A heart-warming story about an 'altruistic' (or live) kidney donor receiving a letter of thanks from the family she helped here. It's good to see donation get regular good press, rather than only being covered when there are scandals.
For the record, the scare quotes round 'altruistic' in the first sentence are not intended to question Ms Pretty's obvious altruism; rather, I find it odd that live donors who donate to strangers (rather than relatives) are referred to as 'altruistic donors', given the commonplace belief that all donations should be altruistic - a reasoning which is often appealed to in order to resist incentives for donors.
If you're interested in this issue, there's a nice piece by Greg Moorlock discussing the altruism requirement in the Journal of Medical Ethics (open access). The next meeting of the RSE project, on Saturday 14th September, will focus on incentives and inducements, so look out for further posts on that theme.
Showing posts with label public attitudes. Show all posts
Showing posts with label public attitudes. Show all posts
Wednesday, 4 September 2013
Friday, 2 August 2013
Organ Donation Debated on Ciao!
The opt-in/opt-out issue has been selected as 'current debate' (for the latter half of July, so now over) on consumer review/opinion site Ciao. See the entries here. I'm pleased to see that most appear to be in favour - though on closer inspection some are only really in favour of organ donation and are sceptical of opt-out.
Tuesday, 18 June 2013
Donor Registration on Facebook
I was interviewed on Facebook's drive to increase organ donation a couple of times by a Canadian journalist (the results can be found here and here).
I've just seen this report, suggesting that there did seem to be a boost in donation rates following the Facebook initiative. I've not read the actual academic article, but I assume the authors at least attempted to show causation, rather than mere correlation.
I've just seen this report, suggesting that there did seem to be a boost in donation rates following the Facebook initiative. I've not read the actual academic article, but I assume the authors at least attempted to show causation, rather than mere correlation.
Tuesday, 4 June 2013
Northern Ireland Consults on Opt-Out
Northern Ireland has just launched a public consultation on proposals to switch from an Opt-In to an Opt-Out system. I was particularly pleased to see that the BBC article on this made no mention of 'presumed consent' - an idea that I've criticised elsewhere. Instead, the proposal is put in straightforward terms: it makes donation easier for those who want to donate, while allowing a refusal for those that do not. Notably, however, the proposal is for a 'soft opt-out' in which the next of kin retain a veto: "However, it proposes to make little change to the current key role played by the family in the final decision in relation to donation of organs. A family would still be consulted for additional medical information and asked about any unregistered objection to donation.".
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.
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.
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.
Wednesday, 24 April 2013
Back From the Dead?
I think stories like this, about people being brought back from the dead, fuel unease about posthumous organ donation. People quite reasonably worry that, if they register as donors, they will be left for dead, when they could have been saved/revived.
It's worth emphasising that the story here is about cardiac death ("Most people regard cardiac arrest as synonymous with death, he says. But it is not a final threshold"). The definition of death used for organ donation is brain death. As the article goes on to say, "[Dr Jerry] Nolan stops short of saying that Carol was brought back from the dead. Hospitals do not declare death, he says, until they have ruled out all processes that can be reversed."
Nonetheless, this article serves to highlight the ambiguity and confusion surrounding death. Of course, public misunderstanding is somewhat to be expected, given current medical practice - e.g. the family may be informed that, since their relative is [brain] dead, doctors intend to turn off life support, in order to 'let them die'.
In the words of Dr Nolan, as quoted in the article, "We used to think death was a sort of sudden event - we stop the oxygen going to the brain and after a few minutes that was that. But actually, we know that the dying process at the cellular level goes on for a period of time". Our understanding of, and attitudes towards, death and dying are obviously crucial for organ donation (provided, of course, we continue to accept the assumption that it is only permissible to take organs from the dead, except in special circumstances).
It's worth emphasising that the story here is about cardiac death ("Most people regard cardiac arrest as synonymous with death, he says. But it is not a final threshold"). The definition of death used for organ donation is brain death. As the article goes on to say, "[Dr Jerry] Nolan stops short of saying that Carol was brought back from the dead. Hospitals do not declare death, he says, until they have ruled out all processes that can be reversed."
