Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.
除了女性的生理易感性之外,有关性别和抗菌药物耐药性(AMR)的研究还很有限。AMR 研究中的性别和公平视角对于促进性别平等和支持现实世界中 AMR 解决方案的有效性、吸收和可持续性是必要的。我们认为,在 AMR 研究和实施中纳入性别和相关交叉问题是伦理和社会正义的当务之急。对人们的不同身份和经历(包括性别、社会经济地位、种族、残疾、年龄和性取向)之间的相互作用进行交叉探讨,有助于我们了解这些因素是如何强化 AMR 风险和脆弱性的,并确保降低 AMR 风险的干预措施不会产生不均衡的影响。本文报告了一项关于 AMR、性别和其他社会行为特征之间相互联系的系统性范围审查结果,以确定低收入国家人类和动物健康方面的优先知识缺口。综述重点关注 2017 年至 2022 年间发表的同行评审文献和灰色文献。三个首要主题是:护理角色和责任的性别分工、决策中的性别权力关系以及性别规范与寻求健康行为之间的相互作用。如果研究未能考虑性别因素及其与种族、阶级和能力等其他不利因素的交叉关系,就有可能失去意义,对急性呼吸道感染的持续和危险蔓延影响甚微。我们建议在 AMR 研究、政策和实践中纳入性别交叉视角。
{"title":"Gender and equity considerations in AMR research: a systematic scoping review.","authors":"Ingrid Lynch, Lorenza Fluks, Lenore Manderson, Nazeema Isaacs, Roshin Essop, Ravikanya Praphasawat, Lyn Middleton, Bhensri Naemiratch","doi":"10.1007/s40592-024-00194-2","DOIUrl":"https://doi.org/10.1007/s40592-024-00194-2","url":null,"abstract":"<p><p>Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-13DOI: 10.1007/s40592-024-00190-6
Antoinette Lundahl
{"title":"Suicide-preventive compulsory admission is not a proportionate measure – time for clinicians to recognise the associated risks","authors":"Antoinette Lundahl","doi":"10.1007/s40592-024-00190-6","DOIUrl":"https://doi.org/10.1007/s40592-024-00190-6","url":null,"abstract":"","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":"74 2","pages":"1-14"},"PeriodicalIF":1.6,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140707726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1007/s40592-024-00187-1
Maxwell J Smith
In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments' use of coercion in public health should be evaluated.
理查德-科克尔(Richard Coker)在 2000 年出版的《从混乱到强制》(From Chaos to Coercion:理查德-科克尔(Richard Coker)在其 2000 年出版的《从混乱到强制:拘留与结核病控制》一书中,就使用强制公共卫生措施应对传染病威胁提出了许多重要的看法和论点。特别是,科克尔认为,我们往往忽视公共卫生威胁,然后要求立即采取行动,这可能使政策制定者的有效选择更少,可能需要(或被认为需要)采取更激进的强制措施来实现公共卫生目标。科克尔提出了一个令人信服的理由,说明为什么当政府发现自己处于这种境地并诉诸强制手段时,我们应该认为这在伦理上是有问题的,但悬而未决的问题是,如果政府和卫生当局发现自己处于这种境地时,是否应该排除使用强制手段的可能性。在本文中,我将论证,当政府因为忽视公共卫生威胁、其原因以及其他可能的应对措施而诉诸强制手段时,我们应该认为这在伦理上是令人反感的,但这并不一定就排除了在这种情况下使用强制手段的可能性;为什么要考虑使用强制手段,这在伦理上是令人反感的,但这并不一定或自动导致我们认为在这种情况下使用强制手段是不合理的。我对这一论点提出了反对意见,并就如何评价政府在公共卫生领域使用强制手段得出了几点结论。
{"title":"Cause for coercion: cause for concern?","authors":"Maxwell J Smith","doi":"10.1007/s40592-024-00187-1","DOIUrl":"https://doi.org/10.1007/s40592-024-00187-1","url":null,"abstract":"<p><p>In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments' use of coercion in public health should be evaluated.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-21DOI: 10.1007/s40592-023-00185-9
B V E Hyde
{"title":"How to love animals: and protect our planet Henry Mance New York: Vintage Books, 2022; paperback, 400 pp., £9.99, ISBN: 9781529112146.","authors":"B V E Hyde","doi":"10.1007/s40592-023-00185-9","DOIUrl":"https://doi.org/10.1007/s40592-023-00185-9","url":null,"abstract":"","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-06-26DOI: 10.1007/s40592-023-00177-9
Joona Räsänen
Is it wrong to create a blind child, for example by in vitro fertilization, if you could create a sighted child instead? Intuitively many people believe it is wrong, but this belief is difficult to justify. When there is a possibility to create and select either 'blind' or 'sighted' embryos choosing a set of 'blind' embryos seems to harm no-one since choosing 'sighted' embryos would create a different child altogether. So when the parents choose 'blind' embryos, they give some specific individual a life that is the only option for her. Because her life is worth living (as blind peoples' lives are), the parents have not wronged the child by creating her. This is the reasoning behind the famous non-identity problem. I suggest that the non-identity problem is based on a misunderstanding. I claim that when choosing a 'blind' embryo, prospective parents harm 'their child', whoever she or he will be. Put another way: parents harm their child in the de dicto sense and that is morally wrong.
