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The Ethics of Persuasion: Evaluating the Ethical Limits on Attempting to Persuade Families to Donate the Organs of Deceased Family Members

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Book cover Ethical Issues in Pediatric Organ Transplantation

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 66))

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Abstract

This chapter examines the ethics of using persuasive techniques to encourage families to consent to organ donation by their deceased loved ones. We review the literature on the psychological effects of donation on families, and consider when and how the treatment of families in the requesting and donation process might put their future psychological well-being at increased risk. We also consider lawsuits brought against healthcare personnel for the negligent infliction of psychiatric injury on family members in several end-of-life contexts including organ donation. Although successful lawsuits arising from the manner in which families are asked to consent are unlikely for several reasons, there are lawsuits in partly analogous contexts that do shed light on the types of treatment that may raise ethical, if not legal, concerns. We do not attempt to propose boundaries for the use of persuasive techniques, as the question of how much risk to families is justified by the potential benefits sought for others (e.g. transplant recipients) is a difficult problem that exceeds the scope of this chapter. Nonetheless, we identify some persuasive practices as ethically justifiable and others that require further ethical consideration.

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Notes

  1. 1.

    As noted above, the interests of the deceased (which are recognized as having a continuing value after death in various contexts), of transplant recipients, and of the broader society must also be considered, and we do not take a position here on which should be weighted more heavily or how any conflicting interests should be balanced.

  2. 2.

    These included uncertainty about the recipient and whether the transplant was successful, skepticism or confusion about brain death, feeling rushed once the donation decision had been made, and keeping a loved one “alive” until donation could occur.

  3. 3.

    These included the receipt of letters from recipients, a thank you ceremony from the transplantation organization. Many also cited the donation as positive in itself as it allowed something good to come from a tragic event or that it gave effect to their loved one’s wishes.

  4. 4.

    The courts use multiple names for this tort, including variants of the negligent infliction of nervous shock, mental or emotional distress, or psychological or psychiatric harm.

  5. 5.

    Similarly, in Joyner, a mother claimed that health officials had led her to believe that no organs would be removed from her child’s body during autopsy, and that their subsequent removal resulted in emotional distress [53].

References

  1. Barnieh L, Gill JS, Klarenbach S, Manns BJ. The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Clin J Am Soc Nephrol. 2013;8(12):2165–73.

    Article  Google Scholar 

  2. Rodrigue JR, Cornell DL, Howard RJ. The instability of organ donation decisions by next-of-kin and factors that predict it. Am J Transplant. 2008;8(12):2661–7.

    Article  Google Scholar 

  3. Rodrigue JR, Scott MP, Oppenheim AR. The tissue donation experience: a comparison of donor and nondonor families. Prog Transplant. 2003;13(4):258–64.

    Article  Google Scholar 

  4. Jacoby L, Jaccard J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of kin. Am J Crit Care. 2010;19(5):e52–61.

    Article  Google Scholar 

  5. Manzari ZS, Mohammadi E, Heydari A. Aghamohammadian, Modabber, Khaleghi E. Exploring families’ experiences of an organ donation request after brain death. Nursing Ethics. 2012;19(5):654–65.

    Article  Google Scholar 

  6. Siminoff LA, Traino HM, Gordon N. Determinants of family consent to tissue donation. J Trauma—Injury, Infect Crit Care. 2010;69(4):956–63.

    Article  Google Scholar 

  7. Carey I, Forbes K. The experiences of donor families in the hospice. Palliat Med. 2003;17(3):241–7.

    Article  Google Scholar 

  8. Blok GA. The impact of changes in practice in organ procurement on the satisfaction of donor relatives. Patient Educ Couns. 2005;58(1):104–13.

    Article  Google Scholar 

  9. Merchant SJ, Yoshida EM, Lee TK, Richardson P, Karlsbjerg KM, Cheung E. Exploring the psychological effects of deceased organ donation on the families of the organ donors. Clin Transplant. 2008;22(3):341–7.

