Bioethics in Daily Life Day 9 Prof Connie

This week • Organ donation/exploitation – – – • Organ donation/wait lists/commodification of organs Exploitation of individuals in developing countries/poor people Informed consent/issue of greater good Reading – Bioethics at the Movies • Chpt 11 (Commodification, exploitation, and the market for transplant organs/Dirty Pretty Things) • Chpt 18 (“If you could cure cancer by killing one person, wouldn’t you have to do that? ”/Extreme Measures) – • • A shocking discovery, Semeniuk, Nature, Oct 4, 2010, 467: 645 http: //www. nature. com/news/2010/101004/full/467645 a. html Video – Never Let Me Go Oral presentations – Robots/personhood/personal identify C. Mulligan, Copyright 2011 2 All rights reserved

Next week • Right to die – – – • Withdrawal of life-sustaining treatment Right to die Relevance to people with disabilities Reading – Bioethics at the Movies – Chpt 14 (False images: Reframing the end-of-life portrayal of disability in Million Dollar Baby) – Chpt 15 (“I can’t be like this, Frankie, not after what I’ve done”: Million Dollar Baby and the value of human lives) • • Video – Million Dollar Baby Oral presentations – – Organ commodification/exploitation (For/Against) Greater good justifies harming few (For/Against) C. Mulligan, Copyright 2011 3 All rights reserved

Changes to class • http: //www. clas. ufl. edu/users/cmulligan/Webpage/Bioethics. 2011/SYLLABUS. htm • Change in groups – – Group 1: Sue, Emma, Abigail, Jie, Carrie Group 2: Salah, Amber, Michelle, Anna Group 3: Rochelle, Kirsten, Angad, Trish Group 4: Miguel, Michael, Nicole, Corey • Still do weekly presentations, but sign up for contrary position to stimulate more discussion – Also, leave more time for discussion • All students will give 3 oral presentations – Designed groups to make this possible – If you have given 3 presentations, you’re done! – If you have only given 1 presentation, be sure to get 2 more in (we have 5 more weeks after today) – If you are unsure how many presentations you’ve given, ask me C. Mulligan, Copyright 2011 4 All rights reserved

Also, new after spring break • Each group project must include at least one peerreviewed journal article – Be sure to include a reference to the article in your ppt and not an online discussion of the article – Mulligan et al. Science, 2006, http: //www. ncbi. nlm. nih. gov/pubmed/17138883 • Paper – 100 pts – In-depth analysis of a bioethical issue of your choice – There must be a clear scientific aspect to the issue and you must explain the science and how it relates to your chosen bioethical issue, in addition to developing the bioethical issue – You must include at least 3 scientific peer-reviewed articles – The expected length ~3000 words, or ~5 -7 single-spaced C. Mulligan, Copyright 2011 pages. 5 All rights reserved

How many people are organ donors? C. Mulligan, Copyright 2011 6 All rights reserved

Organ donation • All major religions allow organ donation in some form – Orthodox Jews consider organ donation obligatory if is will save a life • Relatives can over-ride a loved one’s decision to donate organs C. Mulligan, Copyright 2011 7 All rights reserved

Organ donation • In US, 108, 000 people on organ wait list • Most people are not able to give organs when they die because of infection, poor condition of organs, incompatibility, etc – Range from 34 donors per million inhabitants (Spain) to zero in many countries • Wait is longest for kidney (> 1 year) because dialysis patients live much longer today and shorter for heart or pancreas or liver because demand is less C. Mulligan, Copyright 2011 8 All rights reserved

Distribution of organs • Distribution of organs takes into account the following: distance of transplant center from the donor hospital, blood type, medical urgency, wait time, donor size and tissue typing • Location of transplant center is important because organs start dying once blood no longer perfuses them – Hearts and lungs need to be transplanted within 4– 6 hours – Liver ~ 8– 10 hours, pancreas ~ 15 hours – Kidneys are the most resilient and can be successfully transplanted after 24– 36 hours C. Mulligan, Copyright 2011 9 All rights reserved

Fox News – presumed consent upon death for organ donation • http: //video. foxnews. com/v/4170376/organdonation-controversy – Two parts to proposed law • Part 1 – relatives can’t over-ride loved one’s decision to donate organs • Part 2 – Opt-out box on DMV application would have to be checked or your organs could be used – Opt-out bill in Delaware died in 2008 – Spain, Austria, Belgium have opt-out laws that seem to be working • An additional 21 European countries have ‘softer’ opt-out laws C. Mulligan, Copyright 2011 10 All rights reserved

