Abstract
Emotionally-related live organ donation is different from almost all other medical treatments in that a family member or, in some countries, a friend contributes with an organ or parts of an organ to the recipient. Furthermore, there is a long-acknowledged but not well-understood gender-imbalance in emotionally-related live kidney donation. This article argues for the benefit of the concept of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The concept of just love is helpful in the analysis of these live organ donations even if no statistical gender-imbalance prevails. It is particularly helpful, however, in the analysis of the gender-imbalance in live kidney donations if these donations are seen as a specific kind of care-work, if care-work is experienced as a labour one should perform out of love and if women still experience stronger pressures to engage in care-work than do men. The aim of the article is to present arguments for the need of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The aim is also to elaborate two criteria that need to be met in order for love to qualify as just and to highlight certain clinical implications.
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Notes
Reasoning based on Gilligan’s research has been critiqued for encouraging stereotyped thinking. It is one thing to say that at that time, in that context, more women reasoned in a certain manner than did men. From this, it need not follow that a similar difference prevails today, in other countries. Furthermore, Gilligan’s research tells us nothing about the reasons for the difference in ethical reasoning.
In a U.S. study on long-term survival after live liver donation, more men than women donate. Of all donors (n = 764), 42.5% were female. Similar data is available in a Taiwan study, on all liver donors at Chang Gung Memorial Hospital, during the period 1996–2005. Of all donors (n = 204), 40% were female (Thuluvath and Yoo 2004, Ibrahim et al. 2006).
However, I consider it equally problematic to focus only or primarily on justice, as is sometimes done when scholars apply the social contract model to the family, in order to enable a moral evaluation of intimate relationships. I concur with those who claim that this model, in this context, fails to do justice to “the emotional density” of at least many of the bonds involved. Though one may claim that certain rights and duties/obligations follow from the kind of vows that partners have exchanged or from the fact that parents have begotten the children and that they should therefore care for the other partner/the children, the language of duties and rights between family members fails to do justice to the complex moral interplay within family relation with clear asymmetries. Whereas contracts enable us to make explicit what we expect of ourselves and of others within the contract and whereas contracts can enable us to make explicit what will happen if the contract is breached, family members may not make explicit their expectations, precisely because they are engaged with each other in close relationships.
For examples of live kidney donors’ donation stories, see the home-site of Swedish kidney donors. Available at http://www.nrj.se. Accessed 2008-01-15.
References
Achille, M., J. Soos, M.-C. Fortin, M. Pâquet, and M.-J. Hébert. 2007. Differences in psychosocial profiles between men and women live kidney donors. Clinical Transplantation 21: 314–320.
Baier, A. 1995. The need for more than justice. In Justice and care. Essential readings in feminist ethics, ed. V. Held. Colorado: Westview Press.
Biller-Andorno, N., and H. Schauenburg. 2001. It’s only love? Some pitfalls in emotionally related organ donation. Journal of Medical Ethics 27: 162–164.
Bloembergen, W.E., F.K. Port, E.A. Mauger, J.P. Briggs, and A.B. Leichtman. 1996. Gender discrepancies in living related renal transplant donors and recipients. Journal of the American Society of Nephrology 7: 1139–1144.
Choukèr, A., A. Martignoni, M. Dugas, W. Eisenmenger, R. Schauer, I. Kaufmann, G. Schelling, F. Löhe, K.-W. Jauch, K. Peter, and M. Thiel. 2004. Estimation of liver size for liver transplantation: The impact of age and gender. Liver Transplantation 10: 678–685.
Crouch, R., and C. Elliot. 1999. Moral agency and the family: The case of live related organ transplantation. Cambridge Quarterly of Health Care Ethics 8: 275–287.
Eurotransplant. 1999. Annual report 1998. Leiden: Eurotransplant.
Eurotransplant. 2004. Annual Report 2004. Leiden: Eurotransplant.
Farley, M.A. 2006. Just Love. New York: Continuum.
Friedman, M. 1995. Beyond caring: The de-moralization of gender. In Justice and care. Essential readings in feminist ethics, ed. V. Held. Colorado: Westview Press.
Gilligan, C. 1982. In a different voice. Psychological theory and women’s development. Cambridge, Massachusettes: Harward University Press.
Goodin, R. 1985. Protecting the vulnerable. A re-analysis of our social responsibilities. Chicago: University of Chicago.
Guimaraes, R.J. 2007. Searching for the vulnerable: A review of the concepts and assessments of vulnerability related to poverty. The European Journal of Development Research 19: 234–250.
