Journal of Medicine and Philosophy, 39: 217–222, 2014 doi:10.1093/jmp/jhu016
Why Public Moralities Matter—The Relevance of Socioempirical Premises for the Ethical Debate on Organ Markets Mark Schweda* Silke Schicktanz University Medical Center Göttingen, Göttingen, Germany *Address correspondence to: Mark Schweda, Dr, Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany. E-mail: [email protected]
The ongoing bioethical debate about organ markets rests not only on theoretical premises, but also on assumptions regarding public views of and attitudes toward organ donation that need closer socioempirical examination. Summarizing results from our previous qualitative social research in this field, this paper illustrates the ethical significance of such public moralities in two respects: On one hand, it analyzes the implicit bias of the common rhetoric of “organ scarcity” which motivates much of the commercialization debate. On the other hand, it explores the blind spots of the paradigm of “altruistic donation” which informs many arguments against commercialization. We conclude that the ethical discourse has to appreciate the social nature of organ donation as a reciprocal interaction between different parties with irreducibly different but equally relevant viewpoints. We criticize the neglect of such well-founded public considerations in certain philosophical-ethical approaches and stress the need for further systematic and comparative socioempirical studies about peoples’ actual perspectives in bioethics. Keywords: altruism, commercialization, organ donation, organ scarcity, social research, transplantation medicine It is indeed breathtaking to see how, over the last 10 to 15 years, the debate on the commercialization of organ donation has turned from a highly © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: [email protected]
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
University Medical Center Göttingen, Göttingen, Germany
218
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
scandalized and emotional clash of controversial standpoints to the settled, philosophically sophisticated academic—at times almost scholastic—discourse evident in the recent issue of the Journal of Medicine and Philosophy (34.6). We agree with Benjamin Hippen that the whole debate “relies on answers to a series of more general philosophical problems” (Hippen, 2009, 546). At the same time, however, we would like to add that it also rests on certain socioempirical premises that need to be made explicit and reassessed critically. In a series of studies, we focused on—often implicit—assumptions made by academics about peoples’ attitudes toward and motives for organ donation and organ sale. As a result, we suggest that the question whether it is ethically justified to introduce a regulated market for transplantable organs in western, industrialized countries such as North American or European countries (where we observe a similar debate) should be examined in an adequate framework—which is also a socioempirical one. We have been carrying out qualitative socioempirical research in the field of organ transplantation for several years, especially in focus group discussions with organ recipients, their relatives, and lay persons in six European countries: Austria, Cyprus, France, Germany, the Netherlands, and Sweden.1 As detailed results have been published in a number of research articles in various journals, we want to use this opportunity to summarize our findings in view of a critical reexamination of the academic debate. We will substantiate our claim with regard to two central examples from the discussion in the aforementioned thematic issue: The paradigm of organ scarcity and the idea of altruistic donation. The concept of “organ shortage” or “organ scarcity” constitutes one of the basic premises of many arguments in favor of commercialization. In the thematic issue, for example, Mark Cherry argues that some form of instrumentalization is inherent in the very practice of organ transplantation itself, no matter whether the organs are donated or purchased (Cherry, 2009, 654). To illustrate that organs are actually treated as a resource, Cherry quotes a statement by the American Medical Association Council on Ethical and Judicial Affairs claiming that “the shortage of organs is the most obvious example of scarcity in medical resources” (American Medical Association Council, 1993, 1). What seems obvious at first sight, however, apparently rests on implicit premises at the second: Assessing the number of available organs as too low logically implies some normative standard. In this case, it is the need of the potential recipients: the number of organs is too low, given the number of people who need one. In this sense, addressing organs as scarce resources means tacitly adopting the point of view of (former, prospective, or potential) recipients (Schicktanz and Schweda, 2009, 475). Indeed, in our qualitative empirical studies, we found that mainly organ recipients showed a tendency to speak of organs as scarce resources and to stress, like this German interviewee, “the mismatch between donors and recipients” (Mr. A., German organ recipient). In contrast, many lay persons rather tended
Why Public Moralities Matter
219
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
to take the total number of available donor organs as a given, undisputable fact. From their point of view, transplantations can be conducted—as a participant of the Dutch lay group explained—“as long as there are organs available—and that system at a certain point comes to an end” (Mr. K., Dutch lay person). This difference in perspective (organ shortage versus natural limitation of organs available) is morally relevant because it suggests different ways of framing the problem and considering solutions. Thus, for many patients who are already organ recipients, the discrepancy between the need for and the availability of donor organs constituted the central moral problem because “everybody, no matter how old he is, likes living and […] therefore he should be given the chance […] to receive a matching transplant or an auxiliary organ” (Mr. C., German organ recipient). In consequence, most patients focused on strategies of increasing the total supply through, for example, information