Maryon McDonald

Family over rules? an ethical analysis of allowing families to overrule donation intentions

Abstract Millions of people want to donate their organs after they die for transplantation, and many of them have registered their wish to do so or told their family and friends about their decision. For most of them, however, this wish is unlikely to be fulfilled, as only a small number of deaths (1% in the United Kingdom) occur in circumstances where the opportunity to donate organs is possible. Even for those who do die in the “right” way and have recorded their wishes or live in a jurisdiction with a “presumed consent” system, donation often does not go ahead because of another issue: their families refuse to allow donation to proceed. In some jurisdictions, the rate of “family overrule” is over 10%. In this article, we provide a systematic ethical analysis of the family overrule of donation of solid organs by deceased patients, and examine arguments both in favor of and against allowing relatives to “veto” the potential donors intentions. First, we provide a brief review of the different consent systems in various European countries, and the ramifications for family overrule. Next, we describe and discuss the arguments in favor of permitting donation intentions to be overruled, and then the arguments against doing so. The “pro” arguments are: overrule minimises family distress and staff stress; families need to cooperate for donation to take place; families might have evidence regarding refusal; and failure to permit overrules could weaken trust in the donation system. The “con” arguments are: overrule violates the patients wishes; the family is too distressed and will regret the decision; overruling harms other patients; and regulations prohibit overrule. We conclude with a general discussion and recommendations for dealing with families who wish to overrule donation. Overall, overrule should only rarely be permitted.

PUTTING CULTURE IN ITS PLACE

ABSTRACT The European Union has been constructed through common ontologies of a world composed and divided on spatial scales. This paper elaborates on this point and examines anthropologically some of the key notions that have been called on to construct the EU, notably that of ‘culture’. It is suggested that we might profitably take ‘culture’ out of our own analytical tool-kits and treat it instead as an interesting but problematic invention. Drawing on the authors own fieldwork inside European institutions, the paper explores relevant aspects of life inside the Commission and what it is to be ‘European’. The paper sets out some of the negative and positive ways in which ‘culture’ is lived or understood in the Commission, and it outlines some of the problems of ‘culture’ as an analytical tool, from its earlier history to the stereotypes it still encourages, and in so doing points to aspects of the practical imagination and difficulties of the EU project more generally. We see that Europe may respect cultures but only by cherishing the notionally culture-free.

The ontological turn meets the certainty of death

ABSTRACT The ‘ontological turn’ involves some anthropological points of long standing but the approaches recently coordinated into this turn have been presented as a ‘call to arms’, as shaking up ‘mono-realist singularities’ and as inherently political. This fighting talk has no doubt made important contributions to anthropology and insights from the ontological turn can help in anthropological understandings of medical practices. However, this paper contends that this helpfulness is also limited and that a call to arms may be inappropriate. This point is made through an ethnographic understanding of medical concern about the diagnosis of death.

The exploitation of linguistic mis-match: towards an ethnography of customs and manners

Comparaison des usages et pratiques linguistiques du breton soulignant les differences sociales et les representations ideologiques divergentes des militants regionalistes et des usagers traditionnels de cette langue