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Suhre W, Van Norman GA. Ethical Issues in Organ Transplantation at End of Life: Defining Death. Anesthesiol Clin 2020; 38:231-246. [PMID: 32008655 DOI: 10.1016/j.anclin.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
End-of-life vital organ transplantation involves singular ethical issues, because survival of the donor is impossible, and organ retrieval is ideally as close to the death of the donor as possible to minimize organ ischemic time. Historical efforts to define death have been met with confusion and discord. Fifty years on, the Harvard criteria for brain death continue to be problematic and now face significant legislative efforts to limit their authority.
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Affiliation(s)
- Wendy Suhre
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Box 356540, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Gail A Van Norman
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Bioethics, University of Washington, Seattle, WA, USA.
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Abstract
Bioethics is a practically oriented discipline that developed to address pressing ethical issues arising from developments in the life sciences. Given this inherent practical bent, some form of advocacy or activism seems inherent to the nature of bioethics. However, there are potential tensions between being a bioethics activist, and academic ideals. In academic bioethics, scholarship involves reflection, rigour and the embrace of complexity and uncertainty. These values of scholarship seem to be in tension with being an activist, which requires pragmatism, simplicity, certainty and, above all, action. In this paper I explore this apparent dichotomy, using the case example of my own involvement in international efforts to end forced organ harvesting from prisoners of conscience in China. I conclude that these tensions can be managed and that academic bioethics requires a willingness to be activist.
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Affiliation(s)
- Wendy Rogers
- Philosophy Department, Macquarie University, Sydney, New South Wales, Australia
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Ortega-Deballon I, Rodríguez-Arias D. Uncontrolled DCD: When Should We Stop Trying to Save the Patient and Focus on Saving the Organs? Hastings Cent Rep 2019; 48 Suppl 4:S33-S35. [PMID: 30584855 DOI: 10.1002/hast.950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Uncontrolled donation after circulatory death, which occurs when an individual has experienced unexpected cardiac arrest, usually not in a hospital, generates both excitement and concern. On the one hand, uDCD programs have the capacity to significantly increase organ donation rates, with good transplant outcomes-mainly for kidneys, but also for livers and lungs. On the other hand, uDCD raises a number of ethical challenges. In this essay, we focus on an issue that is central to all uDCD protocols: When should we cease resuscitation and shift to organ preservation? Do current uDCD protocols prematurely consider as potential donors patients who could still have some chances of meaningful survival? Can the best interest of patients be fostered once they are considered and treated as potential donors?
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den Hartogh G. When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule? Theor Med Bioeth 2019; 40:299-319. [PMID: 31562590 PMCID: PMC6790209 DOI: 10.1007/s11017-019-09500-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term "death" nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity for consciousness and the capacity for spontaneous breathing. Having accepted that proposal, the meaning of "irreversibility" need not be twisted in order to claim that DCD protocols can guarantee that the loss of these functions is irreversible. And this guarantee does not mean that reversing that loss is either conceptually impossible or known to be impossible with absolute certainty.
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Affiliation(s)
- Govert den Hartogh
- Department of Philosophy, University of Amsterdam, Amsterdam, Netherlands.
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Abstract
Five decades ago, Henry Knowles Beecher, a renowned professor of research anesthesiology, sought to solve a problem created by modern medicine. The solution proposed by Beecher and his colleagues on the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proved very influential.1 Indeed, other contemporaneous medical developments magnified its significance yet also made the solution it offered somewhat problematic. As we mark this fiftieth anniversary, at a time when concerns about the conceptual model on which its recommendations rested are being voiced by critics from medicine as well as philosophy, it is worthwhile to view the committee's report in relation to the problem that prompted its existence as well as the one to which it was quickly applied.
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Abstract
Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward.
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Affiliation(s)
- Bethany Bruno
- a Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
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Moorlock G, Draper H. Empathy, social media, and directed altruistic living organ donation. Bioethics 2018; 32:289-297. [PMID: 29542172 PMCID: PMC6001484 DOI: 10.1111/bioe.12438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/08/2017] [Accepted: 11/27/2017] [Indexed: 06/13/2023]
Abstract
In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable 'statistical victims' into 'real people' with whom we can identify and feel empathy: the so-called 'identifiable victim effect', which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non-directed altruistic donation; (b) personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two.
