Bioethicists tend to focus on the individual as the relevant moral subject. Yet, in highly complex and socially differentiated healthcare systems a number of social groups, each committed to a common cause, are involved in medical decisions and sometimes even try to influence bioethical discourses according to their own agenda. We argue that the significance of these collective actors is unjustifiably neglected in bioethics. The growing influence of collective actors in the fields of biopolitics and bioethics leads us to pursue (...) the question as to how collective moral claims can be characterized and justified. We pay particular attention to elaborating the circumstances under which collective actors can claim ‘collective agency.’ Specifically, we develop four normative-practical criteria for collective agency in order to determine the conditions that must be given to reasonably speak of ‘collective autonomy’. For this purpose, we analyze patient organizations and families, which represent two quite different kinds of groups and can both be conceived as collective actors of high relevance for bioethical practice. Finally, we discuss some practical implications and explain why the existence of a shared practice of trust is of immediate normative relevance in this respect. (shrink)

Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit––the “surrogacy triad” consisting of the surrogate mother, the child, and the intending parents––whose constituents are bound (...) together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice. (shrink)

The human body and its parts are widely perceived as matters beyond commercial usage. This belief is codified in several national and European documents. This so-called ‘no-property rule’ is held to be the default position across the countries of the European Union. However, a closer look at the most pertinent national and European documents, and also current practices in the field, reveals a gradual model of commercialisation of human tissue. In particular, we will argue that the ban on commercialisation of (...) body material is not as strict as it may appear at first sight, leaving room for the commercial practice of tissue procurement and transfer. We argue for more transparent information for patients and tissue donors, an intensified ethical debate on commercialisation practices, and a critical review of current normative principles. (shrink)

BackgroundThe bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other.MethodsBased on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices’ relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and (...) reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice.ResultsFirst, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy. (shrink)

ZusammenfassungIn der ethischen Debatte um die Forschung mit Biobanken wird selten zwischen verschiedenen Biomaterialien differenziert. Vor diesem Hintergrund widmet sich die vorliegende qualitative Interviewstudie erstmals den praktischen Herausforderungen, die sich bei der Sammlung von postmortal gewonnenem menschlichem Gehirngewebe zu Forschungszwecken aus Sicht von in diese Praxis involvierten Experten in Deutschland stellen. Im Zentrum der ethischen Analyse stehen Herausforderungen der Spenderrekrutierung, der Kommunikation über eine Gehirnspende sowie der informierten Zustimmung. Unsere Ergebnisse relativieren zum einen die Annahme eines sogenannten Spendermangels, insofern insbesondere (...) Kliniker eine Gatekeeper-Rolle bei der Spendergewinnung innehaben. Deren Einstellungen sollten daher als ein die Praxis unmittelbar beeinflussender Faktor stärker berücksichtigt werden; zudem sollten im Wissen um bestehende moralische Vorbehalte Ansätze zur Verbesserung der professionellen Kommunikation entwickelt werden. Bezüglich der Regelung der Einwilligung in postmortale Forschungsspenden wurde in unserem Sample das Bemühen deutlich, den ethischen Vorrang der Organspende nicht zu gefährden und die Postmortalspende vor Assoziationen mit der Organspende zu bewahren. Zur Sicherung des Vertrauens in die Forschung sowie der Autonomie von Spendern befürworteten die Experten nicht nur die Anwendung einer Zustimmungsregelung, sondern auch ein den Familienangehörigen explizit eingeräumtes Recht, einer Gehirnspende selbst dann zu widersprechen, wenn der Verstorbene seine Zustimmung erteilt hat. Die Erfahrung zeigt, dass eine offene Kommunikation über das Erfordernis eines familiären Konsenses zu einer hohen Akzeptanz des Spenderwillens in der Praxis führt. Daher könnte ein solcher, auf den Dialog von Spender und Angehörigen zu Lebzeiten bauender Ansatz auch instruktiv für die Realisierung von Spenden im Kontext der Organspende sein. (shrink)

Human reproduction in the age of reprogenetics raises fundamental ethical and political questions. Critics of so-called liberal eugenics like Jürgen Habermas have sparked an ethical debate on whether selective genetic manipulation might undermine the natural basis of the moral self-conception and autonomy of future generations. Contrary to this perception, the authors of this article argue for a dialectic understanding of the moral challenges arising from human natality: Freedom and dependency, sociality and human embodiment, autonomy and relatedness likewise determine our human (...) existence as moral beings. As an answer to these challenges, the authors develop a dialectic understanding of parenthood in the age of reprogenetics, thereby transcending present debates of modern reproductive medicine. (shrink)