campaigns, political initiatives, and legal regulations, “so that everybody who needs a heart, a kidney, or lungs or something [can get them]” (Mr. G., German organ recipient). The lay persons, on the other hand, rather discussed the rules and criteria for the fair allocation of the actual amount, presuming that organs and tissues will always be a limited resource (Schicktanz and Schweda, 2009, 475). This interesting gap between interpretations of organs as “natural resources” that are eo ipso rare and limited and interpretations of organs as producible materials that are a priori supposed to meet the demand hints at a morally relevant evaluation that is often not reflected in the academic world. In this light, the concept of organ shortage appears neither self-evident nor unproblematic. It seems to be based on a preconception of the situation formed from the point of view of recipients and thus takes sides with the perspectives, interests, and concerns of only one of the parties involved. This one-sidedness can narrow the ethical scope of debate: once the quantity of donor organs is defined as the central moral problem, the search for solutions focuses on strategies of increasing this “supply”, such as financial incentives. A discussion of how to reduce the “demand” (e.g., by prevention) or to deal with the given amount (e.g., by fair allocation) is likely to be neglected. It is the duty of ethicists to be very clear and reflective about such underlying perspectives and their ethical implications (Schicktanz and Schweda, 2009, 476). On the other hand, the central reference point for arguments against commercialization is the idea of altruistic donation. Thus, Davis and Crowe refer to an “ethic of gifting” (Davis and Crowe, 2009, 597) based on “the virtue of generosity” in order to make their point that the commercialization of organ donation would “undercut and dispense with the virtue of generosity in the exchange of human organs and replace it with an economic-financial calculus focused on gain” (Davis and Crowe, 2009, 599). On closer inspection, however, the claim that the practice of organ donation is indeed governed by motives of altruism and generosity is actually an empirical assumption which therefore—as Cherry (2009, 656) also points out in his response—has to be
220
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
examined empirically as well. In the light of our own empirical studies, serious doubts have to be put forward regarding the paradigm of altruistic donation. Thus, although it was clearly preferred to the market model by most of our focus group participants, the idea of donation was at the same time also regarded as problematic because it leaves no room for the recipients’ experience that receiving an organ creates implicit moral bonds and liabilities that are hard to fulfill. In this vein, many of our focus group participants (both patients and lay persons) stressed that accepting a donor organ requires a modest attitude on the part of the recipients. It can make them “feel very guilty because they can’t give it back anymore.” Thus, “someone has given an organ to that other person; that other person needs to be modest enough to accept it, because he cannot do something in return for the person who donated his liver or his kidney” (Ms. V., Dutch lay person). Some lay people even considered this sense of indebtedness as an argument against accepting a donor organ at all because they felt unable to “do enough in return” (Mr. N., Dutch lay person) and feared they would feel guilty for the rest of their lives without the prospect of “settling their account” (Schweda and Schicktanz, 2009, 1133). In fact, almost all participating organ recipients also raised concerns over the complexity of giving and taking, instead of seeing organ donation as a purely altruistic, unidirectional act. In this sense, we found that the strict dichotomy between the idea of purely altruistic donation and market-oriented models underlying much of the academic debate does not reflect the actual perceptions and conflicts of the affected persons themselves. At least for the parties involved personally, the relevant and precarious line of demarcation between what is viewed as acceptable or not does not seem to pit the idea of altruistic donation against the profit-oriented market model, but rather the reciprocal spirit of gift exchange—of giving, receiving, and returning gifts—against both (Schweda and Schicktanz, 2009, 1134). This empirical observation, even if qualitative, is highly significant because it breaks up the accustomed front lines of the debate and opens a completely different perspective: On the one hand, it implies that models involving monetary payments are not perceived as objectionable per se, as long as they are compatible with the principle of reciprocity, which holds true, for example, for forms of compensation and “rewarded gifting”. On the other hand, it also indicates that the mere absence of cash payments does not necessarily make a model of organ procurement more acceptable because nonmonetary models can still infringe on the principle of reciprocity, for example, by appealing to egoistic interests or nonpecuniary greed (Schweda and Schicktanz, 2009, 1134). Therefore, it is important for the ethical-philosophical debate to be more critical concerning the normative framing of organ donation: In practice, especially in living organ donation, empirical information shows that various forms of reciprocity prevail. This could be ethically justified by the morally and culturally loaded meaning a living organ has for the healthy donor and the ill recipient. To our understanding, possible ways of taking
Why Public Moralities Matter
221
Notes 1. Focus group discussion is an appropriate qualitative method to explore arguments, critiques, and positions among the public or patients. In the EU-Project Challenges of Biomedicine, we conducted two focus groups, with on average 7 participants, respectively, in each country. The selection of the participants took place with regard to high heterogeneity of educational and religious background, gender parity, and different levels of illness experience. For a general overview of the research design and the main findings of this EU-funded project, see http://www.univie.ac.at/virusss/cobpublication.