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Abstract
We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a 'spare' kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to sell one's kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market.
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Heathfield LJ, Maistry S, Martin LJ, Ramesar R, de Vries J. Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa. BMC Med Ethics 2017; 18:66. [PMID: 29187190 PMCID: PMC5708083 DOI: 10.1186/s12910-017-0225-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. MAIN BODY This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. CONCLUSION It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.
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Affiliation(s)
- Laura J. Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- MRC/UCT Human Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Sairita Maistry
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Lorna J. Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Raj Ramesar
- MRC/UCT Human Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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Abstract
This paper gives insight into the Islamic bioethical discussion on harvesting and using human embryonic (hESC) and adult stem cells. It describes some of the Islamic legal mechanisms involved in the bioethical discourse among Muslims. As the contemporary Islamic bioethical discourse is very diverse, the paper focuses on the critical discussion of related resolutions of the Saudi-based Islamic Fiqh Academy due to the esteem in which the IFA is held in the Islamic world and the pertinence of their rulings on this issue. This study discusses the different sources of human adult and embryonic stem cells and their use from an Islamic perspective, while questioning some directions the Islamic bioethical discourse has taken. The paper invites interested parties to deliberate the use of some of the legal means resorted to in the ongoing Islamic bioethical discourse.
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Affiliation(s)
- Anke I Bouzenita
- Department of Islamic Sciences, Sultan Qaboos University, PO Box 32, Al Khoud, 123, Muscat, Oman.
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12
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Buhovac M. Crimes against Public Health in Croatia and Bosnia and Herzegovina. Psychiatr Danub 2016; 28 Suppl 2:209-215. [PMID: 28035125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The criminal protection of human health, public health is based on the punishment procedures doctor, pharmacist, ordinary citizen, manufacturers and merchants. It is justified to singleout these crimes in a special group of criminal offenses within the particular part, which is particularly true for those offenses where the focus is not on false threats to the health of a particular individual, but when it may lead to more people lose their lives or get to poor health of more people. This paper will point out the fundamental characteristics of these criminal offenses, their justification to identify a separate chapter in the criminal law, the importance of respect ethical standards in scientific activity, the criminal liability of doctors as fundamental carriers of health activities with regard to the offenses for which the perpetrators appear primary doctor.
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Affiliation(s)
- Maja Buhovac
- Criminal Sciences Faculty of Law, University of Mostar, Mostar, Bosnia and Herzegovina,
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Abstract
Despite seeming uniformity in the law, end-of-life controversies have highlighted variations among state brain death laws and their interpretation by courts. This article provides a survey of the current legal landscape regarding brain death in the United States, for the purpose of assisting professionals who seek to formulate or assess proposals for changes in current law and hospital policy. As we note, the public is increasingly wary of the role of organ transplantation in determinations of death, and of the variability of brain death diagnosing criteria. We urge that any attempt to alter current state statutes or to adopt a national standard must balance the need for medical accuracy with sound ethical principles which reject the utilitarian use of human beings and are consistent with the dignity of the human person. Only in this way can public trust be rebuilt.
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Affiliation(s)
- Nikolas T Nikas
- Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA
| | - Dorinda C Bordlee
- Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA
| | - Madeline Moreira
- Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA Bioethics Defense Fund, Scottsdale, Arizona, USA
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Nair-Collins M, Miller FG. Is heart transplantation after circulatory death compatible with the dead donor rule? J Med Ethics 2016; 42:319-320. [PMID: 26984898 DOI: 10.1136/medethics-2016-103464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
Dalle Ave et al (2016) provide a valuable overview of several protocols for heart transplantation after circulatory death. However, their analysis of the compatibility of heart donation after circulatory death (DCD) with the dead donor rule (DDR) is flawed. Their permanence-based criteria for death, which depart substantially from established law and bioethics, are ad hoc and unfounded. Furthermore, their analysis is self-defeating, because it undercuts the central motivation for DDR as both a legal and a moral constraint, rendering the DDR vacuous and trivial. Rather than devise new and ad hoc criteria for death for the purpose of rendering DCD nominally consistent with DDR, we contend that the best approach is to explicitly abandon DDR.
