© Springer International Publishing Switzerland 2016
Ralf J. Jox, Galia Assadi and Georg Marckmann (eds.)Organ Transplantation in Times of Donor ShortageInternational Library of Ethics, Law, and the New Medicine5910.1007/978-3-319-16441-0_99. How to be a Virtuous Recipient of a Transplant Organ
(1)
Division of Philosophy, Royal Institute of Technology (KTH), Stockholm, Sweden
(2)
Lincoln College Oxford, Oxford, UK
(3)
Department of Philosophy, Texas A&M University, Texas, USA
Barbro Fröding
is an associate professor at the Division of Philosophy, Royal Institute of Technology (KTH) in Stockholm. She is also senior research associate at the Oxford Uehiro Centre for Practical Ethics and a former fellow at Lincoln College Oxford. Dr. Fröding completed her PhD in 2008 and then worked as a Marie Curie post-doc fellow in Oxford before returning to KTH as a senior researcher in 2010. Her research interests include moral philosophy, applied ethics, virtue ethics (modern and Aristotelian), epistemic virtues, ownership of biological material and human cognitive enhancement.
Martin Peterson
is professor of Philosophy at Eindhoven University of Technology. Prior to that, he was a research fellow in the Department of History and Philosophy of Science at Cambridge University. His areas of expertise include normative ethics (consequentialism), decision theory and ethics of technology, but also extends to metaethics, experimental philosophy and epistemology. Martin Peterson’s most recent book is The Dimensions of Consequentialism, published by Cambridge University Press 2013.
9.1 Introduction
This chapter investigates to what extent recipients of transplant organs ought to be held morally accountable for lifestyle choices that jeopardize the function of their new organ and, further, if recipients of transplant organs should in some cases be punished for not taking proper care of their bodies. Consider, for instance, a patient suffering from a life-threatening cardiovascular condition. The patient needs a new heart in order to survive. By prioritizing one patient in what is effectively a zero-sum game, the needs of others will be forgone. It therefore seems that it would be reasonable for the healthcare provider to have some say with regards to the lifestyle of the patient who receives transplanted biological material of which there is limited supply. How much of a say they get is, however, highly controversial.
One, arguably quite extreme, option would be to defend a strong paternalistic position. On such an account, the point of view of the healthcare provider would frequently override the preference and ideals of the patient and, consequently, give the healthcare provider the right to dictate a certain lifestyle for the person in question.
At the other end of the spectrum, we find people rejecting any type of interference in the private sphere. As soon as the patient has received the new organ, it is indeed her organ. The recipient is therefore free to choose any lifestyle she wishes—even if it is likely to have serious negative effects on her overall health and life expectancy. A more moderate, and in our opinion reasonable view, is that a certain set of moral obligations attach to the privilege that has been given to the patient. On our view, if taxpayers (in, say, Europe) invest in your health by paying for your treatment, then you are under at least some obligation to refrain from a lifestyle that is likely to jeopardize your new transplant organ.1
In this chapter, we shall ignore the two extreme views sketched above and focus exclusively on our preferred moderate position. We will discuss the case of biological organs rather than artificial ones in that we find such scenarios more relevant from a moral point of view. While strained resources can also generate demands on patients receiving artificial organs, it seems plausible to argue that the biological version has a set of additional strings attached to it. That being said, it would be a mistake to conclude that recipients of artificial organs are under no obligation to take good care of themselves. Few people would deny that they are.
Our main point can be summarized as follows. From a virtue-ethical point of view, the donation of a biological organ is a gift made for a good cause by the donor (or by the family of the deceased donor), and as a consequence, a set of special obligations arise. This includes the obligation to take good care of that gift.2 Similar obligations do not attach to all gifts, including other forms of medical treatment. What makes organ donation so special is the extreme scarcity of this life-saving resource. Notably, our position, according to which the recipient is under an obligation to refrain from certain choices, should not be conflated with the more demanding obligation to actively make certain choices. The latter would be far more restrictive and to a greater extent infringe on the freedom of the individual.
It deserves to be mentioned that we will not argue that anyone should be punished for a situation that they find themselves in due to unfortunate circumstances. Rather, what will be discussed here is whether or not restrictions on lifestyle choices (which plausibly can be linked to a certain condition) might be imposed by the state post treatment. Note that this is very different from the more extreme position that society can justifiably condition care or medicine on choices that are made prior to the treatment. In other words, while we are committed to the idea that any patient should be eligible for a transplant simply by virtue of being human, we still find it reasonable to impose (certain) restrictions on her future lifestyle choices.3
On a more general note, the best solution to the current shortage of biological transplant material is of course medical and technological developments, e.g. in the fields of stem cell therapy and nanotechnology. Breakthroughs in these areas are highly likely to both cut costs and enable completely novel treatments to improve the lives of many. This contribution, however, focuses exclusively on the current situation where resources are under extreme pressure and choices, affecting the well-being of many, need to be made on a daily basis.
The structure of this chapter is as follows. In Sect. 9.2, we will sketch some key elements of Aristotelian virtue ethics. We will focus in particular on the doctrine of the mean , which we argue, in Sect 9.3, is relevant to our moral attitude to transplant organs. We will try to show that, from a virtue-ethical point of view, we have good reason to accept what we call enforced medium levellifestyle infringements. By this we mean reasonable limitations on the range of lifestyle choices made available to recipients of transplant organs. Finally, in Sects. 9.4 and 9.5 we will address four objections to our analysis and briefly discuss some practical implications of our conclusion.
Before we begin, it should be noted that the underlying motivation for committing to the life of virtue comes from the agent herself and, consequently, that it is voluntary. The desire to lead such a life, which on occasion quite plausibly would require certain efforts, is based on the conviction that a life in accordance with moral and epistemic virtues is the best and happiest life. In this view, the agent ought to seek to look after herself in every respect and this includes physical as well as mental wellbeing.
9.2 Virtue Ethics
The idea that the healthcare provider has a moral right to restrict the choices of the individual and, in particular, that it is in the individual’s interest to accept this arrangement, is best explained from a virtue-ethics perspective.4 In order to sketch a plausible account of why some restrictions are attractive for both parties (i.e., both the individual and the healthcare provider) some theoretical elements of virtue ethics will have to be introduced.
Virtue ethics tells us that the best life for any human being is a life of virtue. Given the choice, this is the life that would enable the rational agent to fare better than she otherwise would. According to Aristotle, agents need to develop a set of moral virtues (e.g., generosity, courage, justice) as well as a set of intellectual virtues (e.g., practical wisdom, sound reasoning, technical skills). Once properly integrated, these character traits will be stable and will always apply in action, one implication of which is that the virtuous agent cannot be tactically vicious on occasion. The virtues become second nature and making the right choices, for the right reason, will become the only option worth considering for the agent.
According to Aristotle, an action X has to meet three necessary and jointly sufficient conditions in order to count as being virtuous. The agent has to:
(i)
Have practical knowledge about X,
(ii)
Choose X and choose it for its own sake and
(iii)
X must flow from her firm character.
Conditions (ii) and (iii) entail that in order to assess if an action is virtuous we need to know how the agent perceived what she was doing and why. In a recent discussion of the Nicomachean Ethics, Hughes stresses that,
At a pinch a person can on occasion exercise self-control and do what needs to be done even when they cannot do it in the way that the good person does it. It is therefore not the case that on each occasion a correct moral assessment of what should be done requires moral virtue, though it is true that moral virtue is needed to get things right consistently, day in and day out. (Hughes 2001, p. 220)Related posts:
The Ethics of Organ Donation: Foundations and Challenges
Organ Donation and Transplantation in Germany
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