{"title":"Defending the de dicto approach to the non-identity problem.","authors":"Joona Räsänen","doi":"10.1007/s40592-023-00177-9","DOIUrl":"10.1007/s40592-023-00177-9","url":null,"abstract":"<p><p>Is it wrong to create a blind child, for example by in vitro fertilization, if you could create a sighted child instead? Intuitively many people believe it is wrong, but this belief is difficult to justify. When there is a possibility to create and select either 'blind' or 'sighted' embryos choosing a set of 'blind' embryos seems to harm no-one since choosing 'sighted' embryos would create a different child altogether. So when the parents choose 'blind' embryos, they give some specific individual a life that is the only option for her. Because her life is worth living (as blind peoples' lives are), the parents have not wronged the child by creating her. This is the reasoning behind the famous non-identity problem. I suggest that the non-identity problem is based on a misunderstanding. I claim that when choosing a 'blind' embryo, prospective parents harm 'their child', whoever she or he will be. Put another way: parents harm their child in the de dicto sense and that is morally wrong.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"124-135"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-11-04DOI: 10.1007/s40592-023-00184-w
Michael Shepanski
{"title":"A review of G. R. McLean, ethical basics for the caring professions: knowledge and skills for thoughtful practice (1st ed. Abingdon, Oxon: Routledge, 2022. 240 p.).","authors":"Michael Shepanski","doi":"10.1007/s40592-023-00184-w","DOIUrl":"10.1007/s40592-023-00184-w","url":null,"abstract":"","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"96-98"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-10-09DOI: 10.1007/s40592-023-00182-y
Ryan Essex, Michael Dudley
There are few issues that have been as vexing for the Australian healthcare community as the Australian governments policy of mandatory, indefinite, immigration detention. While many concepts have been used to begin to describe the many dilemmas faced by healthcare professionals and their resolution, they are limited, perhaps most fundamentally by the fact that immigration detention is antithetical to health and wellbeing. Furthermore, and while most advice recognises that the abolition of detention is the only option in overcoming these issues, it provides little guidance on how action within detention could contribute to this. Drawing on the work of political theorists and the broader sociological literature, we will introduce and apply a form of action that has not yet been considered for healthcare workers within detention, resistance. We will draw on several examples from the literature to show how everyday resistance could be enacted in healthcare and immigration detention settings. We argue that the concept of resistance has several conceptual and practical advantages over much existing guidance for healthcare workers in these environments, namely that it politicises care and has synergies with other efforts aimed at the abolition of detention. We also offer some reflections on the justifiability of such action, arguing that it is largely consistent with the existing guidance produced by all major healthcare bodies in Australia.
{"title":"Resistance and the delivery of healthcare in Australian immigration detention centres.","authors":"Ryan Essex, Michael Dudley","doi":"10.1007/s40592-023-00182-y","DOIUrl":"10.1007/s40592-023-00182-y","url":null,"abstract":"<p><p>There are few issues that have been as vexing for the Australian healthcare community as the Australian governments policy of mandatory, indefinite, immigration detention. While many concepts have been used to begin to describe the many dilemmas faced by healthcare professionals and their resolution, they are limited, perhaps most fundamentally by the fact that immigration detention is antithetical to health and wellbeing. Furthermore, and while most advice recognises that the abolition of detention is the only option in overcoming these issues, it provides little guidance on how action within detention could contribute to this. Drawing on the work of political theorists and the broader sociological literature, we will introduce and apply a form of action that has not yet been considered for healthcare workers within detention, resistance. We will draw on several examples from the literature to show how everyday resistance could be enacted in healthcare and immigration detention settings. We argue that the concept of resistance has several conceptual and practical advantages over much existing guidance for healthcare workers in these environments, namely that it politicises care and has synergies with other efforts aimed at the abolition of detention. We also offer some reflections on the justifiability of such action, arguing that it is largely consistent with the existing guidance produced by all major healthcare bodies in Australia.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"82-95"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-11-04DOI: 10.1007/s40592-023-00183-x
Joseph T F Roberts
It is a common refrain amongst phenomenologists, disability theorists, and feminist legal theorists that medical practice pays insufficient attention to people's embodiment. The complaint that we take insufficient account of people's embodiment isn't limited to the clinical interaction. It has also been directed at healthcare regulation and welfare policy. In this paper, I examine the arguments for taking embodiment seriously in both medical practice and welfare policy, concluding we have good reasons to take better account of people's embodiment. I then set out two challenges to taking embodiment seriously in public policy. First, given the amount of variation in how people are embodied, there is strong possibility that adjusting policy to benefit particular individuals based on an appreciation of their embodied experiences could be detrimental towards other individuals. The second challenge concerns how to ensure that people's testimony about their first-person embodied experience is subject to adequate scrutiny without this resulting in epistemic injustice. I argue that the solution to both of these challenges is to devise a just procedure for soliciting people's testimony and taking it into account in the policy development process. As such, I also provide an outline of what a just procedure should look like.