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Affiliation(s)
- Michael Nair-Collins
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
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Kortram K, Spoon EQW, Ismail SY, d'Ancona FCH, Christiaans MHL, van Heurn LWE, Hofker HS, Hoksbergen AWJ, Homan van der Heide JJ, Idu MM, Looman CWN, Nurmohamed SA, Ringers J, Toorop RJ, van de Wetering J, Ijzermans JNM, Dor FJMF. Towards a standardised informed consent procedure for live donor nephrectomy: the PRINCE (Process of Informed Consent Evaluation) project-study protocol for a nationwide prospective cohort study. BMJ Open 2016; 6:e010594. [PMID: 27036141 PMCID: PMC4823441 DOI: 10.1136/bmjopen-2015-010594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary per centre, and even per individual healthcare professional. The basis for a standardised, uniform surgical informed consent procedure for live donor nephrectomy can be created by assessing what information donors need to hear to prepare them for the operation and convalescence. METHODS AND ANALYSIS The PRINCE (Process of Informed Consent Evaluation) project is a prospective, multicentre cohort study, to be carried out in all eight Dutch kidney transplant centres. Donor knowledge of the procedure and postoperative course will be evaluated by means of pop quizzes. A baseline cohort (prior to receiving any information from a member of the transplant team in one of the transplant centres) will be compared with a control group, the members of which receive the pop quiz on the day of admission for donor nephrectomy. Donor satisfaction will be evaluated for all donors who completed the admission pop-quiz. The primary end point is donor knowledge. In addition, those elements that have to be included in the standardised format informed consent procedure will be identified. Secondary end points are donor satisfaction, current informed consent practices in the different centres (eg, how many visits, which personnel, what kind of information is disclosed, in which format, etc) and correlation of donor knowledge with surgeons' estimation thereof. ETHICS AND DISSEMINATION Approval for this study was obtained from the medical ethical committee of the Erasmus MC, University Medical Center, Rotterdam, on 18 February 2015. Secondary approval has been obtained from the local ethics committees in six participating centres. Approval in the last centre has been sought. RESULTS Outcome will be published in a scientific journal. TRIAL REGISTRATION NUMBER NTR5374; Pre-results.
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Affiliation(s)
- Kirsten Kortram
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Emerentia Q W Spoon
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank C H d'Ancona
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | | | | | - Mirza M Idu
- Department of Surgery, Amsterdam Medical Center, The Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S Azam Nurmohamed
- Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands
| | - Jan Ringers
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - Raechel J Toorop
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | | | - Jan N M Ijzermans
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Affiliation(s)
- Stuart J Youngner
- Professor of bioethics and psychiatry in the Department of Bioethics at Case Western Reserve University in Cleveland, Ohio, and specializes in end-of-life issues, organ transplantation, and clinical ethics consultation
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Kabbur G. Can Social Media Help Increase the Organ Supply While Avoiding Exploitation and Trafficking? AMA J Ethics 2016; 18:115-21. [PMID: 26894807 DOI: 10.1001/journalofethics.2016.18.2.conl1-1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bailey P, Huxtable R. When Opportunity Knocks Twice: Dual Living Kidney Donation, Autonomy and the Public Interest. Bioethics 2016; 30:119-128. [PMID: 26194324 PMCID: PMC5008185 DOI: 10.1111/bioe.12177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Living kidney transplantation offers the best treatment in terms of life-expectancy and quality of life for those with end-stage renal disease. The long-term risks of living donor nephrectomy, although real, are very small, with evidence of good medium-term outcomes. Who should be entitled to donate, and in which circumstances, is nevertheless a live question. We explore the ethical dimensions of a request by an individual to donate both of their kidneys during life: 'dual living kidney donation'. Our ethical analysis is tethered to a hypothetical case study in which a father asks to donate a kidney to each of his twin boys. We explore the autonomy of the protagonists, alongside different dimensions of the public interest, such as the need to protect not only the recipients, but also the donor and even the wider community. Whilst acknowledging objections to 'dual-donation', not least by reference to the harms that the donor might be expected to endure, we suggest there is a prima facie case for permitting this, provided that both donor and recipients are willing and that due attention is paid to such considerations as the autonomy and welfare of all parties, as well as to the wider ramifications of acting on such a request. We argue for broader interpretations of the concepts of autonomy and welfare, recognizing the importance of relationships and the relevance of more than merely physical well-being. Equipped with such a holistic assessment, we suggest there is a prima facie case for allowing 'dual living kidney donation'.
