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A phenomenological approach to the ethics of transplantation medicine: sociality and sharing when living-with and dying-with others

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Abstract

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty’s philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors’ relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine.

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Notes

  1. Briefly, what has been labeled the property rights framework for organ donation introduces an ownership conception of the body, connects to discourses of ownership and individuals’ property rights in other areas, and emphasizes the individual’s property right over her or his body, such as the rights to use, transfer, and manage her or his organs, according her or his own preferences. Furthermore, proponents of this framework often, but do not always, see property rights as including income rights, which allows for the sale of organs. In contrast, the heroic gift-giving framework conceptualizes organ donation as a caring response to others in need. It emphasizes the generosity of donors who donate without any financial benefits and the supererogatory, heroic dimension of this act, whereas the gift-giving as sacrifice framework brings to light the darker sides of organ donation, such as potential social pressure and emotional complexities when one needs to make decisions regarding organ transplantation, for example, when in shock and suffering bereavement after a loved one’s death. It sees donation as a hard-wrought sacrifice and a personal offering for the good of others. Finally, the gift as aporia framework (where aporia means paradox, as in Jacque Derrida’s work [7]) discusses the gift without return, and how concerns about repayment, or indeed, awareness of the gift as a gift, dissolves the act of gift-giving and reduces gift-giving to a gift exchange and to a matter of the human propensity to give-and-reciprocate in circles of gift-debt-countergift. See [9].

  2. The term “intercorporeality” was used in Merleau-Ponty’s posthumously published The Visible and the Invisible [18] in a discussion of how to rethink subjectivity. For more recent discussions of intercorporeality, see [15–17, 19–22].

  3. Cf. Diprose [21]. For an analysis of how others’ way of giving us the world as meaningful by sharing their mode of being may have detrimental consequences for us, see Zeiler [23].

  4. Cf. Zeiler [9].

  5. A qualification is also needed: some forms of giving may be of the potlatch kind, as Mauss used this term [27], where someone gives in order to make a certain status statement, but this is no reason to assume that gifts cannot also be given because the giver wishes to promote the recipient’s well-being and because she or he enjoys seeing the other thrive.

  6. See Zeiler [9].

  7. Despite their differences, phenomenologists also tend to agree that intersubjectivity does not only concern face-to-face encounters, but is also at stake in perception, emotion, self-awareness, or tool-use. For a good overview of different phenomenological positions on this, see Zahavi [34].

  8. For a longer discussion of these frameworks, see Zeiler [9].

  9. This, of course, is not what Derrida himself tries to do. Rather, he explores the possibility to give without entering the cycle of debt and repayment.

  10. In this way, the property rights framework states that it is up to the individual to decide whether or not to donate, and the heroic gift-giving framework tells us that it is positive and heroic to give, but neither says anything about in what circumstances we may be ethically justified not to act in this way.

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Acknowledgments

This article is part of my work as Pro Futura Scientia Fellow. I am very thankful to the Swedish Collegium for Advanced Study, Uppsala University, and Riksbankens Jubileumsfond for their financial support for this work.

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  1. Department of Thematic Studies - Technology and Social Change, Linköping University, 581 83, Linköping, Sweden

    Kristin Zeiler

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Correspondence to Kristin Zeiler.

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Zeiler, K. A phenomenological approach to the ethics of transplantation medicine: sociality and sharing when living-with and dying-with others. Theor Med Bioeth 35, 369–388 (2014). https://doi.org/10.1007/s11017-014-9307-3

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