{"title":"Taking embodiment seriously in public policy and practice: adopting a procedural approach to health and welfare.","authors":"Joseph T F Roberts","doi":"10.1007/s40592-023-00183-x","DOIUrl":"10.1007/s40592-023-00183-x","url":null,"abstract":"<p><p>It is a common refrain amongst phenomenologists, disability theorists, and feminist legal theorists that medical practice pays insufficient attention to people's embodiment. The complaint that we take insufficient account of people's embodiment isn't limited to the clinical interaction. It has also been directed at healthcare regulation and welfare policy. In this paper, I examine the arguments for taking embodiment seriously in both medical practice and welfare policy, concluding we have good reasons to take better account of people's embodiment. I then set out two challenges to taking embodiment seriously in public policy. First, given the amount of variation in how people are embodied, there is strong possibility that adjusting policy to benefit particular individuals based on an appreciation of their embodied experiences could be detrimental towards other individuals. The second challenge concerns how to ensure that people's testimony about their first-person embodied experience is subject to adequate scrutiny without this resulting in epistemic injustice. I argue that the solution to both of these challenges is to devise a just procedure for soliciting people's testimony and taking it into account in the policy development process. As such, I also provide an outline of what a just procedure should look like.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"20-48"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-09-09DOI: 10.1007/s40592-023-00179-7
Hagai Boas
Figuring out what pushes individuals to become organ donors has become the holy grail of social scientists interested in transplantations. In this paper I concentrate on solidarity as a determinant of organ donation and examine it through the history of organ donation in Israel. By following the history of transplantation policies since 1968 and examining them in relation to different types of solidarities, this paper leads to a nuanced understanding of the ties between solidarity and health policy. Attempts to foster an all-encompassing consensus on the definition of brain death yielded the Transplantation and the Brain-Respiratory Death Laws of 2008. It was hoped that a wide "civic solidarity" would render Israel self-sufficient in its organ economy. However, the failure of the law led to the breakdown of civic solidarity in organ donation. As a result, initiatives such as the priority policy and non-directed living organ donations, developed out of a narrower conception of solidarity. Juxtaposing these initiatives sheds light on macro level processes for policy makers and suggests solidarity as a key bioethical concept to understand organ donation policies.
{"title":"How did organ donation in Israel become a club membership model? From civic to communal solidarity in organ sharing.","authors":"Hagai Boas","doi":"10.1007/s40592-023-00179-7","DOIUrl":"10.1007/s40592-023-00179-7","url":null,"abstract":"<p><p>Figuring out what pushes individuals to become organ donors has become the holy grail of social scientists interested in transplantations. In this paper I concentrate on solidarity as a determinant of organ donation and examine it through the history of organ donation in Israel. By following the history of transplantation policies since 1968 and examining them in relation to different types of solidarities, this paper leads to a nuanced understanding of the ties between solidarity and health policy. Attempts to foster an all-encompassing consensus on the definition of brain death yielded the Transplantation and the Brain-Respiratory Death Laws of 2008. It was hoped that a wide \"civic solidarity\" would render Israel self-sufficient in its organ economy. However, the failure of the law led to the breakdown of civic solidarity in organ donation. As a result, initiatives such as the priority policy and non-directed living organ donations, developed out of a narrower conception of solidarity. Juxtaposing these initiatives sheds light on macro level processes for policy makers and suggests solidarity as a key bioethical concept to understand organ donation policies.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"49-65"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10193526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-12-09DOI: 10.1007/s40592-022-00166-4
Alison C Weightman, Simon Coghlan, Philip A Clayton
Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.
{"title":"Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria.","authors":"Alison C Weightman, Simon Coghlan, Philip A Clayton","doi":"10.1007/s40592-022-00166-4","DOIUrl":"10.1007/s40592-022-00166-4","url":null,"abstract":"<p><p>Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"156-173"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}