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Guidry-Grimes L. The Case of Ms D: A Family's Request for Posthumous Procurement of Ovaries. J Clin Ethics 2016; 27:51-58. [PMID: 27045305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The MedStar Washington Hospital Center clinical ethics team became involved in a case when the family requested the posthumous removal of a patient's ovaries for future reproductive use. This case presents a novel question for clinical ethicists, since the technology for posthumous female reproduction is still in development. In the bioethics literature, the standard position is to refuse to comply with such a request, unless there is explicit consent or evidence of explicit conversations that demonstrate the deceased would have wanted this option pursued. Ms D's case, we suggest, offers an exception to this default position; complying with the family's request could have been ethically permissible in this case, had it been medically feasible.
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Affiliation(s)
- Laura Guidry-Grimes
- MedStar Washington Hospital Center, Center for Ethics, 110 Irving St., NW, East Bldg Room 3108, Washington, DC USA.
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Affiliation(s)
- David M Shaw
- Institute for Biomedical Ethics, University of Basel, 4056 Basel, Switzerland
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Abstract
A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out policies do secure people's actual-if not explicit-consent, provided that certain conditions are satisfied. I argue that Gill and Saunders' arguments are not successful. My conclusion does not imply that jurisdictions should not implement opt-out policies-their failure to secure people's actual consent may be outweighed by other considerations. But, my conclusion does imply that Gill and Saunders are mistaken to claim that opt-out policies are respectful of people's autonomy.
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Omelianchuk A. 'Total disability' and the wrongness of killing. J Med Ethics 2015; 41:661-662. [PMID: 25323315 DOI: 10.1136/medethics-2014-102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/23/2014] [Indexed: 06/04/2023]
Abstract
Walter Sinnott-Armstrong and Franklin G Miller recently argued that the wrongness of killing is best explained by the harm that comes to the victim, and that 'total disability' best explains the nature of this harm. Hence, killing patients who are already totally disabled is not wrong. I maintain that their notion of total disability is ambiguous and that they beg the question with respect to whether there are abilities left over that remain relevant for the goods of personhood and human worth. If these goods remain, then something more is lost in death than in 'total disability,' and their explanation of what makes killing wrong comes up short. But if total disability is equivalent with death, then their argument is an interesting one.
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Marguénaud JP. [Postmortem paternity]. J Int Bioethique 2015; 26 Spec no:119-128. [PMID: 26638328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
The effort to develop international guidelines for determination of death purports to start with an objective examination of the biology of death. So far, however, it is showing once again how moral and metaphysical claims about death masquerade as scientific facts.
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Affiliation(s)
- Antoine Baumann
- Hôpital Central - Centre Hospitalier Universitaire, EA7299 - Université de Lorraine, Nancy, France,
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28
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Delegates vote on ethical dilemmas. Vet Rec 2015; 176:401-2. [PMID: 25883183 DOI: 10.1136/vr.h2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Youngner SJ. Talking about death is not the same as communicating about death. J Med Ethics 2015; 41:303. [PMID: 25575507 DOI: 10.1136/medethics-2014-102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. J Med Ethics 2015; 41:291-6. [PMID: 24769621 DOI: 10.1136/medethics-2013-101930] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed.
