Swedish white paper on donation can give more donors without compromising ethics The White Paper on organ donation (SOU 2015:84) proposes new regulations for organ donation. In particular it spells out that it is permissible to take medical steps to preserve organs while the patient is still alive. It is proposed that this should be allowed after the medical team has declared that the continuation of life sustaining treatment is futile. The white paper opens up for donation after cardiac death. There has been some critique of the white paper for lack of deeper ethical discussions. The ethical issues pertaining to the proposals are discussed in this paper. It is concluded that the proposals are ethically acceptable. The human dignity principle will however demand that the decision to end life sustaining treatment is taken regardless of whether the patient is a possible organ donor or not.

We are very grateful to Chong-Ming Lim for his thoughtful reply published in this journal on one of our articles, which motivated us to think more carefully about accommodating autistic individuals and treating autism. However we believe there are some confusions in Lims argument. Lim uses the accommodation thesis, according to which we should accommodate autistic individuals rather than treat autism, as the starting point for his reasoning. He claims that if the accommodation thesis is right, then we should not treat autistic individuals for their autism, not even low-functioning (i.e. intellectually disabled) ones, because this would be disrespectful to all autistic individuals. We should instead limit ourselves to accommodate all autistic individuals. However, the opposition between accommodation and treatment is not valid in the case of autism, because of ambiguity in the concepts of accommodation and treatment. Moreover there is confusion in Lims reasoning caused by omitting important facts about the practice of treating autism.

Njurar från avlidna donatorer är en gemensam resurs

Gemensamma resurser ska fördelas på ett effektivt och rättvist sätt.

I en intervjustudie innefattande svenska transplantationskirurger, nefrologer och transplantationskoordinatorer undersöktes faktorer och värden som ligger till grund för allokering av njurar.

Två risker för orättvisa i fördelningssystemet identifierades.

Faktorer och värden som ligger till grund för beslut bör göras mer publika och lättillgängliga.

Sverige bör införa ett nationellt, centraliserat fördelningssystem.

In order to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework, 15 interviews with transplant surgeons, nephrologists, and coordinators were carried out. The factors described by interviewees and the values they rest on satisfy the relevance criterion of the A4R. Two potential sources for unfair inequalities were identified, namely the use of clinical judge­ments and varying institutional policies among dif­ferent centres. It is recommended that factors and values used in the priority process are made more public. Sweden should also consider a national, centralised system for allocation of kidneys and not rely on present day local allocation.

During the last decades, Ingvar Johansson has made a formidable contribution to the development of philosophy in general and perhaps especially to the development of metaphysics. This volume consists of original papers written by 50 philosophers from all over the world in honour of Ingvar Johansson to celebrate his 70th birthday. The papers cover traditional issues in metaphysics and the philosophy of mind, applied ethics and applied metaphysics, the nature of human rights, the philosophy of economics and sports. Some of the papers study the philosophy of Ingvar Johansson.All of them studies subjects which he has shown an interest in. The variety of subjects covered, testifies to the extraordinary wide range of issues his thought has had a bearing on.

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

Cultured meat, or in vitro meat, is one of the ideas that are being proposed to help solve the problems associated with the ever-growing global meat consumption. The prospect may bring benefit for the environment, climate, and animal ethics, but has also generated doubts and criticism. A discussion of the possible environmental benefit and of animal ethics issues in relation to cultured meat production will be given. A perceived ’unnaturalness’ of cultured meat may be one of the strongest barriers for public acceptance. This will be discussed and rejected. As to our relations with nature and animals, it is plausible that cultured meat will lead to improvement rather than to deterioration. The issue of public acceptance and some of the problems of introducing this new product on the market will also be discussed. 

Background: Kidney transplantation is the established treatment of choice for end-stage renal disease; it increases survival, and quality of life, while being more cost effective than dialysis. It is, however, limited by the scarcity of kidneys. The aim of this paper is to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework. To achieve this, two significant stages of the process influencing access to transplantation are examined: assessment for transplant candidacy, and allocation of kidneys from deceased donors.

Methods: Semi-structured interviews were the main source of data collection. Fifteen Interviewees included transplant surgeons, nephrologists, and transplant coordinators representing centers nationwide. Thematic analysis was used to analyze interviews, with the Accountability for Reasonableness framework serving as an analytical lens.

Results: Decision-making both in the assessment and allocation stages are based on clusters of factors that belong to one of three levels: patient, professional, and the institutional levels. The factors appeal to values such as maximizing benefit, priority to the worst off, and equal treatment which are traded off.

Discussion and Conclusions: The factors described in this paper and the values on which they rest on the most part satisfy the relevance condition of the accountability for reasonableness framework. There are however two potential sources for unequal treatment which we have identified: clinical judgment and institutional policies relating both to assessment and allocation. The appeals mechanisms are well developed and supported nationally which help to offset differences between centers. There is room for improvement in the areas of publicity and enforcement. The development of explicit national guidelines for assessing transplant candidacy and the creation of a central kidney allocation system would contribute to standardize practices across centers; and in the process help to better meet the conditions of fairness in reference to the A4R. The benefits of these policy proposals in the Swedish kidney transplant system merit serious consideration.

Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable. We will discuss the effects of DSM categorization and the medical model for high functioning autists. After a discussion of autism as a culture we will analyze various possible strategies for the neurodiversity movement to claim extra resources for autists as members of an underprivileged culture without being labelled disabled or as having a disorder. We will discuss their vulnerable status as a group and what obligation that confers on the majority of neurotypicals.