According to 2021 data, the United States’ opt-in system of posthumous organ donation results in seventeen Americans dying each day waiting for vital organs, while many good undonated organs go to the grave with the corpse. One of the most aggressive, and compelling, proposals to resolve this tragedy is postmortem organ conscription, also called routine salvaging or organ draft. This proposal entails postmortem retrieval of needed organs, regardless of the prior authorization or refusal of the deceased or his family. The (...) argument of most proponents of conscription relies heavily upon a denial of the possibility of posthumous harms. While I also deny the possibility of posthumous harms, I argue this denial fails to acknowledge other serious wrongs that could be done to the deceased person and his corpse. While the person can no longer be harmed, his _life_, in a roughly biographical sense, can be damaged. Humans highly value life in this sense, often more than biological life. Respect for this sense of life also informs appropriate treatment of particular human corpses, which already have special value beyond mere resource. I will argue that conscription proponents fail to appropriately value lives and human corpses. This failure can lead to multiple wrongs, among them a wrongful exploitation of the vulnerability of a person’s life and corpse and a disrespect of persons. While it is possible that some biographical lives could be made better, or at least less bad, by conscription, the judgments such decisions would require make conscription bad policy. (shrink)

I argue that desire satisfaction theories of welfare are not committed to the view that changes in welfare levels can happen after death, or that events that occur after death impact the agent's welfare levels now. My argument is that events that occur after death have only epistemological import. They may reveal that the person was successful (unsuccessful) in life, but the desire was already frustrated or satisfied before the person died. The virtue of the account is that it gives (...) us a way to acknowledge both the intuition that we cannot be harmed after we die and, in a sense, the intuition that things that happen after we die are relevant to our lives. (shrink)

In order to make progress in the welfare debate, we need a way to decide whether certain cases depict changes in well-being or not. I argue that an intuitive idea by Nagel has received insufficient attention in the literature and can be developed into a test to that purpose. I discuss a version of such a test proposed by Brad Hooker, and argue that it is unsuccessful. I then present my own test, which relies on the claim that if compassion (...) is fitting towards a person due to her having (or lacking) certain properties, then we know that having (or lacking) those properties affect the person’s well-being. I show how my test yields results in cases of deception, which have implications for central questions in the literature on well-being, such as whether what you do not experience can affect your well-being (the so-called Experience Requirement). (shrink)

advanced directivesend-of-life decisionsharming the deadposthumous reproductiontransplant ethics.

In this paper, I offer a prolegomenon to the philosophy of harm reduction. I begin with an overview of the philosophical literature on both harm and harm reduction, and a brief summary of harm reduction scholarship outside of philosophy in order to make the case that philosophers have something to contribute to understanding harm reduction, and moreover that engagement with harm reduction would improve philosophical scholarship. I then proceed to survey and assess the nascent and still modest philosophy of harm (...) reduction literature that has begun to emerge. I pay particular attention to two Canadian philosophers who have called for the expansion of harm reduction beyond the realm of so-called “vice”. Finally, I sketch some of the most interesting and important philosophical issues that I think the philosophy of harm reduction must grapple with going forward. (shrink)

Advances in technology have made it possible for us to take actions that affect the numbers and identities of humans and other animals that will live in the future. Effective and inexpensive birth control, child allowances, genetic screening, safe abortion, in vitro fertilization, the education of young women, sterilization programs, environmental degradation and war all have these effects. Although it is true that a good deal of effort has been devoted to the practical side of population policy, moral theory has (...) not dealt adequately with the new possibilities. The dilemma faced by moral theory is that traditional theories cannot answer moral questions involving the creation of people. Two related problems arise. The first concerns numbers: how many people should there be? The second asks what sort of people should live and what their levels of well-being should be. Conventional social-contract theories, including the work of Rawls (1971), are restricted to situations with a fixed number of individuals. Sumner (1978) attempts to extend a Rawlsian veil-of-ignorance approach to possible people but is aware of the difficulties involved. The main problem is that possible people must be thought to benefit when they move from non-existence to existence, a view that we reject (see Section 1, Heyd, 1992, Chapter 1; McMahan, 1996a; Parfit, 1984, Appendix G). Rights-based and duty-based theories suffer from a similar problem; there must be a person who has the right or a person to whom the duty is owed (see McMahan, 1981). (shrink)

Background:Even in countries with an opt-out or presumed consent system, relatives have a considerable influence on the post-mortem organ harvesting decision. However, their reflection capacity may be compromised by grief, and they are, therefore, often prone to choose refusal as default option. Quite often, it results in late remorse and dissatisfaction. So, a high-quality reflection support seems critical to enable them to gain a stable position and a long-term peace of mind, and also avoid undue loss of potential grafts. In (...) practice, recent studies have shown that the ethical aspects of reflection are rarely and often poorly discussed with relatives and that no or incomplete guidance is offered. No review of the literature is available to date, although it could be of value to improve the quality of the daily practice.Objectives:The objective was to review and synthesize the main concepts and approaches, theories and practices of ethical reflection support of the relatives or surrogates of potential post-mortem organ donors.Research design:A narrative review was performed in the medical, psychological and ethical fields using PubMed, PsycArticles and Web of Science databases (1980–2020).Results:Out of 150 papers, 25 were finally retained. Four themes were drawn: the moral status of the potential post-mortem organ donor, the principlistic approach with its limits and critics, the narrative approach and the transcendental approach.Discussion:This review suggests an extension of psychological support towards ethical reflection support. The process of helping relatives in their ethical exploration of post-mortem organ donation is psychologically and morally characterized. The need for specialized professionals educated and experienced both in clinical psychology and in health ethics to carry out this task is discussed.Practical impact:This review could contribute to optimize the quality of the ethical reflection support by initiating an evolution from an empirical, partial and individual-dependent support to a more systematized, professionalized and exhaustive support. (shrink)

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

First, what constitutes a person's death? It is clear enough that people die when their lives end, but less clear what constitutes the ending of a person's life.