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Affiliation(s)
- Seema K Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Kenneth Kasper
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Franklin G Miller
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
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Deleuze J. [Transgress to progress]. Rev Prat 2015; 65:299. [PMID: 26016178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Overby KJ, Weinstein MS, Fiester A. Response to Open Peer Commentaries on "Addressing Consent Issues in Donation After Circulatory Determination of Death". Am J Bioeth 2015; 15:W3-W5. [PMID: 26305767 DOI: 10.1080/15265161.2015.1076672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Bruzzone P. "Brain Death" and dead donor rule. Discussion and proposals on the thesis of Truog. Ann Ital Chir 2015; 86:85-87. [PMID: 25817846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The introduction in 1968 by the "ad hoc" Harvard committee of the concept of "Brain Death" gave birth to the worldwide diffusion of organ transplantation. Recently "Total Brain Failure" has been proposed as preferred term, instead of "Brain Death", by the President's Council on Bioethics. The concepts of "brain death" and of "dead donor rule" remain the ethical and moral support of organ transplantation. However both criteria has been questioned , either separately or all together , by many authors and particularly by Dr. Robert D. Truog.
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Bliss SE, Macauley RC. The Least Bad Option: Unilateral Extubation after Declaration of Death by Neurological Criteria. J Clin Ethics 2015; 26:260-265. [PMID: 26399676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Typically, the determination of death by neurological criteria follows a very specific protocol. An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to "say goodbye," and at such a time to permit organ retrieval (with authorization of the patient or consent of the next of kin). Such a process maximizes transparency and ensures generalizability. In exceptional circumstances, however, it may be necessary to deviate from this protocol in order to spare family members unnecessary suffering and to reduce moral distress felt by clinical staff. It may also be appropriate, we argue, to refrain from even inquiring about organ donation when the next-of-kin is not only certain to refuse, but lacks the decision-making capacity to potentially consent. The case described in this article calls into question generally reliable assumptions about determination of death by neurological criteria, where the best the clinical team could do for the patient and his family was "the least bad option."
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Affiliation(s)
- Sally E Bliss
- University of Vermont College of Medicine, Burlington, Vermont USA.
| | - Robert C Macauley
- University of Vermont College of Medicine, Department of Pediatrics, 111 Colchester Avenue, Smith 266, Burlington, Vermont 05401 USA.
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Tsujimura-Ito T, Inoue Y, Yoshida KI. Organ retention and communication of research use following medico-legal autopsy: a pilot survey of university forensic medicine departments in Japan. J Med Ethics 2014; 40:603-608. [PMID: 23912741 DOI: 10.1136/medethics-2012-101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study investigated the circumstances and problems that departments of forensic medicine encounter with bereaved families regarding samples obtained from medico-legal autopsies. A questionnaire was posted to all 76 departments of forensic medicine performing medico-legal autopsies in Japan, and responses were received from 48 (63.2%). Of the respondents, 12.8% had approached and communicated with bereaved families about collecting samples from the deceased person during an autopsy and the storage of the samples. In addition, 23.4% of these had informed families that samples might be used in research. Eighteen departments had received enquiries and requests from families about the samples, with most requests concerning their return. The response to such requests varied according to the department. Few departments interacted with the bereaved families regarding the procedure for obtaining autopsy samples, and their methods for handling family concerns differed depending on the person within the department authorised to contact the family. Moreover, the procedures for engaging in such communication have long been unclear, and no legal or ethical consensus or agreement with the general public has been established. It is important for researchers to further discuss the correct way for forensic medicine departments to communicate with bereaved families.
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Affiliation(s)
- Takako Tsujimura-Ito
- Department of Japanese Linguistics, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Inoue
- Department of Public Policy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Ken-ichi Yoshida
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kapocsi E. [Current bioethical issues in Germany]. Lege Artis Med 2014; 24:394-400. [PMID: 25272571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
In many cases, claims that a transaction is exploitative will focus on the details of the transaction, such as the price paid or conditions. For example, in a claim that a worker is exploited, the grounds for the claim are usually that the pay is not sufficient or the working conditions too dangerous. In some cases, however, the claim that a transaction is exploitative is not seen to rely on these finer details. Many, for example, claim that organ sales would be exploitative, in a way that doesn't seem to depend on the details. This article considers, but ultimately rejects, a number of arguments which could be used to defend this sort of claim.