Hallan, S.I., J. Coresh, B. Astor, et al. 2006. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. Journal of American Society of Nephrology 17: 2275–2284.
Ibrahim, S., C.-L. Chen, C.-C. Lin, C.-H. Yang, C.-C. Wang, S.-H. Wang, Y.-W. Liu, C.-C. Yong, A. Concejero, B. Jawan, and Y.-F. Cheng. 2006. Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy. Liver Transplantation 12: 950–957.
Jecker, N.S. 2002. Taking care of one’s own: Justice and family caregiving. Theoretical Medicine 23: 117–133.
Kärrfelt, H.M.E., U.B. Berg, and F.I.E. Lindblad. 2000. Renal transplantation in children: Psychological and donation-related aspects from the parental perspective. Pediatric Transplantation 4: 305–312.
Koehn, D. 1998. Rethinking feminist ethics: Care, trust and empathy. London and New York: Routledge.
Kottow, O.M.H. 2003. The vulnerable and the susceptible. Bioethics 17: 460–471.
Levine, C., R. Faden, C. Grady, D. Hammerschmidt, L. Eckenwiler, and J. Sugerman. 2004. The limitations of ‘vulnerability’ as a protection for human research participants. The American Journal of Bioethics 4: 44–49.
Lewis, J., and S. Giullari. 2005. The adult worker model family, gender equality and care: the search for new policy principles and the possibilities and problems of a capabilities approach. Economy and Society 34: 76–104.
Oien, C., A. Reisaeter, T. Leivestad, P. Pfeffer, P. Fauchald, and I. Os. 2005. Gender imbalance among donors in living kidney transplantation: the Norwegian experience. Nephrology, Dialysis, Transplantation 20: 783–789.
Okin, S.M. 1989. Justice, gender and the family. New York: BasicBooks, Inc.
O’Neill, O. 1996. Towards justice and virtue. New York: Cambridge University Press.
Radzik, L. 2005. Justice in the family: A defence of feminist contractarianism. Journal of Applied Philosophy 22: 45.
Rawls, J. 2005. A theory of justice. Cambridge: Harvard University Press [1971].
Reding, R. 2005. Is it right to promote live donor liver transplantation for fulminant Hepatic failure in pediatric recipients? American Journal of Transplantation 5: 1587–1591.
Ricoeur, P. 1995. Love and justice. Figuring the sacred: Religion, narrative and imagination. Minneapolis: Fortress Press.
Rudow, D.L., M. Chariton, C. Sanchez, S. Chang, D. Serur, and R.S. Brown Jr. 2005. Kidney and liver living donors: A comparison of experiences. Progress in Transplantation 15: 185–191.
Rustgi, V.K., G. Marino, M.T. Halpern, L.B. Johnson, W.O. Umana, and C. Tolleris. 2002. Role of gender and race mismatch and graft failure in patients undergoing liver transplantation. Liver Transplantation 8: 514–518.
Sandel, M. 1982. Liberalism and the limits of justice. Cambridge, New York and Melbourne: Cambridge University Press.
Sandel, M. 1984. Justice, the Good. In Liberalism and its critics, ed. M. Sandler. London: Basil Blackwell.
Schicktanz, S., J.W. Rieger, and B. Lüttenberg. 2006. Geschlechterunterschiede bei der Lebendnierentransplantation: Ein Vergleich bei globalen, mitteleuropäischen und deutchen Daten und deren ethische Relevanz. Transplantationsmedizin 18: 83–90.
Shoeman, F. 1980. Rights of children, rights of parents, and the moral basis of the family. Ethics 91: 6–19.
Thiel, G., C. Nolte, and D. Tsinalis. 2005. Gender imbalance in live kidney donation in Switzerland. Transplantation Proceedings 37: 592–594.
Thuluvath, P.J., and H.Y. Yoo. 2004. Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantation. Liver Transplantation 10: 1263–1268.
Young, I.M. 1990. Justice and the politics of difference. Princeton: Princeton University Press.
Zeiler, K. 2005. Chosen children. An empirical study and a philosophical analysis of moral aspects of pre-implantation genetic diagnosis and germ-line gene therapy. Linköping: Linköping University Press.
Zimmerman, D., S. Donnelly, J. Miller, D. Steward, and S.E. Albert. 2000. Gender disparity in live renal transplant donation. American Journal of Kidney Diseases 36: 534–540.
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I borrow the “Just Love” part of the title from M. A. Farley’s (2006) Just Love.