References American Medical Association Council on Ethical and Judicial Affairs. 1993. Ethical Considerations in the Allocation of Organs and Other Scarce Medical Resources Among Patients [Online]. CEJA Report K-A-93 Available: http://www.ama-assn.org/resources/ doc/ethics/x-pub/ceja_ka93.pdf (accessed April 16, 2014).
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
this significance of reciprocity into account could be sociocultural rituals of expressing gratitude; of public recognition of the donors’ act and also a more pronounced discussion of the role of reciprocity for allocation rules (Schweda, Woehlke, and Schicktanz, 2009, 2511). Overall, these empirically based considerations have one thing in common: they remind us that an appropriate theoretical and practical framework for organ donation has to take into account the actual views and standpoints of all parties involved and concerned (Schicktanz, Schweda, and Wynne, 2012). In this respect, our findings hint at a certain one-sidedness of the academic and political debate which often focuses either only on the (actual or potential) recipients and their needs when defining the basic problem of transplantation in terms of “organ scarcity” or—vice versa—on the donors and their altruistic or profit-oriented motivations to donate when it comes to procurement strategies. On the basis of our empirical results and in line with theoretical contributions (Healy, 2006), we strongly recommend avoiding such unilateralism in the discussion of transplantation medicine: Both sides should widen their scope and gain an appreciation of the social nature of organ donation as a reciprocal interaction between different parties with irreducibly different but—at least prima facie—equally relevant and legitimate perspectives and interests (Schweda and Schicktanz, 2009, 1135). A current systematic overview of quantitative surveys on public attitudes toward commercialization confirms public reluctance regarding commercialization and support for reciprocity models. At the same time, the methodological heterogeneity of existing empirical studies becomes clear (Hoeyer, Schicktanz, and Deleuran, 2013). More systematic and comparative socioempirical studies on peoples’ actual attitudes toward organ donation and their ideational and motivational backgrounds are needed. They can help to critically reflect our empirical premises and contribute to a more “empirically informed” approach (Musschenga, 2005) to the ethics of organ donation.
222
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
Cherry, M. J. 2009. Why should we compensate organ donors when we can continue to take organs for free? A response to some of my critics. Journal of Medicine and Philosophy 34:649–73. Davis, F. D. and S. J. Crowe. 2009. Organ markets and the ends of medicine. Journal of Medicine and Philosophy 34:586–605. Healy, K. 2006. Last Best Gifts. Altruism and the Market for Human Blood and Organs. Chicago, IL: The University of Chicago Press. Hippen, B. E. 2009. Introduction: Symposium on a regulated market in transplantable organs. Journal of Medicine and Philosophy 34:545–51. Hoeyer, K., S. Schicktanz, and I. Deleuran. 2013. Public attitudes to financial incentive models for organs: A literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity.’ Transplant International 26:350–7. Musschenga, A. W. 2005. Empirical ethics, context-sensitivity, and contextualism. Journal of Medicine and Philosophy 30:467–90. Schicktanz, S. and M. Schweda. 2009. “One man’s trash is another man’s treasure”: Exploring economic and moral subtexts of the “organ shortage” problem in public views on organ donation. Journal of Medical Ethics 35:473–6. Schicktanz, S., M. Schweda, and B. Wynne. 2012. The ethics of ‘public understanding of ethics’—Why and how bioethics expertise should include public and patients’ voices. Medicine, Health Care and Philosophy 15:129–39. Schweda, M. and S. Schicktanz. 2009. Public ideas and values concerning the commercialization of organ donation in four European countries. Social Science & Medicine 68:1129–36. Schweda, M., S. Woehlke, and S. Schicktanz. 2009. Understanding public skepticism toward organ donation and its commercialization: The important role of reciprocity. Transplantation Proceedings 41:2509–11.