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Affiliation(s)
- Rob Lawlor
- Inter-Disciplinary Ethics Applied CETL (Centre of Excellence in Teaching and Learning) at the University of Leeds
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Abstract
BACKGROUND Debates and controversies have shaped the understanding and the practices related to death determined by neurological criterion (DNC). Confusion about DNC in the public domain could undermine this notion. This confusion could further jeopardise confidence in rigorous death determination procedures, and raise questions about the integrity, sustainability, and legitimacy of modern organ donation practices. OBJECTIVE We examined the depictions of 'brain death' in major American and Canadian print media to gain insights into possible common sources of confusion about DNC and the relationship between expert and lay views on this crucial concept. METHODS We gathered 940 articles, available in electronic databases, published between 2005 and 2009 from high-circulation Canadian and American newspapers containing keywords 'brain dead' or 'brain death'. Articles were systematically examined for content (eg, definitions of brain death and criteria for determination of death) using the NVivo 8 software. RESULTS Our results showed problematic aspects in American and Canadian media, with some salient differences. DNC was used colloquially in 39% (N=366) of the articles and its medical meaning infrequently defined (2.7%; N=14 in the USA and 3.6%; N=15 in Canada). The neurological criterion for determination of death was mentioned in less than 10% of the articles, and life support in about 20% of the articles. Organ donation issues related to DNC were raised more often in Canadian articles than in American articles (33.5% vs 21.2%; p<0.0001). INTERPRETATION Further discussion is needed to develop innovative strategies to bridge media representations of DNC with experts' views in connection with organ donation practices.
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Affiliation(s)
- Ariane Daoust
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, , Montréal, Quebec, Canada
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Lawlor M, Kerridge I. Understanding selective refusal of eye donation. Identity, beauty, and interpersonal relationships. J Bioeth Inq 2014; 11:57-64. [PMID: 24363177 DOI: 10.1007/s11673-013-9497-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/03/2013] [Indexed: 06/03/2023]
Abstract
Corneal transplantation is the most common form of organ transplantation performed globally. However, of all organs, eyes have the highest rate of refusal of donation. This study explored the reasons why individuals decide whether or not to donate corneas. Twenty-one individuals were interviewed who had made a donation decision (13 refused corneal donation and eight consented). Analysis was performed using Grounded Theory. Refusal of corneal donation was related to concerns about disfigurement and the role of eyes in memory and communication. The request for donation therefore raised concerns about a potential adverse change in the ongoing relationship with the deceased, even in death. For those who refused donation, these concerns overshadowed awareness of need or benefit of transplantation. Adjusting the donation message to be more congruent with the real, lived experience of corneal donation may to some extent "prepare" individuals when the donation question is raised.
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Affiliation(s)
- Mitchell Lawlor
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia,
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Kinnaert P. [The definition of death and organ retrieval: a persisting philosophical controversy]. Rev Med Brux 2014; 35:103-111. [PMID: 24908950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Since the publication of the recommendations of the ad hoc committee of the Harvard Medical School to examine the definition of brain death in 1968, philosophical discussions concerning the licit character of organ retrieval in brain dead patients never ceased. The present paper summarizes the main arguments of supporters and opponents of this procedure.
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Abstract
With the case of Belgium as a negative example, this paper will evaluate the legitimacy of using mentally incompetents as organ sources. The first section examines the underlying moral dilemma that results from the necessity of balancing the principle of respect for persons with the obligation to help people in desperate need. We argue for the rejection of a radical utilitarian approach but also question the appropriateness of a categorical prohibition. Section two aims to strike a fair balance between the competing interests at stake and to define the conditions under which organ harvest from mentally incompetents might be morally acceptable. To this end, we morally assess the main requirements that have been put forward to allow organ removal from incompetent donors. We conclude that the current Belgian legislation is far too permissive and that national regulations that do not permit the harvest of non-regenerable organs from mentally incompetents in exceptional circumstances are too restrictive. On the basis of this discussion, we propose a number of guiding principles for decision-making in this area.
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Affiliation(s)
- Kristof Van Assche
- Faculty of Law and Criminology of the Vrije Universiteit Brussel (VUB) University of Liège (ULg), Belgium Ghent University, Belgium and Vrije Universiteit Brussel (VUB)
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Last chance at grandchildren: a request for perimortem sperm harvesting. Hastings Cent Rep 2014; 44:13. [PMID: 24408594 DOI: 10.1002/hast.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hanson SS. Case study. Last chance at grandchildren: a request for perimortem sperm harvesting. Commentary. Hastings Cent Rep 2014; 44:13-14. [PMID: 24696920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between "legally dead" and "legally blind" demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike.
