Psycholegal issues in sibling bone marrow donation

The only hope of survival for children with a number of life-threatening illnesses is a successful bone marrow transplant (BMT). Unlike the treatment source for most therapies, the raw material for transplant therapy comes from a human being. Although many BMTs are autologous, utilizing the patient's own bone marrow, a large percentage of childhood BMTs rely on bone marrow from children or adolescents who are biological siblings to the sick child. Medical and legal systems are confronted with a dilemma when healthy children are needed to undergo minimally risky, yet somewhat painful, procedures for the benefit of their critically ill siblings. This article reviews legal issues involved in sibling bone marrow donation and psychological research that is relevant to those issues. The article concludes with proposed directions for future psycholegal research and a discussion of ethical issues that are not amenable to empirical investigation.     

Blood donation is an act of benevolence rather than altruism.

OBJECTIVES: Blood donation is described as an archetypal altruistic behavior, and recruitment/retention campaigns emphasize altruism. Here, a benevolence hypothesis for blood donation (both the donor and recipient benefit) rather than the altruism hypothesis (only the recipient gains) is proposed. DESIGN: Three United Kingdom-based studies contrasted benevolence and altruism: (a) a 6-month prospective study of blood donor behavior (Study 1: N = 957), (b) a cross-sectional study of blood donors' intentions (Study 2: N = 333), and (c) an experimental study examining the effect of benevolent and altruistic messages on willingness to help across high- and low-cost helping behaviors for committed and noncommitted blood donors (Study 3: N = 200). MAIN OUTCOME: Donor behavior and intentions-willingness. MEASURES: Beliefs in personal and societal benefit (Time 1) and actual donations (Time 2) were assessed in Study 1; beliefs in benevolence, altruism, hedonism, and kinship along with donation intentions were assessed in Study 2; and empathy, donor commitment, and willingness to donate blood, money, fund-raise, and staff a telephone helpline were assessed in Study 3. RESULTS: Beliefs in personal rather than societal benefit predicted actual future donation. A path model showed that only beliefs in benevolence were associated with intentions to donate. Committed blood donors were more willing to donate blood when exposed to a benevolent message rather than an altruistic one. This effect was not observed for other forms of helping. CONCLUSIONS: The benevolence hypothesis is supported, suggesting that blood donor motivation is partly selfish. Blood donation campaigns should focus on benevolent rather than purely altruistic messages.     

Duty and inclination: The phenomenological value ethics of Hans Reiner

I wish to thank Hans Reiner who gave me the opportunity of spending a day in discussion with him in Freiburg i.Br.     

Exploring the relationship between umbilical blood cord donation and the impact of social distance on altruism and trust

Allogeneic umbilical cord blood (UCB) donation is a pro-social behaviour directed to strangers that has a certain cost for the donor. Although the promotion of such behaviour is an important goal for many countries' health systems, little is known about the reasons that would lead to it. With this study, we explored how the impact of social closeness on altruism and trust could be related to UCB donation in a sample of new-mothers (N = 167). Participants played hypothetical Dictator and Trust games with socially close (e.g., parents) or distant (e.g., strangers) others. They donated more money to parents and siblings compared to cousins, friends and strangers and they trusted more parents, siblings and friends than cousins and strangers. Interestingly, the lower the impact of social closeness on altruism (i.e., generosity towards socially distant others), the higher the intention and the actual probability of UCB donation. A mediation analysis has shown that the relationship between social closeness on altruism and UCB donation was mediated by objective intention to donate (i.e., having followed all the procedures needed). These findings show that other-oriented motivations towards distant others might have important practical implications in identifying the targets of interventions for the promotion of UCB donation.     

The ethics and politics of the brain drain: A communal alternative to liberal perspectives

In Debating Brain Drain, Gillian Brock and Michael Blake both draw on a liberal moral-political foundation to address the issue, but they come to different conclusions about it. Despite the commonly held value of free and equal persons having a dignity that grounds human rights, Brock concludes that many medical professionals who leave a developing country soon after having received training there are wrong to do so (if they do not provide compensation) and that the state may place some limits on their ability to exit, whereas Blake infers that there is neither any wrongdoing on their part, nor rightful restrictions placed on them. In this article, rather than sort out which has the better interpretation of what liberalism entails, I consider the medical brain drain in the light of an alternative normative framework, one informed by ideals of communion salient in the sub-Saharan moral tradition. I argue that a principle of prizing communal relationships more naturally entails Brock’s conclusions than does her appeal to liberalism.     

Using multilevel analyses with sibling data to increase analytic power: an illustration and simulation study

This study investigates the extent to which analytic power can be increased through the inclusion of siblings in a data set and the concomitant use of random coefficient multilevel models. Analyses of real-world data regarding the predictors of young adult alcohol use illustrate how parallel single-level analyses of a 1-child-per-family data set and multilevel analyses of a data set including all siblings in each family would be conducted. A simulation study, closely based on the illustrative analyses, compares the empirical power to detect main, moderation, and mediation effects under three conditions: (a) single-level analyses of 1-child-per-family data, (b) multilevel analyses of all-siblings data, and (c) single-level analyses of independent data with sample size equivalent to the all-siblings condition. Supplementary analyses are conducted to determine the conditions under which greater analytic power could be achieved with the addition of siblings to a data set than with the addition of a lesser number of independent individuals at equivalent cost.     

Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination.     

Instrumentalist analyses of the functions of ethics concept-principles: a proposal for synergetic empirical and conceptual enrichment

Theoretical Medicine and Bioethics - Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has...     

Evolution and the problem of altruism

Genuine altruism would appear to be incompatible with evolutionary theory. And yet altruistic behavior would seem to occur, at least on occasion. This article first considers a game-theoretical attempt at solving this seeming paradox, before considering agroup selectionist approach. Neither approach, as they stand, would seem to render genuine, as opposed to reciprocal, altruism compatible with the theory of evolution. The article concludes by offering an alternative game-theoretical solution to the problem of altruism.     

Death anxiety,altruism, self‐efficacy,and organ donation intention among Japanese college students: A moderated mediation analysis

The shortage of organs for transplantation in Japan has alerted health professionals to the low organ donation rate among Japanese people. The unique cultural view of death and altruism has been suggested leading to their low intent to donate cadaveric organs. A cross‐sectional survey was conducted in Japan to investigate the interplay of death anxiety, altruism, and self‐efficacy in influencing Japanese college students' intention to sign donor cards, in order to mobilise this large potential source of organ donors in the future. Six hundred and seven Japanese non‐donor card signers voluntarily completed a self‐administered questionnaire. The results of mediation and moderated mediation analyses with bootstrap approach suggest that death anxiety indirectly hinders Japanese people's intention to become a donor card signer through lowering of self‐efficacy, while altruism intensifies the positive impact of self‐efficacy on signing intention. These findings provide useful insights for organ procurement organisations seeking behavioural change not only in Japan but also in multi‐ethnic societies with a substantial Japanese population.