    Article  Google Scholar 

  10. Jansen NE, Van Leiden HA, Haase-Kromwijk BJJM, Van Der Meer NJM, Kruijff EV, Van Der Lely N, et al. Appointing ‘trained donation practitioners’ results in a higher family consent rate in the Netherlands: a multicenter study. Transpl Int. 2011;24(12):1189–97.

    Article  Google Scholar 

  11. Bellali T, Papadatou D. Parental grief following the brain death of a child: does consent or refusal to organ donation affect their grief? Death Stud. 2006;30(10):883–917.

    Article  Google Scholar 

  12. Siminoff LA, Mercer MB. Public policy, public opinion, and consent for organ donation. Camb Q Healthcare Ethics: CQ: Int J Healthcare Ethics Committees. 2001;10(4):377–86.

    Article  Google Scholar 

  13. Cleiren MPHD, Van Zoelen AAJ. Post-mortem organ donation and grief: a study of consent, refusal and well-being in bereavement. Death Stud. 2002;26(10):837–49.

    Article  Google Scholar 

  14. Tavakoli SAH, Shabanzadeh AP, Arjmand B, Aghayan SHR, Nozary Heshmati B, Emami Razavi SH, et al. Comparative study of depression and consent among brain death families in donor and nondonor groups from march 2001 to december 2002 in Tehran. Transpl Proc. 2008;40(10):3299–302.

    Article  Google Scholar 

  15. Manzari ZS, Mohammadi E, Heydari A, Aghamohammadian M, Khaleghi E. Exploring families’ experiences of an organ donation request after brain death. Nurs Ethics. 2012;19(5):654–65.

    Article  Google Scholar 

  16. Tong YF, Holroyd EA, Cheng C. Needs and experiences of Hong Kong Chinese cadaveric organ donor families. Hong Kong J. Nephrol. 2006;8(1):24–32.

    Article  Google Scholar 

  17. Shih FJ, Lai MK, Lin MH, Lin HY, Tsao CI, Chou LL, et al. Impact of cadaveric organ donation on Taiwanese donor families during the first 6 months after donation. Psychosom Med. 2001;63(1):69–78.

    Article  Google Scholar 

  18. Smudla A, Hegedus K, Mihaly S, Szabo G, Fazakas J. The HELLP concept—relatives of deceased donors need the help earlier in parallel with loss of a loved person. Ann Transplant. 2012;17(2):18–28.

    Article  Google Scholar 

  19. Exley M, White N, Martin JH. Why families say no to organ donation. Critical Care Nurse. 2002;22(6):44–51.

    Google Scholar 

  20. Kesselring A, Kainz M, Kiss A. Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU. Am J Transplant. 2007;7(1):211–7.

    Article  Google Scholar 

  21. Sque M, Long T, Payne S, Allardyce D. Why relatives do not donate organs for transplants: ‘sacrifice’ or ‘gift of life’? J Adv Nurs. 2008;61(2):134–44.

    Article  Google Scholar 

  22. Siminoff LA, Agyemang AA, Traino HM. Consent to organ donation: a review. Prog Transplant. 2013;23(1):99–104.

    Article  Google Scholar 

  23. Metzger RA, Taylor GJ, McGaw LJ, Weber PG, Delmonico FL, Prottas JM. Research to practice: a national consensus conference. Prog Transplant (Aliso Viejo, Calif.). 2005;15(4):379–84.

    Google Scholar 

  24. Zink S, Wertlieb S. A study of the presumptive approach to consent for organ donation: a new solution to an old problem. [Review] [8 refs]. Crit Care Nurse. 2006;26(2):129–36.

    Google Scholar 

  25. Williams MA, Lipsett PA, Rushton CH, Grochowski EC, Berkowitz ID, Mann SL, et al. The physician’s role in discussing organ donation with families. Crit Care Med. 2003;31(5):1568–73.

