Anthony Wrigley

People have understandable concerns over what happens to their bodies, both during their life and after they die. Consent to organ donation is often perceived as an altruistic decision made by individuals prior to their death so that others can benefit from use of their organs once they have died. More recently, live organ donation has also been possible, where an individual chooses to donate an organ or body tissue that will not result in their death (such as a kidney). Although these live organ donations can be purely altruistic, they are usually done to benefit a close family member. An additional complicating factor with both kinds of donation is whether forms of extended decision-making can be used as a means of consent. This is where instructions are issued through some form of advance directive giving specific written instructions as to donation or by appointing a proxy surrogate decision-maker to determine such issues. In the case of deceased donation, there is a question as to whether an advance directive can override the wishes of family members. In the case of live organ donation, there is a largely untested concern as to whether advance directives or surrogates can provide acceptable consent to donation when an individual, though still alive, has lost the capacity to consent for themselves. In this paper, I will focus predominantly on the second of these issues concerning live organ donation and the challenges this poses for donors who have lost capacity to consent. I argue that the limitations on advance directives and surrogate decision-making mean that they can only give us an indication of preference and cannot serve as an authoritative consent where there is any dispute over donation. Instead, in turns out that family members have a significant and usually determinate role to play in these decisions. Although I am focusing on organ donation, the implications for this potentially extend to the use of other tissues and even gametes, which could be used for reproductive purposes.

Two notable limitations exist on the use of personhood arguments in establishing moral status. Firstly, although the attribution of personhood may give us sufficient reason to grant something moral status, it is not a necessary condition. Secondly, even if a person is that which has the ‘highest’ moral status, this does not mean that any interests of a person are justifiable grounds to kill something that has a ‘lower’ moral status. Additional justification is needed to overcome a basic wrongness associated with killing something possessing moral status. There are clear arguments already available in this regard in the case of a foetus that are not available in the case of a newborn infant. Hence, there is scope to consistently hold that abortion may be permissible but that after-birth abortion may not be permissible

We argue that the way in which the concept of expertise is understood and invoked has prevented progress in the debate as to whether moral philosophers can be said to be ‘moral experts’. We offer an account of expertise that draws on the role of tacit knowledge in order to provide a basis upon which the debate can progress. Our analysis consists of three parts. In the first part we highlight two specific problems in the way that the concept of expertise has been invoked in the moral expertise debate, namely the understanding of expertise as an exclusive concept and the conflation of expertise with the idea of ‘authority’. In the second part we suggest an alternative way of approaching the concept of expertise. This is based on Collins and Evans’ sociological theory of expertises. This theory provides a valuable analytical framework for thinking about claims to expertise and for drawing the kinds of distinctions which allow for different kinds of moral expertises and competencies. In the final part, we show how the application of this theory helps to avoid some of the problematic conclusions which theorists have arrived at to date and provides a common platform for debate. Ultimately, it permits the argument to be made that moral philosophers could be considered specialist members of an expert community of moral decision-makers.