Nonetheless, this article serves to highlight the ambiguity and confusion surrounding death. Of course, public misunderstanding is somewhat to be expected, given current medical practice - e.g. the family may be informed that, since their relative is [brain] dead, doctors intend to turn off life support, in order to 'let them die'.
In the words of Dr Nolan, as quoted in the article, "We used to think death was a sort of sudden event - we stop the oxygen going to the brain and after a few minutes that was that. But actually, we know that the dying process at the cellular level goes on for a period of time". Our understanding of, and attitudes towards, death and dying are obviously crucial for organ donation (provided, of course, we continue to accept the assumption that it is only permissible to take organs from the dead, except in special circumstances).
Saturday, 13 April 2013
Grayling on Respect for the Dead
There's a piece by A. C. Grayling criticising the notion of respect for the dead in the Independent. It isn't directly related to organ donation, since it's really concerned with the (im)propriety of speaking ill of Margaret Thatcher, but it occurs to me that 'respect for the dead' is a more general notion.
It's often assumed that we ought to respect someone's wishes concerning what happens to their organs after they die, hence why we give people the opportunity to record their wishes through donor registers and the like. It's sometimes pointed out that we don't think this respect, if demanded at all, is an absolute demand on us. Imagine a militant vegetarian who said that, after their death, they would like their rotting body to be left outside their local McDonalds, or something. We wouldn't feel any obligation to comply with these wishes, since we also accept that people's rights over their bodies can be circumscribed on grounds of public health (or perhaps even decency).
Unsurprisingly, there's much controversy about the implications of this for organ donation. Burying or cremating someone with their organs, which could have been used to save lives of those needing transplants, could be said to be similarly objectionable. That is, there's a case that could be made that, given what's at stake here, we ought to be prepared to override the wishes of the deceased. I'm not endorsing this position, just pointing out that we need to confront issues of the respect owed to the dead.
It's often assumed that we ought to respect someone's wishes concerning what happens to their organs after they die, hence why we give people the opportunity to record their wishes through donor registers and the like. It's sometimes pointed out that we don't think this respect, if demanded at all, is an absolute demand on us. Imagine a militant vegetarian who said that, after their death, they would like their rotting body to be left outside their local McDonalds, or something. We wouldn't feel any obligation to comply with these wishes, since we also accept that people's rights over their bodies can be circumscribed on grounds of public health (or perhaps even decency).
Unsurprisingly, there's much controversy about the implications of this for organ donation. Burying or cremating someone with their organs, which could have been used to save lives of those needing transplants, could be said to be similarly objectionable. That is, there's a case that could be made that, given what's at stake here, we ought to be prepared to override the wishes of the deceased. I'm not endorsing this position, just pointing out that we need to confront issues of the respect owed to the dead.
Thursday, 11 April 2013
UK Donor Increase
Organ donation is in the news today. Since the Organ Donation Taskforce, which reported in 2008, there's been a significant increase in the number of registered donors and, consequently, in the number of transplants performed.
This is welcome news, but it shouldn't blind us to the fact that demand still exceeds supply, with three people dying each day in the United Kingdom because of a lack of transplant organs (figure from the BBC article, linked above). It's important to consider ways in which we might continue to do even better, including for instance an opt-out system.
It's also notable that, according to the first article, "Last year, 125 families overruled an individual's intention to donate". The UK's present system allows relatives of the deceased to override his/her expressed wishes. Whether this is justifiable or not ought, I think, to be more debated. It's an issue that we intend to examine in the next RSE workshop.
This is welcome news, but it shouldn't blind us to the fact that demand still exceeds supply, with three people dying each day in the United Kingdom because of a lack of transplant organs (figure from the BBC article, linked above). It's important to consider ways in which we might continue to do even better, including for instance an opt-out system.
