A Defense of the Obligation to Keep Promises to the Dead.

It is widely held that to break a promise that one made to a person who is now dead would be to wrong her. This view undergirds many positions in bioethics, ranging from those that concern who may access a person's medical records after she has died, to questions concerning organ procurement and posthumous procreation. Ashley Dressel has argued that there is no reason to believe that promissory obligations can be owed to people who are dead.

Platelets, Puppies, and Payment: How Surveys can be Misleading in the Remuneration Debate.

In a recent article ("The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages") published in Transfusion, Stubbs et al. have argued that platelet donors should be paid. Dodd et al.

Social Autonomy and Family-Based Informed Consent.

The Western focus on personal autonomy as the normative basis for securing persons' consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor's wish to donate after she has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept.

The Irrelevance of Harm for a Theory of Disease.

Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield's harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns (dysfunctions) in evolved mechanisms that cause significant harm to the organism.

Why Prohibiting Donor Compensation Can Prevent Plasma Donors from Giving Their Informed Consent to Donate.

In recent years, there has been a considerable increase in the degree of philosophical attention devoted to the question of the morality of offering financial compensation in an attempt to increase the medical supply of human body parts and products, such as plasma. This paper will argue not only that donor compensation is ethically acceptable, but that plasma donors should not be prohibited from being offered compensation if they are to give their informed consent to donate. (While this paper will focus on the ethics of compensating plasma donors, its arguments are also applicable to the ethics of offering compensation for other body parts, such as kidneys.

From Directed Donation to Kidney Sale: Does the Argument Hold Up?

The UCLA Medical Center has initiated a "voucher program" under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections.

WTF WHO?

How can healthcare systems gain self-sufficiency in their procurement and distribution of blood and blood products efficiently while maintaining a degree of relatively equitable access for patients? This is a question that, at first look, the World Health Organization (WHO) has answered in detail by advocating for self-sufficiency through non-remunerated blood donation. This essay serves two purposes. First, it illustrates key differences between the WHO's policy recommendations and the realities of healthcare.

Moral repugnance, moral distress, and organ sales.

Many still oppose legalizing markets in human organs on the grounds that they are morally repugnant. I will argue in this paper that the repugnance felt by some persons towards sales of human organs is insufficient to justify their prohibition. Yet this rejection of the view that markets in human organs should be prohibited because some persons find them to be morally repugnant does not imply that persons' feelings of distress at the possibility of organ sales are irrational.

Public moralities and markets in organs.

Schweda and Schicktanz argue that the debate over the ethics of using financial incentives to procure human transplant organs rests on socioempirical premises that need to be critically assessed. They contend that once this is achieved a completely new perspective on the debate should be adopted, with organ donation being viewed primarily as a reciprocal social interaction between donor and recipient. This paper challenges this conclusion, arguing that rather than supporting a new perspective on the debate over the commercial procurement of organs, the observations of Schweda and Schicktanz support the view that human organs should be commercialized.

Market-based reforms in health care are both practical and morally sound.

In this paper I argue that the free-market provision of health care is both practical and morally sound, and is superior in both respects to its provision by the State. The State provision of health care will be inefficient compared to its free-market alternative. It will thus provide less health care to persons for the same amount of expenditure, and so save fewer lives and alleviate less suffering for two reasons: state actors have no incentive to husband their resources effectively, and that in a non-market setting, special interest groups can capture resources through lobbying, perverting them away from their efficient allocation.

The value of autonomy and the right to self-medication.

In 'Three Arguments Against Prescription Requirements', Jessica Flanigan argues that 'prescription drug laws violate patients' rights to self-medication' and that patients 'have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC), claiming that the strongest of these reasons is grounded on the value of autonomy. However, close examination of the moral value of autonomy shows that rather than being the strongest justification for the DIC, respect for the value of autonomy is actually the weakest, and it is dependent upon the first two well-being-based justifications for the DIC. Recognising this has important implications for Flanigan's argument against prescription requirements.

Titmuss revisited: from tax credits to markets.

Petersen and Lippert-Rasmussen argue that persons who decide to be organ donors should receive a tax break, and then defend their view against eight possible objections. However, they misunderstand the Titmuss-style concerns that might be raised against their proposal. This does not mean that it should be rejected, but, instead, that when it is reconfigured to meet the Titmuss-style charges against it, they should support legalizing markets in human organs rather than merely offering tax breaks to encourage their donation.

Introduction: HEC Forum special issue on privacy and commodification.

The papers in this special thematic issue of HEC Forum critically and carefully explore key issues at the intersection of patient privacy and commodification. For example, should hospitals be required to secure a person's consent to any possible uses to which his discarded body parts might be put after his treatment or should it only be concerned with securing his informed consent to his treatment? Should a hospital be required to raise the possibility of the commodification of such (patient-discarded) body parts, or should it only be required to address this issue if the patient asks about it? Should persons be paid to engage in medical research, or should they only be compensated for their time, on the grounds, perhaps, that such payment would be coercive or exploitative, for it might move some persons to agree to participate in research who otherwise would not have done? This number of HEC Forum illustrates the widespread implications of these issues upon which healthcare ethics committees are called to deliberate.