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Donating Organs from Anencephalic Babies

Walking the Ethical Plank?

Summary

Virtuous Ethics

Deontologism

For:

For

  • Save as many lives as possible
  • Dead Donor Rule should include anencephalic infants
  • Definition of brain death
  • Anencephalic baby = dead or alive?

  • Violation of the Dead Donor rule?

  • Is the benefit to society worth it?

  • Various ethical standpoints?

  • Issues regarding organ viability?

  • What would you do?
  • American Medical Association Council (1994) supported, however donation not encouraged due to law.

Good for parental mental health.

Each anencephalic = four organs = four new lives. 30-50% babies die while waiting...

Against

Against:

  • Violates Dead Donor Rule
  • Slippery slope
  • Problems with diagnosis
  • Hippocratic Oath: "Do no harm"
  • "The irreversible cessation of the circulation of blood or irreversible cessation of all function of the brain of the person" (ANZICS, 1998)

Pluralism

Consequentialism

For:

Autonomy

Parent's rights and wishes

For

Beneficence

No harm to infant

Net benefit to society (costs/lives)

  • Brain dead (no higher brain function)
  • Benefits of saving lives outweigh the costs
  • Parental wishes are respected

Non-maleficence

Against

Organ transplantation does no harm to the infant. No pain is felt.

Parents informed of the risks involved.

Anencephalic Organ Donation

  • Harm to baby, organ recipient, parents, medical professionals, society (policies)
  • Limited application and benefit

Justice

Parent's wishes should be respected and meaning given to the birth of their baby.

Modification of Dead Donor Rule

Ethical Principles

Anencephaly is a congenital CNS abnormality

  • Cranial end of neural tube fails to close completely

Results in:

  • Absence of the forebrain, skull, and scalp
  • Partial or fully functioning brainstem

Almost all die during birth or very shortly after.

So should we donate their organs?

Pluralism

Benefits vs. costs

Consequentialism

Against:

Universal principles

Deontologism

Autonomy

Not in patient's best interest Coercion of parents

Virtue Ethics

Virtuous character

Virtue midpoint

Beneficence

Sanctity of human life

Pluralism

Non-maleficence

Breaking the Dead Donor Rule & Hippocratic Oath

Autonomy

Beneficence

Non-maleficence

Justice

Justice

Non-equitable treatment of anencephalic infants

References

  • Byrne, P. 2005, Use of Anencephalic Newborns as Organ Donors, Paediatric Child Health 10(6): 335-7.
  • Fost, N. 2004, Reconsidering the dead donor rule: is it important that organ donors be dead? The Kennedy Institute of Ethics Journal 14:249-260.
  • James, R. 2003, "What is Morality", The Elements ofMoral Philosophy (4th edition). McGraw-Hill: Boston.
  • Robley, R.L. 1998, Increasing the Availability of organs for transplantation: an ethical analysis, Journal of the Medical Association of Georgia 87(2):113-6.
  • Steinberg, A. Katz, E. Sprung, C L. 1993, Use of Anencephalic neonates as organ donors, Critical Care Medicine 21:1787-1790.
  • Willis, W. 1990, Anencephalic as organ donor: Whose baby is it anyway? Journal of Religion and Health 29(2):139-148.
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