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Abstract
The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public.
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Auden AL. Case study. Last chance at grandchildren:a request for perimortem sperm harvesting. Commentary. Hastings Cent Rep 2014; 44:14. [PMID: 24696921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Pope TM. Legal briefing: Brain death and total brain failure. J Clin Ethics 2014; 25:245-257. [PMID: 25192349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This issue's "Legal Briefing" column covers recent legal developments involving total brain failure. Death determined by neurological criteria (DDNC) or "brain death" has been legally established for decades in the United States. But recent conflicts between families and hospitals have created some uncertainty. Clinicians are increasingly unsure about the scope of their legal and ethical treatment duties when families object to the withdrawal of physiological support after DDNC. This issue of JCE includes a thorough analysis of one institution's ethics consults illustrating this uncertainty. This experience is not unique. Hospitals across the country are seeing more DDNC disputes. Because of the similarity to medical futility disputes, some court cases on this topic were reviewed in a prior "Legal Briefing" column. But a more systematic review is now warranted. I categorize recent legal developments into the following nine categories: (1) History of Determining Death by Neurological Criteria, (2) Legal Status of Determining Death by Neurological Criteria, (3) Legal Duties to Accommodate Family Objections, (4) Protocols for Determining Death by Neurological Criteria, (5) Court Cases Seeking Physiological Support after DDNC, (6) Court Cases Seeking Damages for Intentionally Premature DDNC, (7) Court Cases Seeking Damages for Negligently Premature DDNC, (8) Court Cases Seeking Damages for Emotional Distress, (9) Pregnancy Limitations on DDNC.
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Affiliation(s)
- Thaddeus Mason Pope
- Health Law Institute, Hamline University School of Law, MS-D2017, 1536 Hewitt Avenue, Saint Paul, MN 55104-1237 USA,
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Chan TK, Tipoe GL. The policy statement of the American Academy of Pediatrics -- children as hematopoietic stem cell donors -- a proposal of modifications for application in the UK. BMC Med Ethics 2013; 14:43. [PMID: 24176038 PMCID: PMC4228464 DOI: 10.1186/1472-6939-14-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a view to addressing the moral concerns about the use of donor siblings, the Policy Statement of the American Academy of Pediatrics - Children as Hematopoietic Stem Cell Donors (the Policy) has laid out the criteria upon which tissue harvest from a minor would be permissible. DISCUSSION Although tissue harvest serves the best interests of recipient siblings, parents are also obliged to act in the best interests of the donor sibling in the UK. Tissue harvest should proceed if and only if it serves the best interests of both the donor and recipient. Parents should be forbidden, and they are by UK law, to consent to tissue harvest unless there are substantial benefits for an incompetent minor that can outweigh the potential harm. There is no basis to subject a minor to the medical risks of tissue harvest if the recipient sibling can wait without significant risks of complications until the donor becomes Gillick competent. We also argue that the Policy fails to take into account recent advances in haematopoietic transplantation from haploidentical donors or related tissue-matched donors. SUMMARY Unless a recipient sibling will suffer from serious complications or die without the transplantation and no other medically equivalent donors are available, there is no moral or legal basis to violate the donor sibling's right to bodily integrity. Accordingly, we propose that the Policy should be modified in order to fully satisfy the legal requirements for application in the UK and other commonwealth jurisdictions with similar statute laws protecting minors.
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Affiliation(s)
- Tak Kwong Chan
- Anatomy, University of Hong Kong, L1-59, Laboratory Block, 21 Sassoon Road, Hong Kong, Hong Kong
| | - George Lim Tipoe
- Department of Anatomy, University of Hong Kong, L1-59, Laboratory Block, 21 Sassoon Road, Hong Kong, Hong Kong
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Kouros N. China's organ donation head should be stripped of honours. Monash Bioeth Rev 2013; 31:12. [PMID: 24844060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The "dead donor rule" should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor's and recipient's interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants' roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.
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