Why Public Moralities Matter—The Relevance of Socioempirical Premises for the Ethical Debate on Organ Markets Mark Schweda* Silke Schicktanz University Medical Center Göttingen, Göttingen, Germany *Address correspondence to: Mark Schweda, Dr, Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany. E-mail: [email protected]
The ongoing bioethical debate about organ markets rests not only on theoretical premises, but also on assumptions regarding public views of and attitudes toward organ donation that need closer socioempirical examination. Summarizing results from our previous qualitative social research in this field, this paper illustrates the ethical significance of such public moralities in two respects: On one hand, it analyzes the implicit bias of the common rhetoric of “organ scarcity” which motivates much of the commercialization debate. On the other hand, it explores the blind spots of the paradigm of “altruistic donation” which informs many arguments against commercialization. We conclude that the ethical discourse has to appreciate the social nature of organ donation as a reciprocal interaction between different parties with irreducibly different but equally relevant viewpoints. We criticize the neglect of such well-founded public considerations in certain philosophical-ethical approaches and stress the need for further systematic and comparative socioempirical studies about peoples’ actual perspectives in bioethics. Keywords: altruism, commercialization, organ donation, organ scarcity, social research, transplantation medicine It is indeed breathtaking to see how, over the last 10 to 15 years, the debate on the commercialization of organ donation has turned from a highly © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: [email protected]
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
University Medical Center Göttingen, Göttingen, Germany
218
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
scandalized and emotional clash of controversial standpoints to the settled, philosophically sophisticated academic—at times almost scholastic—discourse evident in the recent issue of the Journal of Medicine and Philosophy (34.6). We agree with Benjamin Hippen that the whole debate “relies on answers to a series of more general philosophical problems” (Hippen, 2009, 546). At the same time, however, we would like to add that it also rests on certain socioempirical premises that need to be made explicit and reassessed critically. In a series of studies, we focused on—often implicit—assumptions made by academics about peoples’ attitudes toward and motives for organ donation and organ sale. As a result, we suggest that the question whether it is ethically justified to introduce a regulated market for transplantable organs in western, industrialized countries such as North American or European countries (where we observe a similar debate) should be examined in an adequate framework—which is also a socioempirical one. We have been carrying out qualitative socioempirical research in the field of organ transplantation for several years, especially in focus group discussions with organ recipients, their relatives, and lay persons in six European countries: Austria, Cyprus, France, Germany, the Netherlands, and Sweden.1 As detailed results have been published in a number of research articles in various journals, we want to use this opportunity to summarize our findings in view of a critical reexamination of the academic debate. We will substantiate our claim with regard to two central examples from the discussion in the aforementioned thematic issue: The paradigm of organ scarcity and the idea of altruistic donation. The concept of “organ shortage” or “organ scarcity” constitutes one of the basic premises of many arguments in favor of commercialization. In the thematic issue, for example, Mark Cherry argues that some form of instrumentalization is inherent in the very practice of organ transplantation itself, no matter whether the organs are donated or purchased (Cherry, 2009, 654). To illustrate that organs are actually treated as a resource, Cherry quotes a statement by the American Medical Association Council on Ethical and Judicial Affairs claiming that “the shortage of organs is the most obvious example of scarcity in medical resources” (American Medical Association Council, 1993, 1). What seems obvious at first sight, however, apparently rests on implicit premises at the second: Assessing the number of available organs as too low logically implies some normative standard. In this case, it is the need of the potential recipients: the number of organs is too low, given the number of people who need one. In this sense, addressing organs as scarce resources means tacitly adopting the point of view of (former, prospective, or potential) recipients (Schicktanz and Schweda, 2009, 475). Indeed, in our qualitative empirical studies, we found that mainly organ recipients showed a tendency to speak of organs as scarce resources and to stress, like this German interviewee, “the mismatch between donors and recipients” (Mr. A., German organ recipient). In contrast, many lay persons rather tended
Why Public Moralities Matter
219
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
to take the total number of available donor organs as a given, undisputable fact. From their point of view, transplantations can be conducted—as a participant of the Dutch lay group explained—“as long as there are organs available—and that system at a certain point comes to an end” (Mr. K., Dutch lay person). This difference in perspective (organ shortage versus natural limitation of organs available) is morally relevant because it suggests different ways of framing the problem and considering solutions. Thus, for many patients who are already organ recipients, the discrepancy between the need for and the availability of donor organs constituted the central moral problem because “everybody, no matter how old he is, likes living and […] therefore he should be given the chance […] to receive a matching transplant or an auxiliary organ” (Mr. C., German organ recipient). In consequence, most patients focused on strategies of increasing the total supply through, for example, information campaigns, political initiatives, and legal