Saturday, 18 May 2013

Commemorating Donors

If I understand this story correctly, it seems that over £10,000 is being spent on a stained glass window to commemorate organ donors (£6,800 from the Tayside NHS Board Endowment Fund, plus £3,500 from Revival). It's an interesting question whether this is money well spent, or whether it could be used to fund potentially life-saving (or improving) treatment.

I think a common immediate reaction would be that it's a 'waste' of NHS (and other) money that could have been spent more productively. But, who knows, perhaps such gestures will encourage more people to donate, if only by generating publicity? I'd be interested to know whether any empirical work had been done on such matters. I don't, however, think its justification depends entirely on these instrumental considerations though. Arguably, norms of gratitude and reciprocity may make it appropriate to do something to recognise the gift of donors.

Friday, 17 May 2013

Bioethical Expertise

There's an interesting, though perhaps slightly obscure, Guardian column on the notion of expertise in bioethics here. The author, Nathan Emmerich, suggests that we should be wary of making professional bioethicists into a 'priestly caste'. I'd suggest that professional bioethicists may be better than priests, but I think he has a point about moral knowledge/expertise and deference.

The moral or political philosopher doesn't have the kind of expertise that delivers answers that others must simply defer to. I frequently stress to my students that an argument from authority is worthless and that they need to assess what they read critically. Does this mean that there is no such thing as moral expertise? Well, not exactly - it all depends what you mean by 'expertise'.

All of us are capable of thinking deeply and careful about important moral questions. Those who research, or have studied, moral philosophy have an advantage in that they have spent more time than most engaged in such reflection and will presumably be familiar with certain argumentative moves (e.g. slippery slopes) and common fallacies. Thus, we might hope, they will be less likely to reach the conclusions that they do on the basis of bad reasoning and so, hopefully, less likely to reach bad conclusions.

To the worry that relying on moral experts is undemocratic, I think the appropriate response is the broadly Millian one, that the value of free speech is that it allows bad arguments to be confronted by better ones. Experts shouldn't be able to silence ordinary people in virtue of their expertise - our basis for trust in their judgements should rest on the fact that they cannot be defeated by opposing arguments. (There is, of course, a problem here is saying who wins an argument; the quality of public debate is often lamentably poor.)

I don't think that anything I say here challenges Emmerich's position. He concludes "Expert bioethicists cannot allow themselves to become a priestly caste. They must engage with the public and, in doing so, become more fully engaged by and with their concerns", which is not to say that there is no expertise in bioethics, but only that expert bioethicists must engage with the public. That's something I wholeheartedly agree with and one of the purposes of this blog, to facilitate engagement and exchange of view.

David Hunter has his own response to Emmerich on the BMJ blog.

Tuesday, 7 May 2013

Nudge, Nudge

I discovered a 'new' (as in, new to me) weblog about nudging here, run by a group of geographers (mostly) from Aberystwyth. I've not thoroughly explored yet, but it looks interesting. In particular, of relevance here, are their comments on organ donation. (Richard Thaler's own favoured position is 'prompted choice', rather than 'presumed consent'.) Another interesting point is that the term 'nudge' was suggested by the publisher. Perhaps this explains why Thaler and Sunstein (infamously) don't clearly define it...

This all came to my attention because one of the blog authors, Jessica Pykett, is speaking at Stirling next week.

Sunday, 5 May 2013

Regrowing Livers

The fact that livers can regrow means that it's sometimes possible to take a liver lobe from a healthy donor, transplant it to someone suffering liver failure, and for both to end up with a fully functioning liver - as reported here. Recent evidence, however, suggests that this same ability means that some people's need for a transplant is only temporary, since their damaged livers may repair themselves.

Despite the focus on transplants saving lives, it shouldn't be forgotten that it's preferable if people don't need a transplant at all, saving them from major operations and a lifetime of immunosuppressant drugs. Perhaps the gap between supply and demand can be reduced, in part, by reducing demand. And, of course, it's preferable that livers that are available for transplant go to those that really need them (long term).