Rivista per le Medical Humanities
Alberto Bondolfi
rMH 7, 2008, 11-23
General ethical considerations on a practice in continual development
This article gives a general overview of the ethical debate over the practice of organ transplants. A description of the historical background of this debate, which was originally dominated by the views of the Christian Church, will be followed by an account of the reasons that have brought about the introduction of «brain death» as the new criterion. Problems arising from the possible commercialization of organs are further considered, as well as the definition of criteria that might permit a free and equitable distribution of organs. Finally, more specific issues arising from the new Swiss regulation are considered and discussed, with particular regard to the distribution of organs.
Simone Romagnoli
rMH 7, 2008, 24-26
Who am I now? Identity and transplants
Since its origins philosophy considers the being under the category of determination; being a thing means being a determined thing, and to persist over time means to persist as one and the same thing. This metaphysical presupposition leads the theorists to consider the question of identity in three ways: class differentiation (a man isn’t a wolf, an animal is not a tree), individuation (John isn’t Paul) and re-identification (this person in front of me is the same person I met ten years ago). The “identity crisis” experienced by people who have had transplants seems to contradict the interpretation of the being in the category of determination. It is therefore necessary to give sense to these experiences to reconsider the role of change in our existence. Is aesthetic surgery properly medicine? The answer comes from the meaning of the whole action and not from the analysis of its parts or conditions. An artificial manipulation of the body deserves to be qualified as a clinical act not because it simply requires technical skills, nor because some pathological consequences may occur (if a layman implements it), but if the procedure is performed in order to care for an ill person. The purpose of health care may take different forms: prevention, cure, pain killing, palliative help, nursing assistance, rehabilitation. If no illness exists or is foreseen, the mere informed, competent, free request of a paying citizen to undergo a bodily modification (as in cases of piercing, body-artists’ performances, religious circumcisions) should be considered as an expression of a non-clinical need. It is more a desire that a physician has no duty to (and sometimes he must not) satisfy, unless a state law imposes it for the sake of public good, of a peaceful social life, or in order to avoid a bigger evil. A surgeon is not a beauty improvement professional. In the contemporary world, the practice of organ transplants can be justified, more than from a utilitarian logic, but as an example of values (altruism, collaboration, solidarity) shared on an individual level by therapeutic institutions and by society. This requires an extensive consensus on the procedures that permit it, as currently occurs with respect to donation in a state of brain death. The reserves of the public and the resuscitation staff with respects to donation in cardiac arrest, perceived and transmitted as such by the operators themselves, are an indisputable reality that cannot be overcome without clearing the transplant of the symbolic values that justify it.
Paolo Marino Cattorini
rMH 7, 2008, 27-31
Another face, please
Is aesthetic surgery properly medicine? The answer comes from the meaning of the whole action and not from the analysis of its parts or conditions. An artificial manipulation of the body deserves to be qualified as a clinical act not because it simply requires technical skills, nor because some pathological consequences may occur (if a layman implements it), but if the procedure is performed in order to care for an ill person. The purpose of health care may take different forms: prevention, cure, pain killing, palliative help, nursing assistance, rehabilitation. If no illness exists or is foreseen, the mere informed, competent, free request of a paying citizen to undergo a bodily modification (as in cases of piercing, body-artists’ performances, religious circumcisions) should be considered as an expression of a non-clinical need. It is more a desire that a physician has no duty to (and sometimes he must not) satisfy, unless a state law imposes it for the sake of public good, of a peaceful social life, or in order to avoid a bigger evil. A surgeon is not a beauty improvement professional.
Pietro Majno
rMH 7, 2008, 32-37
The practice of organ transplants from non-heart-beating donors
In the contemporary world, the practice of organ transplants can be justified, more than from a utilitarian logic, but as an example of values (altruism, collaboration, solidarity) shared on an individual level by therapeutic institutions and by society. This requires an extensive consensus on the procedures that permit it, as currently occurs with respect to donation in a state of brain death. The reserves of the public and the resuscitation staff with respects to donation in cardiac arrest, perceived and transmitted as such by the operators themselves, are an indisputable reality that cannot be overcome without clearing the transplant of the symbolic values that justify it.
Christine F. Maurus
Daniel Dindo
Reto Stocker
Markus Weber
rMH 7, 2008, 38-41
Medical legal and ethical aspects in retrieving organs from donors without a heartbeat
Organ transplants today is a medically accepted procedure and the best if not the only treatment for multiple diseases such as end-stage liver disease, severe heart failure and lung diseases, and end-stage kidney disease. There are three different organ sources for transplants: living donors, brain-dead donors and donors after irreversible cardiac arrest (non-heart-beating donors). With increasing success of organ transplants, the number of patients waiting for an organ constantly rise whereas the number of available organs from brain-dead donors has remained stable. Faced with patients who died on the waiting list before a suitable organ became available, the search for alternative organ sources was put in motion. A protocol for retrieving organs from non-heart-beating donors was developed in 1993 in Pittsburgh, USA, and was further defined during an international workshop in 1995 in Maastricht, Netherlands. The medico-ethical standards “do not harm” the donor’s body, by beginning procedures for organ preservation which are not directed towards saving the donor’s life but towards protecting his or her organs that may conflict with “protecting life” of the recipient by organ transplant. To date, it is illegal in Switzerland to start any diagnostics or treatment not directed towards the patient’s care but to organ preservation, before consent to donate organs has been given. At present however, the SAMW guidelines and transplant law do not in fact allow non-heartbeating donations in daily practice as affirmative statements by the potential donor, allowing for preparatory measures before entry of death that are normally lacking. The different ethical issues of protecting a potential donor and of allowing organ retrieval that is potentially life saving for the recipient, need to be balanced.
Bernard Baertschi
rMH 7, 2008, 83-89
Dignity, instrumentalization and humiliation
Human dignity is now frequently invoked in ethical debates. But what is the exact meaning of this concept? A survey of the Swiss Constitution shows that respect of dignity implies respect of freedom and equality, and the prohibition of instrumentalization and degrading treatments, i.e. humiliation. The Kantian aspect of instrumentalization’s prohibition is the reason why we have so much analysis of it in bioethical debates; but it does not explain the neglect of the other dignitary harm, humiliation. This paper underlines the importance of this other harm, and shows that, on an emotional level it has much more appeal than instrumentalization, especially when it is linked to shame.
Alberto Bondolfi
rMH 7, 2008, 90-95
Dignity, otherness and justice
Dignity, otherness, justice, and the tenuous link they share. Three useful concepts for those who, even before using them in their every day talk, experience it in the intimacy of their professional conflicts and problems. The relationship of care calls upon them constantly and is therefore suitable to re-examine them so they can become instruments of rational and empathic reflection at the same time.
Paolo Marino Cattorini
rMH 7, 2008, 96-101
Beyond rights: ethical advice
Several patients’ Rights Acts have been approved to defend the worthiness and to satisfy the needs of vulnerable people in condition of disease and in the health care process. Unfortunately, the rhetorical use of the term “right” carries some misunderstandings and spreads confusion about the meaning, limits and foundations of such claims. This article tries to clarify the ethical dimensions of the relationship between rights and duties in health care institutions, and proposes to establish clinical ethics divisions, where the patient, the family, the staff and the administrator could find experts in ethics and medical humanities to help deal with moral dilemmas and to debate, deepen and possibly solve them.