US organ donor ads • http: //www. bing. com/videos/watch/video/anew-day-organ-donationcommercial/f 3980 a 81 bf 7 dc 2 e 6729 ff 3980 a 81 bf 7 dc 2 e 6729 f 420314939666? q=organ+donation&FROM=L KVR 5&GT 1=LKVR 5&FORM=LKVR 34 C. Mulligan, Copyright 2011 11 All rights reserved

UK organ donor ads • http: //www. bing. com/videos/watch/video/organdonation-tvadvert/4 e 5 e 45 af 923455 a 1 fe 484 e 5 e 45 af 923455 a 1 fe 4 8419804545126? q=organ+donation&FROM=LKVR 5 &GT 1=LKVR 5&FORM=LKVR 30 • http: //news. sky. com/skynews/Home/video/Organ. Donation-Should-It-Be-Compulsory-After. Death/Video/201005315632677 C. Mulligan, Copyright 2011 12 All rights reserved

Ethics of organ donation • Kieran Healey, Duke University http: //www. bing. com/videos/watch/video/conversa tions-in-ethics-kieran-healy-on-the-ethics-of-organ donation/eb 1 d 2580 d 19 ca 54425 b 3 eb 1 d 2580 d 19 ca 5 4425 b 3415218468037? q=organ+donation&FROM=LKVR 5 &GT 1=LKVR 5&FORM=LKVR 36 • Ask, pay, or presume? C. Mulligan, Copyright 2011 13 All rights reserved

What about prisoners? • Should prisoners be equally eligible for organ transplants? – They currently are and medical costs associated with the surgery and followup care can cost the prison system ~1 million dollars • Some states allow compassionate early release to avoid the high costs associated with the organ transplant C. Mulligan, Copyright 2011 14 All rights reserved

What about prisoners? • Should prisoners be equally eligible for organ transplants? – What about felons with a history of murder, rape, violence, etc? C. Mulligan, Copyright 2011 15 All rights reserved

What about prisoners? • Should prisoners be given shortened sentences if they donate blood marrow or kidneys? – Ethicists say no because the person isn’t able to consent in a free and non-coercive environment C. Mulligan, Copyright 2011 16 All rights reserved

Video C. Mulligan, Copyright 2011 17 All rights reserved

Discussion – greater good • What did Miss Emily mean when she said they were trying to answer a question at Hailsham that no one was asking? • Why was no one asking the question? C. Mulligan, Copyright 2011 18 All rights reserved

Discussion • Is it ever morally permissible to sacrifice lives so that a greater number may benefit? – US scientists have done morally questionable things (like infect Guatemalan inmates with syphilis to see if penicillin could be used prophylactically) because they thought the situation was so dire that it required extreme measures C. Mulligan, Copyright 2011 19 All rights reserved

Discussion • If yes, does it matter how the donors are treated? – Hailsham seemed like a nice place, donors were given homes, food, etc for free for life – There is reference in the movie to Hailsham closing and the other institutes not being nice but like factories • Do you think there is a temptation to reduce the costs of the system once it’s been in place awhile and everyone counts on it? C. Mulligan, Copyright 2011 20 All rights reserved

Discussion - Organ commodification • Should there be a legal market for sale of organs? – If no, shouldn’t people have the right to decide what to do with their organs, including selling them? – If yes, will it further exploit people who are already economically disadvantaged? C. Mulligan, Copyright 2011 21 All rights reserved

Discussion • In terms of selling organs, do you think people selling their organs are paid too little? – Legal and black market prices vary from $150$5000 and an average in Chennai, India’s back market is ~$1000 C. Mulligan, Copyright 2011 22 All rights reserved

Discussion • In terms of selling organs, do you think people selling their organs are paid too little? – Legal and black market prices vary from $150$5000 and an average in Chennai, India’s back market is ~$1000 – What might happen if they were paid more, like a market rate for organs? C. Mulligan, Copyright 2011 23 All rights reserved

Discussion • In terms of selling organs, do you think people selling their organs are paid too little? – Legal and black market prices vary from $150$5000 and an average in Chennai, India’s back market is ~$1000 – What might happen if they were paid more, like a market rate for organs? – Do you think people in the US would sell their organs? C. Mulligan, Copyright 2011 24 All rights reserved