The increasing appreciation of ethical principles in medicine in the 20th century were probably one of the most significant contributions to a good and responsible medicine in the last century. Some examples of statements and principles that have a guiding role in medical ethics related to transplant medicine are compiled below.
One of the earliest referrals to medical ethics goes back to the Hippocratic Oath. A modern definition of medical ethics can be found in Principles of Biomedical Ethics. The co-authors Tom Beauchamp and James Childress present four principles for consideration in medical practice: Respect for autonomy of the patient, the treatment should be beneficial to the patient, the treatment should not do harm to the patient and a just and fair treatment of the patient should be ensured. Other definitions would also include respect for the patient and requiring informed consent before treatment.
The Nuremberg Code was compiled as consequence of the inhuman experimentations during the Holocaust. It stresses the voluntary consent in medical experiments and aims for preventing harm to the patient.
One of the important ethical guidelines for medical research includes the WMA Declaration of Helsinki.
Ethical Guidelines related to Transplantation
The World Health Organization has provided some specific requirements for ethical transplant practices in the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation.
The Declaration of Istanbul describes principles how to prevent unethical practices and transplant tourism in transplant medicine.
In 2012 the World Medical Association adopted a revised WMA Statement on Organ and Tissue Donation which addresses the particular situation of organ harvesting from executed prisoners. It states:
“Free and informed decision making requires not only the provision of information but also the absence of coercion. Any concerns about pressure or coercion should be resolved before the decision to donate organs or tissue is made.
Prisoners and other people who are effectively detained in institutions should be eligible to donate after death only in exceptional circumstances where:
- there is evidence that this represents their long-standing and considered wish and safeguards are in place to confirm this; and
- their death is from natural causes; and
- the organs are donated to a first or second degree relative either directly or through a properly regulated pool.
In jurisdictions where the death penalty is practised, executed prisoners must not be considered as organ and/or tissue donors. While there may be individual cases where prisoners are acting voluntarily and free from pressure, it is impossible to put in place adequate safeguards to protect against coercion in all cases.”
Due to the unethical organ procurement practices in China, The Transplantation Society has adopted a specific Policy on Interactions with China.
Further references: Medical ethics
Forced Organ Harvesting in the Context of Genocide
The Convention on the Prevention and Punishment of the Crime of Genocide describes elements of acts that were “committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group.”
Forced organ harvesting from defined groups of prisoners of conscience as well as transplant medicine that exploits the availability of organs procured through such process, require a level of coordination and organization, which mirrors a certain level of intent. The destruction of the people subjected to forced organ harvesting is evident. In the People’s Republic of China the practice of forced organ harvesting from certain groups of prisoners of conscience, in particular from Falun Gong, meets criteria of the genocide definition and has to be assessed in this context.