Organ Trafficking: Why Do Healthcare Workers Engage in It?

Organ trafficking in all its various forms is an international crime which could be entirely eliminated if healthcare professionals refused to participate in or be complicit with it. Types of organ trafficking are defined and principal international declarations and resolutions concerning it are discussed. The evidence for the involvement of healthcare professionals is illustrated with examples from South Africa and China. The ways in which healthcare professionals directly or indirectly perpetuate illegal organ transplantation are then considered, including lack of awareness, the paucity of both undergraduate and postgraduate education on organ trafficking, turning a blind eye, advocacy of organ commercialism, and the lure of financial gain.

Opt-outs and upgrades. Ethics and law in the United Kingdom.

We report on two areas in which UK law and ethics seem out of step with each other. 2013 saw the passing of the Human Transplantation (Wales) Bill, which will introduce an opt-out system of organ donation in Wales from 2015. In the first section, we discuss the convoluted evolution of the Bill and some potential problems that we consider may prevent it from achieving its intended goal of increasing the number of organs transplanted. The prospect of being able to enhance human cognition through cognitive-enhancing drugs ("smart drugs") also presents a nexus of questions associated with future ambitions, hopes, and concerns as a society. How these drugs might affect the future of work and employment is beginning to generate wide public engagement in the UK and forms the focus of the second section.

The Evolution of Autonomy.

There can be little doubt, at least in the Western world, that autonomy is theruling principle in contemporary bioethics. In spite of its 'triumph' however,the dominance of the utilitarian concept of autonomy is being increasinglyquestioned. In this paper, I explore the nature of autonomy, how it came todisplace the Hippocratic tradition in medicine and how different conceptsof autonomy have evolved. I argue that the reduction of autonomy to'the exercise of personal choice' in medicine has led to a 'tyranny of autonomy' which can be inimical to ethical medical practice rather than conducive to it.I take the case of Kerrie Wooltorton as an illustration of how misplacedadherence to respect for patient autonomy can lead to tragic consequences.An analysis of autonomy based on the work of Rachel Haliburton isdescribed and applied to the role of autonomy in a recent bioethicaldebate--that arising from Savulescu's proposal that conscientious objection by health-care professionals should not be permitted in the NHS. Inconclusion, I suggest Kukla's concept of conscientious autonomy as onepromising pathway to circumvent both the limitations and adverse effectsof the dominance of current (mis)understandings of autonomy in biomedical ethics.