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Title of Journal: Neuroethics

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Abbravation: Neuroethics

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Springer Netherlands

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DOI

10.1002/chin.201138089

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1874-5504

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Moral Evaluations of Organ Transplantation Influen

Authors: Michael NairCollins Mary A Gerend
Publish Date: 2015/08/11
Volume: 8, Issue: 3, Pages: 283-297
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Abstract

Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette Those who were randomly assigned to the good condition vs bad were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death Furthermore attitudes toward euthanasia and organ donation independently predicted judgments of death and causation regardless of experimental condition The results are discussed in light of the framework of motivated reasoning in which motivation influences the selection of cognitive processes and representations applied to a given domain as well as Knobe’s personasmoralist model in which many basic concepts are appropriately imbued with moral features On either explanatory framework these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heartbeating donors which holds that neurological criteria for death are scientifically justified independently of concerns about organ transplantation These data suggest that rather than concluding that organ removal is permissible because the donor is dead people may believe that the donor is dead because they believe organ removal to be permissibleThe practice of organ transplantation is premised on an ethical constraint known as the dead donor rule which states that the removal of vital organs must not cause the death of the donor This deontic constraint forbids the causing of one patient’s death in order to benefit others even if the patient is unconscious debilitated or very near death 1 It serves to protect vulnerable patients from exploitation to maintain public trust in the transplantation enterprise and has been described as “a centerpiece of the social order’s commitment to respect for persons and human life” 1 p 6 The majority of transplant organs are procured from patients who have been declared dead by neurologic criteria or “brain dead” and thus the removal of organs from these patients is believed to accord with the dead donor rule Furthermore the prevailing view holds that from a biomedical perspective neurological and circulatory criteria for the determination of death are simply two different ways of identifying the same underlying state of human death 2 According to this view neurological criteria for death are based on sound biomedical science and philosophical reasoning and are justified independently of other concerns including organ transplantation 3Although mostly accepted in the medical and legal communities 4 neurological criteria for death are controversial Scholars have argued that brain death is insufficient for the death of a human organism in a biological sense since patients who meet diagnostic criteria for brain death retain the capacity to function as an integrated whole in the maintenance of homeostasis and resistance of entropy 5 6 Furthermore some argue that rather than reflecting an advance in the scientific understanding of death the concept of brain death embodies or reflects an implicit moral evaluation specifically that it is permissible to remove vital organs in the condition of devastating neurological injury known as brain death 7 8 Thus rather than concluding that organ removal is permissible because the donor is dead perhaps people believe that the donor is dead because they believe organ removal to be permissibleIn this article we describe two experiments designed to ascertain whether people’s moral evaluations of organ transplantation influence their judgments of death and causation in an organ removal scenario We situate the results within the framework of motivated reasoning in which motivation influences the selection of cognitive representations applied to a given domain In the discussion section we also consider an alternative theoretical framework for interpreting the results similar to Knobe’s personasmoralist model 9 in which the concepts of death and causation are treated as partially moral concepts rather than valueneutral factual concepts cf 7 Finally we discuss the implications of these results for the bioethical debate on death and organ transplantationMotivated reasoning is an empirically wellvalidated framework that explains people’s reasoning processes in terms of an interaction of motivational and cognitive processes Motivation – that is any wish desire or preference to reach a particular conclusion – impacts the reasoning process by influencing the selection of cognitive processes and representations applied to a given reasoning problem in such a way that the outcome of the reasoning process is biased towards the preferred conclusion 10 Motivated reasoning has been found in a variety of domains including beliefs about the self and others 10 11 and in moral cognition 12Particularly relevant to the present context there are a series of findings of motivated reasoning involving blame causation and harm Alicke 13 14 found that people tend to interpret relevant facts about a given situation in a way that validates a prior assessment of blame For example people were more likely to blame the driver of a car for being involved in an accident when he was speeding home to hide a vial of cocaine from his parents than when he was speeding home to hide an anniversary present In accordance with motivated reasoning people were also more likely to judge the driver as the cause of the accident when he was speeding home to hide cocaine vs an anniversary present thus validating their prior assessment of blame even though all other factors were the same between the two cases 13 In a legal context Sood and Darley 15 found motivated reasoning about the concept of harm Participants were more likely to assert that harm is caused by some distasteful action such as washing a sidewalk with the flag when they believed that the law requires showing the occurrence of harm in order to criminalize the behavior they found distasteful However when not constrained by demonstrable harm as a requirement of criminalization participants who found the action distasteful and wished to see it criminalized did not assert that it caused harm thus demonstrating that judgments of harm were recruited in a motivated fashion in order to justify their preference for criminalization Similarly Miller et al 16 have argued that much of what is taken as received wisdom in medical ethics relies on a series of moral fictions 16 or moral bias 5 which involve the motivated misinterpretation of facts about causation and intention in order to allow accepted medical practices at the end of life such as withdrawing lifesustaining treatment to appear consistent with traditional norms such as that doctors must not cause death Although plausible they do not present experimental evidence for motivated reasoning in this specific contextThe theoretical framework of motivated reasoning is useful for investigating beliefs about death and organ transplantation If an observer were to judge organ removal from a given donor as morally good or as not blameworthy then according to the motivated reasoning model that observer would be motivated to interpret the scenario in a way that validates the observer’s ethical judgment for example by concluding that the act of removing organs did not cause death and that the donor was already dead before organs were removed On the other hand were an observer to judge organ removal as morally bad or as blameworthy then this would create a motivation to interpret the scenario differently by concluding that the donor was still alive when organs were removed and that organ removal was the cause of deathIn light of this background we predicted that people’s beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette would vary depending on whether the vignette was framed as morally good or bad Participants presented with the good scenario would be more likely to judge that the unconscious donor was already dead prior to organ removal and that organ removal did not cause death as compared to the bad scenario Further we expected that individual differences in attitudes toward organ transplantation and euthanasia would predict participants’ beliefs about whether the organ donor was dead and whether organ removal caused death regardless of experimental condition That is participants with more favorable attitudes toward organ donation in general would be more likely to believe that the donor was dead and organ removal did not cause death than those with less favorable attitudes regardless of whether they read the morally good or bad scenario Conversely participants with less favorable attitudes toward euthanasia would be more likely to believe that the donor was alive and that organ removal caused death than those with more favorable attitudes


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