Record Transplants in UK

A record number of organ transplants took place in 2012, the BBC reports. The increase of 6% on the previous year is largely attributed to an increase in the number of registered donors, which suggests that the limiting factor on transplants was indeed donations, rather than space in operating theatres. Of course, a dramatic increase in the number of donors may see some other factor, such as space in operating theatres, become the new limiting factor. But, for now, it seems that our focus should be on increasing decisions to donate, whether from individuals or their families.

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.

An Economist's Perspective

Economist Tim Harford considers some of the measures to increase organ procurement and suggests the importance of asking people to give their consent. (Thanks to Chris Bertram for directing me to this, on Twitter.)

I think Harford is right to say that many people, given the opportunity, will consent, so it's a good thing to ask people's views when, for instance, they apply for driving licences. It's unclear, however, whether this is sufficient to address the organ shortage. It's interesting that one reason he offers for 'rejecting presumed' is that it will not assure relatives of their loved one's wishes. As he asks, rhetorically, "If we fill our donor registry with auto-enrolled donors, will that really persuade distraught families to support transplants?"

This is all very well, but the unspoken assumption here is that family consent should be needed, along with that of individuals. Granted, perhaps in the opt-out system he was considering, this makes sense: the family should have the option to express an objection that the deceased may have had but never registered (a 'soft opt-out'). The danger, however, is that such systems potentially allow the family to override the wishes of the deceased. There have been a number of papers (for instance, this one) arguing that, even in an opt-out system, we ought not to consult the family: that the absence of objection from the deceased should be sufficient to license donation.

The appropriate role, if any, of families and next of kin is something we intend to explore in the next RSE Workshop.

Munthe on Harvesting from Living Donors

This new piece by Walter Glannon challenges the almost universally accepted Dead Donor Rule (DDR), arguing that it can be ethically permissible to harvest organs from a donor before their death, provided that this does not harm them. An interesting, and provocative, thesis. I suspect that most of those who would resist harvesting organs from living donors could in fact accept this conditional, but would hold that removing someone's vital organs is always a harm.

Christian Munthe has offered some alternatives reasons to be sceptical of Glannon's conclusions on his blog, here. Munthe accepts that Glannon is right about the ethics - it is morally permissible to remove the person's organs in this case - but points out that we cannot simply conclude, from this, that the Dead Donor Rule is unjustified. The law is a somewhat blunt instrument, so sometimes it must prohibit all actions of a certain kind because not to do so would result in harm, even if some actions of the prohibited kind are morally permissible. Relaxing the Dead Donor Rule, Munthe suggestions, might weaken socially useful prohibitions on killing in other cases, and thus the law justifiably prevents harvesting from living donors, in order to prevent greater evil.

I'm not sure what I think of this particular case - I'm inclined to agree with Munthe, but haven't yet read Glannon's piece (only Munthe's summary of it) - but it's a useful reminder of the general point that law or policy cannot simply be ethics; we need to attend to institutional matters.