Introduction by the Guest Editors
- Introduction by the Guest Editors
This special issue has its origins in a two-part workshop entitled “Dying Well”, held in November and December 2015 at the Centre for Bioethics of the Chinese University of Hong Kong. Numerous scholars and practitioners from Hong Kong and four other countries presented, some with support from an associated grant from the Arts and Humanities Research Council (UK). Rather than simply publish workshop proceedings, the organisers decided to publish in a bioethics journal articles based on a selection of the presentations. We had the privilege of being visiting faculty in the Centre at CUHK during the months of the workshops and therefore became guest editors for this special issue. We are very grateful to Asian Bioethics Review for providing a venue for these timely pieces.
We chose to use presentations that focused specifically on philosophical questions raised by advance directives and euthanasia/assisted suicide. To these, we added a spirited debate on paid organ donation. This debate, which was not part of the “Dying Well” workshop, also took place at CUHK in November 2015. Finally, we included a case commentary from the workshop by a physician with the Centre on the existential and spiritual challenges raised by caring for terminally ill patients.
The Market in Organs Debate
Hundreds of thousands of people worldwide with end-stage renal disease are on waiting lists to receive kidneys, and thousands die before kidneys become available. To alleviate this situation, people are often urged to donate their organs after their deaths, by signing up with an organ donor registry, signing donor cards, or making their wishes known to family members. Live donation [End Page 159] is also permitted, although usually restricted to family members. However, while altruistic donation is encouraged, commercial transactions—paid organ donations—are prohibited in all countries, with the exception of Iran. Whether this prohibition is justified is the topic of the debate between philosophers Alastair Campbell and Cansu Canca that opens this special issue.
Campbell begins by acknowledging the massive gap between the demand for organs and the available supply. Supporters of a regulated market in organs believe it would help to alleviate the crisis. Campbell argues that it would more likely make it worse. More importantly, he thinks that even if a market in organs would save lives, it would be in principle wrong, “since it commodifies the human body and inevitably exploits the poor and socially vulnerable”. Noting that slavery is in principle wrong because it turns the human person into a thing that has a market value, Campbell makes a similar claim about a market in organs. It might be objected that compensating people for their organs does not enslave them so long as their choice is truly voluntary. Campbell replies that this is not possible because any market in organs will be inevitably exploitive.
Canca rejects both of Campbell’s claims. She cites many studies purporting to show that a market system would reduce, if not eliminate, the shortage of organs. As for non-voluntariness and coercion, she points out that the current system of voluntary donation also runs these risks, at least in the case of living donation. How free is the choice not to provide a family member with a kidney when the alternative is that person’s death? This situation may be exacerbated by feelings of shame or guilt, or isolation imposed by other family members. With regard to the impact on the poor and socially vulnerable, Canca points out that chronic and end-stage renal disease disproportionately affect lower social-economic groups who would more likely benefit from a well-regulated market in which many more of those receiving dialysis would instead be provided kidneys. Canca believes that concerns about exploitation stem from the illegal organ trade. By contrast, a legal and well-regulated market would not, she argues, harm or exploit people and would in fact save thousands of lives a year.
Advance Directives: Justification and Challenges for Public Policy
In “Advance Care Planning: What Gives Prior Wishes Normative Force?” philosopher Nancy Jecker examines the philosophical justification of advance directives (ADs). Critics have attacked ADs on the ground that...
