Chapter 1 Guidance on answering selected questions from the book

Question

Consider how the different ethical approaches would deal with a case in which a father wanted to donate his heart to his daughter, who needed a heart transplant, even though the result would be that the father would die.

Guidance

We could start by thinking about the four principles set out in principlism.

  1. Autonomy.  This approach might suggest that the father should be allowed to make the decision about his own body.  If he wants to donate his heart to his daughter no one else should be able to interfere in that decision however foolish or immoral they thought it might be.  The only issue, from an autonomy perspective, might be whether he has the capacity to make the decision: is he so upset by the impending death of his daughter that he cannot make a genuine decision?
  2. Beneficence.  Whether the issue is beneficial might depend on whom we see as the patient here.  Clearly this will be beneficial for the daughter: her life will be saved.  At first sight we might think this is clearly not beneficial for the father.  However, much depends on who decides if the procedure is beneficial.  If the father decides what is best he might claim he would rather die than see his daughter die.
  3. Non-malefeasance.  The doctors must do no harm.  They will not be harming the daughter in not performing the operation, but they will be harming the father if they remove his heart. This principle points against performing the operation.
  4. Justice.  The primary relevance of justice here might be whether if the heart is removed from the father it would be better to give the father’s heart to his daughter, rather than whoever is top of the list of those waiting for heart transplants.

We might also note that consequentialists and deontologists might respond differently to this question.  For a consequentialist the key point is that one life will be lost, but one will be saved.  A consequentialist might suggest that more good will come from keeping the daughter alive as she will live for longer than the father.  A deontologist may rely on the principle of sanctity of life which prohibits the intentional taking of an innocent life, however good the consequences.

Reading

Beauchamp, T. and Childress, J. (2013) Principles of Biomedical Ethics (Oxford  University Press)

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