Transplantation

Question 1

What is the Human Tissue Act of 2004?

Answer 1

An act that governs the removal, use or storage of tissue for scheduled purposes, including:

1 - Anatomical examination.

2 - Determining the cause of death.

3 - Public display.

4 - Transplantation.

5 - Education.

Question 2

List the codes of practice of the Human Tissue Act 2004.

Answer 2

• Code A: Guiding principles (the overarching code).
• Code B: Post-mortem examination.
• Code C: Anatomical examination.
• Code D: Public display.
• Code E: Research.
• Code F: Donation of solid organs for transplantation.
• Code G: Donation of allogeneic bone marrow and peripheral blood stem cells for transplantation.

Question 3

List 2 arguments for the opt-in system.

Answer 3

1 - Autonomy - ensuring people make their own decisions about what happens to them.

2 - Opt-in means that you can be fairly certain that if someone has opted in, their wishes are being followed.

Question 4

List 2 arguments against the opt-in system.

Answer 4

1 - The opt-in system provides less organs than opt-out.

2 - Some people are willing to donate but don’t get around to opting-in.

Question 5

List 2 arguments for the opt-out system.

Answer 5

1 - The opt-out system provides more organs than opt-in.

2 - An increase in organ donation would help reduce illegal organ traffic.

Question 6

List 4 arguments against the opt-out system.

Answer 6

1 - Some believe opt-out implies state ownership of organs.

2 - People being unaware of the move to an opt-out system.

3 - People being opposed to donating but not getting around to opting-out.

4 - Presumed consent isn’t true consent (see elements of consent card).

Question 7

List the elements of consent.

Answer 7

1 - Competence.

2 - Information.

3 - Voluntariness.

Question 8

Which section of the Human Tissue Act of 2004 makes it an offence to undertake scheduled activities without appropriate consent from the donor?

Which section of the HUman Tissue Act of 2004 states the requirements of consent, and when consent can be considered to be valid?

Answer 8

• Section 5 makes it an offence to undertake scheduled activities without consent from the donor.
• Section 1 states the requirements of consent, and when consent can be considered to be valid.

Question 9

Who can give appropriate consent for anatomical examination of donated human tissue?

How is this consent given?

Answer 9

• Only the donor can consent to anatomical examination of their donated human tissue.
• Consent must be written by, or at the direction of, the person concerned whilst in the presence of at least one witness.
• Consent can also be contained within the person’s will.

Question 10

Define phronesis.

Answer 10

A concept which advocates a way to make ethical decisions that are grounded in an accumulated wisdom gained through previous practice, dilemmas and decisions.

Question 11

List 3 theories concerning ethical decisions.

Answer 11

1 - Consequentialism (utilitarianism) - the end result is the only thing that matters.

2 - Deontology - doing the right thing by following the guidelines.

3 - Practice-based virtue ethics - the practice peer group agrees on a decision based on intra-practice and inter-practice moral debate to best serve the patient and societal wellbeing. It is founded on the idea that good judgement is founded on good character.

Question 12

Define virtue.

How does a person act in a virtuous way?

Answer 12

• A mean between two vices of excess and deficiency (each virtue is based on this continuum).
• To arrive at this mean, a person needs to demonstrate phronesis, because each virtue is:

1 - Culturally sensitive.

2 - Contextualised.

3 - Variable between practices.

Question 13

Why is phronesis necessary for good practice according to Tyreman?

Answer 13

Because phronesis adds a necessary corrective dimension to over-emphasis on scientific knowledge.

Question 14

What, according to MacIntyre, has had a negative impact on the cultivation of ethical practice?

Answer 14

According to MacIntyre, the gradual erosion of arts and humanities in professional education has had a negative impact on the cultivation of ethical practice.

Question 15

List 3 examples of virtues and, for each, give examples of an excess and a deficiency for which the virtue represents the mean.

Answer 15

1 - Negotiation:

• Excess: Doctor decides.
• Deficiency: Patient decides.

2 - Fairness.

• Excess: All receive a treatment.
• Deficiency: Only a select few get the treatment.

3 - Lawfulness:

• Excess: Constant worry over litigation.
• Deficiency: Ignoring legal constraints.

Question 16

List 4 questions that should be addressed when answering an ethical question according to practice-based virtue ethics.

Answer 16

1 - What is the purpose of the practice?

2 - What are the concrete particularities of the situation?

3 - What are the virtues and their continuums?

4 - What are the actions based on practically wise decisions?

Question 17

List 4 positive outcomes from a moral dilemma.

Answer 17

1 - Patient benefit.

2 - Community benefit.

3 - Professional fulfilment.