regulations, “so that everybody who needs a heart, a kidney, or lungs or something [can get them]” (Mr. G., German organ recipient). The lay persons, on the other hand, rather discussed the rules and criteria for the fair allocation of the actual amount, presuming that organs and tissues will always be a limited resource (Schicktanz and Schweda, 2009, 475). This interesting gap between interpretations of organs as “natural resources” that are eo ipso rare and limited and interpretations of organs as producible materials that are a priori supposed to meet the demand hints at a morally relevant evaluation that is often not reflected in the academic world. In this light, the concept of organ shortage appears neither self-evident nor unproblematic. It seems to be based on a preconception of the situation formed from the point of view of recipients and thus takes sides with the perspectives, interests, and concerns of only one of the parties involved. This one-sidedness can narrow the ethical scope of debate: once the quantity of donor organs is defined as the central moral problem, the search for solutions focuses on strategies of increasing this “supply”, such as financial incentives. A discussion of how to reduce the “demand” (e.g., by prevention) or to deal with the given amount (e.g., by fair allocation) is likely to be neglected. It is the duty of ethicists to be very clear and reflective about such underlying perspectives and their ethical implications (Schicktanz and Schweda, 2009, 476). On the other hand, the central reference point for arguments against commercialization is the idea of altruistic donation. Thus, Davis and Crowe refer to an “ethic of gifting” (Davis and Crowe, 2009, 597) based on “the virtue of generosity” in order to make their point that the commercialization of organ donation would “undercut and dispense with the virtue of generosity in the exchange of human organs and replace it with an economic-financial calculus focused on gain” (Davis and Crowe, 2009, 599). On closer inspection, however, the claim that the practice of organ donation is indeed governed by motives of altruism and generosity is actually an empirical assumption which therefore—as Cherry (2009, 656) also points out in his response—has to be
220
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
examined empirically as well. In the light of our own empirical studies, serious doubts have to be put forward regarding the paradigm of altruistic donation. Thus, although it was clearly preferred to the market model by most of our focus group participants, the idea of donation was at the same time also regarded as problematic because it leaves no room for the recipients’ experience that receiving an organ creates implicit moral bonds and liabilities that are hard to fulfill. In this vein, many of our focus group participants (both patients and lay persons) stressed that accepting a donor organ requires a modest attitude on the part of the recipients. It can make them “feel very guilty because they can’t give it back anymore.” Thus, “someone has given an organ to that other person; that other person needs to be modest enough to accept it, because he cannot do something in return for the person who donated his liver or his kidney” (Ms. V., Dutch lay person). Some lay people even considered this sense of indebtedness as an argument against accepting a donor organ at all because they felt unable to “do enough in return” (Mr. N., Dutch lay person) and feared they would feel guilty for the rest of their lives without the prospect of “settling their account” (Schweda and Schicktanz, 2009, 1133). In fact, almost all participating organ recipients also raised concerns over the complexity of giving and taking, instead of seeing organ donation as a purely altruistic, unidirectional act. In this sense, we found that the strict dichotomy between the idea of purely altruistic donation and market-oriented models underlying much of the academic debate does not reflect the actual perceptions and conflicts of the affected persons themselves. At least for the parties involved personally, the relevant and precarious line of demarcation between what is viewed as acceptable or not does not seem to pit the idea of altruistic donation against the profit-oriented market model, but rather the reciprocal spirit of gift exchange—of giving, receiving, and returning gifts—against both (Schweda and Schicktanz, 2009, 1134). This empirical observation, even if qualitative, is highly significant because it breaks up the accustomed front lines of the debate and opens a completely different perspective: On the one hand, it implies that models involving monetary payments are not perceived as objectionable per se, as long as they are compatible with the principle of reciprocity, which holds true, for example, for forms of compensation and “rewarded gifting”. On the other hand, it also indicates that the mere absence of cash payments does not necessarily make a model of organ procurement more acceptable because nonmonetary models can still infringe on the principle of reciprocity, for example, by appealing to egoistic interests or nonpecuniary greed (Schweda and Schicktanz, 2009, 1134). Therefore, it is important for the ethical-philosophical debate to be more critical concerning the normative framing of organ donation: In practice, especially in living organ donation, empirical information shows that various forms of reciprocity prevail. This could be ethically justified by the morally and culturally loaded meaning a living organ has for the healthy donor and the ill recipient. To our understanding, possible ways of taking
Why Public Moralities Matter
221
Notes 1. Focus group discussion is an appropriate qualitative method to explore arguments, critiques, and positions among the public or patients. In the EU-Project Challenges of Biomedicine, we conducted two focus groups, with on average 7 participants, respectively, in each country. The selection of the participants took place with regard to high heterogeneity of educational and religious background, gender parity, and different levels of illness experience. For a general overview of the research design and the main findings of this EU-funded project, see http://www.univie.ac.at/virusss/cobpublication.
