Bioethical Issues

1. Bioethical Issues • Corneal Transplantation • Who should receive corneas? • An issue of distributive justice • Limited supply of corneas • Need to answer: How are we to fairly distribute this scarce resource? • Possible answers: • Equal access • Maximum benefit

2. Bioethical Issues • Equal access • Based on objective criteria like age or length of time waiting • Transplantation is a benefit everyone needing it is worthy of • Selection free of biases like race, sex, income, geographic location • May even exclude medical and social biases • Medical biases e.g. lifestyle or behavioral choices that led to patient’s organ being damaged in the first place • Even such criteria as say, probability of transplant success, probable remaining life span of patient

3. Bioethical Issues • Equal access • Social biases e.g. patient’s place and contribution to society • Say, a doctor with keratoconusvs a janitor, both needing transplants…Who should get it? An elderly business man or a young, fit lowly government employee? • Equal access says: 1. Individual worth has nothing to do with medical need. 2. Who should even judge people as worthy? 3. Judging worthiness is a path to a slippery slope.

4. Bioethical Issues • Maximum benefit • Maximize success of transplants • Because organs are very scarce resources • Examples of criteria: probability of success, medical need(who is sickest), how long will the organ function? • Say a corneal recipient develops failure of his transplant, does she still deserve another one? • If a patient has a psychiatric illness or is suicidal, does she deserve a transplant?

5. Bioethical Issues • Maximum benefit • Arguments against: • 1. It is difficult to predict medical success.(Or for that matter…how do you define success?) • Years an organ functions after transplant? • Quality of life after transplant? • 2. From 1., it’s a slippery slope down: • Open doors to bias, favoritism, etc. • 3. Using criteria like remaining life span or transplant success devalues life • Is one person’s remaining life span less valuable or worthy than anyone else’s life span?

6. Bioethical Issues • Governed by RA 7785 with reference to RA 7170 aka Organ Donation Act of 1991 • Basically, corneas like other organs are donated in the manner of “movable property” • Movable property – private property as opposed to immovable property like land or buildings • If consent from donor lacking, donation can be executed by spouse, child, parents, siblings or guardians • Corneas can be received by hospitals, eye banks, educational institutions or specified individuals

7. Bioethical Issues • How to increase cornea supply?: • Education – encourage people to donate…but • Would implementation unfairly pressure certain groups to donate? • Incentives – financial or payment incentives like welfare support for donor’s family…but • Some argue that incentives are inherently unfair and coercive • Say if you were a poor blue collar worker in a high risk job and were offered incentives for your corneas in the event of death, could you really make a free choice?

8. Bioethical Issues • Mandated choice – mandate everyone to state in some legal document (e.g. income tax return) whether they wish to donate an organ or not…but • Would you trust your if you become gravely ill doctors to still care for you as a human being and not look at you as just a potential bag of donatable organs

9. Bioethical Issues • Presumed consent – unless stated by the person otherwise otherwise, every citizen of this country is a potential organ donor • Organ donation can be construed as a civic duty of every citizen • You can also say this is coercive and unfair

10. Bioethical Issues • Condemned prisoners – take corneas from those executed • The death penalty is not in effect in the Philippines

11. Sources • http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf • http://www.chanrobles.com/republicactno7885.htm