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

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

Bioethical Issues

• Equal access– Social biases e.g. patient’s place and contribution

to society– Say, a doctor with keratoconus vs 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.

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?

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?

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

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?

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

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

Bioethical Issues

• Condemned prisoners – take corneas from those executed

• The death penalty is not in effect in the Philippines

• Sources• http://www.ahc.umn.edu/img/assets/26104/

Organ_Transplantation.pdf• http://www.chanrobles.com/republicactno78

85.htm