Tuesday, February 25, 2014

Pros and cons of paying for kidneys, in the Journal of Medical Ethics

Some pros and cons on paying for kidneys in the Journal of Medical Ethics, March 2014, Volume 40, Issue 3

From the editors' summary in the first article ("The concise argument")"

"For over half a century the subject of organ transplantation has attracted ethical debate. One such ongoing debate, provoked by the severe scarcity of organs for transplantation and a concern to increase their supply, has been about why willing live donors should continue to be prohibited from offering their own organs for sale. Against allowing this, it has often been argued that prohibition protects people in poverty from being driven to, and then harmed by, this desperate last resort. But is that how such people in poverty themselves see it? From their point of view, it has been suggested, wouldn't it be reasonable to see prohibition as depriving them of their best option, leaving them worse off than if they had been able to exercise it? Isn't the claim to protect people in poverty therefore ‘misplaced paternalism’, providing no ethical justification for prohibition?

"In this month's feature article, Simon Rippon (see page 145, Editor's choice) mounts a serious and sustained challenge to that conclusion. He argues that while it would be reasonable for people in poverty to sell their organs if given the option, it would be equally reasonable, given the ‘significant and unavoidable’ harms of a live organ donor market, for them to prefer not to have this option at all. In her commentary on Rippon's paper, Janet Radcliffe-Richards (see page 152) acknowledges that ‘a plausible case for prohibition would probably take this form’, but goes on to argue that ‘although in principle prohibition need not be paternalistic, in practice it is’, since it ‘has been imposed on everyone irrespective of any consultation’. To this, and two further commentaries, by Gerald Dworkin (see page 151) and by Adrian Walsh (see page 153), Rippon responds (see page 155) in a significant contribution to a debate that nevertheless seems likely to continue unabated as long as the need for whole organs continues so greatly to exceed their supply."

The concise argument

  • Responding to complexity

    • Kenneth Boyd
    J Med Ethics 2014;40:143-144 doi:10.1136/medethics-2014-102070

Feature article

  • Imposing options on people in poverty: the harm of a live donor organ market

    • Simon Rippon
    J Med Ethics 2014;40:145-150 Published Online First: 28 June 2012doi:10.1136/medethics-2011-100318
    Editor's ChoiceFREE

Commentaries

  • Organ sales and paternalism

    • Gerald Dworkin
    J Med Ethics 2014;40:151-152 Published Online First: 19 June 2012doi:10.1136/medethics-2012-100647

  • Commentary by Janet Radcliffe-Richards on Simon Rippon's ‘Imposing options on people in poverty: the harm of a live donor organ market’

    • Janet Radcliffe-Richards
    J Med Ethics 2014;40:152-153 Published Online First: 19 October 2012doi:10.1136/medethics-2012-100645

  • Commentary on Simon Rippon, ‘Imposing options on people in poverty: the harm of a live donor organ market’

    • Adrian Walsh
    J Med Ethics 2014;40:153-154 Published Online First: 29 June 2012doi:10.1136/medethics-2012-100646

  • Organ markets and harms: a reply to Dworkin, Radcliffe Richards and Walsh

    • Simon Rippon
    J Med Ethics 2014;40:155-156 Published Online First: 5 November 2012doi:10.1136/medethics-2012-101083

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