It's also notable that, according to the first article, "Last year, 125 families overruled an individual's intention to donate". The UK's present system allows relatives of the deceased to override his/her expressed wishes. Whether this is justifiable or not ought, I think, to be more debated. It's an issue that we intend to examine in the next RSE workshop.
Monday, 18 March 2013
Transplanting Disease
It's well known that organ transplants can save lives. It is, sadly, also true that they can cost lives - and not only through surgery. I reported last year on the case of a young woman who died of lung cancer after receiving a smoker's lungs. In the US, one man has died and three others are receiving treatment after being given organs from a donor who died of rabies in 2011. Again, this is a tragic case, but - lest donation rates be harmed by negative publicity - it's worth stressing the concluding statement that the benefits of organ donation generally outweigh the risks: even those who die due to an infected transplant may well have died without it.
Monday, 7 January 2013
Why Don't People Register as Donors?
So far this blog has mainly focused on current news items, but I thought this piece from 2005 was interesting enough to deserve comment. Thanks to Christopher Hourigan for bringing it to my attention, in a piece in the British Journal of General Practice, October 2005.
Though surveys usually show a majority of people are in favour of organ donation, actual registration rates are much lower. (Of course, actual donation rates are lower still - people often don't die in ways that facilitate the use of their organs.) Why is this? Of course, there are many reasons, and one shouldn't discount the possibility that people who say they are in favour of donation in surveys aren't really so, at least in their own case. But it's worth investigating people's reasons.
According to the survey reported by the BBC, just over 50% of those who hadn't registered as donors hadn't thought about the issue. While this needn't license using their organs anyway, it does suggest that they didn't have serious objections to the practice. Most of this people, if they had thought about the issue, and were typical of those who had, probably would choose to register. So, one obstacle to donor registration appears to be apathy or, perhaps more accurately, an understandable squeamishness in thinking about death. Drives to increase donor registration should encourage people to think and talk about these issues.
Perhaps even more interesting is that 30% of respondents said they 'hadn't got round to it'. These people want to donate their organs and, it seems, their wishes would be respected by an opt-out scheme.
Only 10% report an objection to the use of their organs. Interestingly, many of these objections appeared to be based on false beliefs or misconceptions. This doesn't mean that the objection can simply be ignored, but it does suggest that these people might change their views - and consent to organ donation - if they were properly informed.
Looking at the reasons why people do and do not register as donors can help inform registration policy. Stirling psychologist Ronan O'Carroll has been doing some interesting work in this area, some of which I hope to report on in a later post. I'd be interested in more recent studies like that discussed here, if anyone has any.
Though surveys usually show a majority of people are in favour of organ donation, actual registration rates are much lower. (Of course, actual donation rates are lower still - people often don't die in ways that facilitate the use of their organs.) Why is this? Of course, there are many reasons, and one shouldn't discount the possibility that people who say they are in favour of donation in surveys aren't really so, at least in their own case. But it's worth investigating people's reasons.
According to the survey reported by the BBC, just over 50% of those who hadn't registered as donors hadn't thought about the issue. While this needn't license using their organs anyway, it does suggest that they didn't have serious objections to the practice. Most of this people, if they had thought about the issue, and were typical of those who had, probably would choose to register. So, one obstacle to donor registration appears to be apathy or, perhaps more accurately, an understandable squeamishness in thinking about death. Drives to increase donor registration should encourage people to think and talk about these issues.
Perhaps even more interesting is that 30% of respondents said they 'hadn't got round to it'. These people want to donate their organs and, it seems, their wishes would be respected by an opt-out scheme.
Only 10% report an objection to the use of their organs. Interestingly, many of these objections appeared to be based on false beliefs or misconceptions. This doesn't mean that the objection can simply be ignored, but it does suggest that these people might change their views - and consent to organ donation - if they were properly informed.
Looking at the reasons why people do and do not register as donors can help inform registration policy. Stirling psychologist Ronan O'Carroll has been doing some interesting work in this area, some of which I hope to report on in a later post. I'd be interested in more recent studies like that discussed here, if anyone has any.
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