References American Medical Association Council on Ethical and Judicial Affairs. 1993. Ethical Considerations in the Allocation of Organs and Other Scarce Medical Resources Among Patients [Online]. CEJA Report K-A-93 Available: http://www.ama-assn.org/resources/ doc/ethics/x-pub/ceja_ka93.pdf (accessed April 16, 2014).
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
this significance of reciprocity into account could be sociocultural rituals of expressing gratitude; of public recognition of the donors’ act and also a more pronounced discussion of the role of reciprocity for allocation rules (Schweda, Woehlke, and Schicktanz, 2009, 2511). Overall, these empirically based considerations have one thing in common: they remind us that an appropriate theoretical and practical framework for organ donation has to take into account the actual views and standpoints of all parties involved and concerned (Schicktanz, Schweda, and Wynne, 2012). In this respect, our findings hint at a certain one-sidedness of the academic and political debate which often focuses either only on the (actual or potential) recipients and their needs when defining the basic problem of transplantation in terms of “organ scarcity” or—vice versa—on the donors and their altruistic or profit-oriented motivations to donate when it comes to procurement strategies. On the basis of our empirical results and in line with theoretical contributions (Healy, 2006), we strongly recommend avoiding such unilateralism in the discussion of transplantation medicine: Both sides should widen their scope and gain an appreciation of the social nature of organ donation as a reciprocal interaction between different parties with irreducibly different but—at least prima facie—equally relevant and legitimate perspectives and interests (Schweda and Schicktanz, 2009, 1135). A current systematic overview of quantitative surveys on public attitudes toward commercialization confirms public reluctance regarding commercialization and support for reciprocity models. At the same time, the methodological heterogeneity of existing empirical studies becomes clear (Hoeyer, Schicktanz, and Deleuran, 2013). More systematic and comparative socioempirical studies on peoples’ actual attitudes toward organ donation and their ideational and motivational backgrounds are needed. They can help to critically reflect our empirical premises and contribute to a more “empirically informed” approach (Musschenga, 2005) to the ethics of organ donation.
222
Mark Schweda and Silke Schicktanz
Downloaded from http://jmp.oxfordjournals.org/ at Simon Fraser University on June 17, 2015
Cherry, M. J. 2009. Why should we compensate organ donors when we can continue to take organs for free? A response to some of my critics. Journal of Medicine and Philosophy 34:649–73. Davis, F. D. and S. J. Crowe. 2009. Organ markets and the ends of medicine. Journal of Medicine and Philosophy 34:586–605. Healy, K. 2006. Last Best Gifts. Altruism and the Market for Human Blood and Organs. Chicago, IL: The University of Chicago Press. Hippen, B. E. 2009. Introduction: Symposium on a regulated market in transplantable organs. Journal of Medicine and Philosophy 34:545–51. Hoeyer, K., S. Schicktanz, and I. Deleuran. 2013. Public attitudes to financial incentive models for organs: A literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity.’ Transplant International 26:350–7. Musschenga, A. W. 2005. Empirical ethics, context-sensitivity, and contextualism. Journal of Medicine and Philosophy 30:467–90. Schicktanz, S. and M. Schweda. 2009. “One man’s trash is another man’s treasure”: Exploring economic and moral subtexts of the “organ shortage” problem in public views on organ donation. Journal of Medical Ethics 35:473–6. Schicktanz, S., M. Schweda, and B. Wynne. 2012. The ethics of ‘public understanding of ethics’—Why and how bioethics expertise should include public and patients’ voices. Medicine, Health Care and Philosophy 15:129–39. Schweda, M. and S. Schicktanz. 2009. Public ideas and values concerning the commercialization of organ donation in four European countries. Social Science & Medicine 68:1129–36. Schweda, M., S. Woehlke, and S. Schicktanz. 2009. Understanding public skepticism toward organ donation and its commercialization: The important role of reciprocity. Transplantation Proceedings 41:2509–11.
