Simon Paul Jenkins

This paper presents a moral‐theoretical evaluation of medical electives, applying different frameworks of distributive justice to the phenomenon of healthcare students visiting countries with less access to resources in order to bolster their own learning. Currently, discussions of ethical issues around these medical electives largely focuses on issues arising during the placement experience itself, in the form of dilemmas to which an individual must react in an ethical way. Applying different frameworks of distributive justice to the wider issue of how an elective project is designed and organised suggests that electives need to focus a great deal more on conferring benefits to host communities – that is, the communities being visited by students from wealthier settings – than is currently the case. To avoid the charge that medical electives are impermissibly extractive insofar as they impose burdens on host communities that are not justified by appeal to the benefits that the visiting students (or their communities) enjoy, I propose that both students and educators in the healthcare professions consider advocating an offsetting system to compensate host communities for the harms caused by the elective's taking place. The offsetting could comprise a monetary payment, a resolution to work in a lower‐resource setting in the future, or some combination of those two things. While this system may not even be permissible under all the distributive justice frameworks considered, it represents an improvement on the current state of affairs whilst still allowing trainees to gain useful experiences from electives.

The question of whether donors should be able to set conditions on who can receive their tissue has been discussed by bioethicists, but so far there has been little consideration of whether the answer to this question should be different depending on the type of tissue under discussion. In this article, we compare the donation of organs with the donation of reproductive material such as sperm, eggs, and embryos, exploring possible arguments for allowing donors to set conditions in one case but not the other. After considering arguments from procreative liberty, special parental obligations, and donors meeting their genetic offspring, we find that there is no ethically defensible reason to have different policies between these two cases. As a consequence, we conclude that jurisdictions operating with this inconsistency should consider moving their policies into better alignment. We also make some recommendations for the standardisation of the terminology around conditional donation.

This paper argues that the convention of allocating donated gametes on a ‘first come, first served’ basis should be replaced with an allocation system that takes into account more morally relevant criteria than waiting time. This conclusion was developed using an empirical bioethics methodology, which involved a study of the views of 18 staff members from seven U.K. fertility clinics, and 20 academics, policy-makers, representatives of patient groups, and other relevant professionals, on the allocation of donated sperm and eggs. Against these views, we consider some nuanced ways of including criteria in a points allocation system. We argue that such a system is more ethically robust than ‘first come, first served’, but we acknowledge that our results suggest that a points system will meet with resistance from those working in the field. We conclude that criteria such as a patient's age, potentially damaging substance use, and parental status should be used to allocate points and determine which patients receive treatment and in what order. These and other factors should be applied according to how they bear on considerations like child welfare, patient welfare, and the effectiveness of the proposed treatment.