect that person by denying choice? choice to sell organ. � “In a just world, no one would have to sell a � Capitalism based on free exchange, using money body part to survive or save child’s life.” � “If a policy or practice benefits everyone concerned…” Medical Ethics 2

Organ Transplants and Larger Issues Limits to Economic Liberty Moral argument � Money and free exchange have as purpose � Inconsistent with how we treat other conditions: accident victim without seatbelts, smokers, etc. “the satisfaction of natural human needs…to encourage the full flowering of � If alcoholism a disease, no reason to bar human possibility” (p. 783-2) � We don’t exclude people for other moral failings � Can we base ethics on some conception of � Would require great intrusiveness to monitor the natural or on natural human needs? Kass: Commodification Medical argument � Repugnance may teach us something. Think of � Not clear that prognosis for alcoholics is example of neomorts. worse � Beyond just feeling of repugnance: it is wrong to � Even if lower survival rate, still would be make some things commodities (even if “benefits everyone…”) inconsistent with how we treat other groups � Comes up in other issues; e.g., surrogate motherhood. � Is health care itself (in danger of becoming) a commodity? Might the combination of arguments Alcoholics and Liver Transplants be sound? � Raises larger issue of whether one’s past Principle: people should not be excluded behavior causing disease affects one’s from treatment if they cause their disease claim to health care. or if their prognosis is somewhat worse � Cohen-Benjamin reject two kinds of But arguments Combination of the two a reason to exclude? � Alcoholics morally disqualify themselves (Just asking) � Alcoholics medically disqualify themselves Medical Ethics 3