Abstract
The paper argues that the idea of gift-giving and its associated imagery, which has been founding the ethics of organ transplants since the time of the first successful transplants, should be abandoned because it cannot effectively block arguments for (regulated) markets in human body parts. The imagery suggests that human bodies or their parts are transferable objects which belong to individuals. Such imagery is, however, neither a self-evident nor anthropologically unproblematic construal of the relation between a human being and their body. The paper proposes an alternative conceptualization of that relation, the identity view according to which a human being is identical with their living body. This view, which offers a new ethical perspective on some central concepts of transplant medicine and its ethical and legal standards and institutions, supports widely shared intuitive ethical judgments. On this proposal, an act of selling a human body or one of its parts is an act of trade in human beings, not in owned objects. Transfers of human body parts for treatment purposes are to be seen as sharing in another human being’s misfortune rather than as giving owned objects. From the perspective of policy-making, the proposal requires, first, that informed consent for removal of transplant material be obtained from the potential benefactor. Secondly, explicit consent by the prospective benefactor is obligatory in the case of removal of transplant material from a living benefactor. Thirdly, in the case of posthumous retrieval, informed consent by the potential benefactor during their life is not ethically indispensable. Additionally, while refusal of posthumous retrieval expressed by a potential benefactor during their life must be respected, such a refusal needs ethical justification and explanation.
Highlights
The idea of gift-giving or donation and associated imagery has been the foundation of the ethics of organ transplants since the time of the first successful transplants in the 1950s (Hamilton 2012)
To the extent to which individuals are rights holders, decisions to donate made by living human beings are indispensable for legitimate removal of transplant material from them
It has been argued that the gift-giving metaphor associated with transplant ethics, albeit helpful in many respects, is based on the perception of the human body as an object of more or less exclusive control, which is akin to property
Summary
In the account of the identity of human beings and their bodies, a decision to allow others to remove a body part in order for it to be transferred into someone else is an exercise of a personal right such as, among others, the right to self-determination or privacy. The identity approach is more adequate anthropologically than the gift-giving imagery but it can support a more plausible view of the ethics of organ transplant by being adapted to the nature of human social interactions.
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