    Article  Google Scholar 

  26. Streat S. Clinical review: moral assumptions and the process of organ donation in the intensive care unit. Crit Care. 2004;8(5):382–8.

    Article  Google Scholar 

  27. Shih F, Lai M, Lin M, Lin H, Tsao C, Duh B, et al. The dilemma of “to-be or not-to-be”: needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition. Soc Sci Med. 2001;53(6):693–706.

    Article  Google Scholar 

  28. Whyte KP, Selinger E, Caplan AL, Sadowski J. Nudge, nudge or shove, shove—the right way for nudges to increase the supply of donated cadaver organs. Am J Bioeth. 2012;12(2):32–9.

    Article  Google Scholar 

  29. Truog RD. When does a nudge become a shove in seeking consent for organ donation? Am J Bioeth. 2012;12(2):42–4.

    Article  Google Scholar 

  30. Rodrigue JR, Cornell DL, Howard RJ. Organ donation decision: comparison of donor and nondonor families. Am J Transplant. 2006;6(1):190–8.

    Article  Google Scholar 

  31. Siminoff LA, Gordon N, Hewlett J, Arnold RM. Factors influencing families’ consent for donation of solid organs for transplantation. J Am Med Assoc. 2001;286(1):71–7.

    Article  Google Scholar 

  32. Rodrigue JR, Cornell DL, Howard RJ. Pediatric organ donation: what factors most influence parents’ donation decisions? Pediatr Crit Care Med. 2008;9(2):180–5.

    Article  Google Scholar 

  33. Siminoff LA, Arnold RM, Hewlett J. The process of organ donation and its effect on consent. Clin Transplant. 2001;15(1):39–47.

    Article  Google Scholar 

  34. Sanner MA. Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event. J Crit Care. 2007;22(4):296–304.

    Article  Google Scholar 

  35. Joule RV, Bernard F, Geissler A, Girandola F, Halimi-Falkowicz S. Binding communication at the service of organ donations. Revue Int De Psychol Sociale-Int Rev Social Psychol. 2010;23(2–3):211–38.

    Google Scholar 

  36. Siminoff LA, Traino HM, Gordon NH. An exploratory study of relational, persuasive, and nonverbal communication in requests for tissue donation. J Health Commun. 2011;16(9):955–75.

    Article  Google Scholar 

  37. Anker AE, Feeley TH. Difficult communication: compliance-gaining strategies of organ procurement coordinators. J Health Commun. 2011;16(4):372–92.

    Article  Google Scholar 

  38. Anker AE, Feeley TH. Asking the difficult questions: message strategies used by organ procurement coordinators in requesting familial consent to organ donation. J Health Commun. 2011;16(6):643–59.

    Article  Google Scholar 

  39. Trillium Gift of Life Act, R.S.O. 1990, c. H.20.

    Google Scholar 

  40. Washington v. Knight, Collom & Carney Clinic Association and Texarkana Memorial Hospital, D/B/A/ Wadley Regional Medical Center, 887 S.W.2d 211 (Tex. App 1994).

    Google Scholar 

  41. Strachan v. John F. Kennedy memorial hospital and A.R. Pirolli, 507 A.2d 718 (N.J. Super. 1986).

    Google Scholar 

  42. Bastien et al v Ottawa Hospital (General Campus), (2001) 56 O.R. (3d) 397.

    Google Scholar 

  43. Devji v Burnaby (District), (1998) 158 D.L.R. (4th) 747.

    Google Scholar 

  44. Lew v Mount Saint Joseph Hospital Society, (1997) 44 B.C.L.R. (3d) 84, [1997] B.C.J. No. 2461.

    Google Scholar 

  45. Perry v. Saint Francis Hospital and Medical Center Inc and American National Red Cross, 886 F. Supp 1551 (U.S.Dist. 1995).

    Google Scholar 

  46. Mansaw v. Midwest Organ Bank and Truman Medical Center West, No. 97-0271-CV-W-6 (U.S. Dist. 1998).

    Google Scholar 

  47. George H. Lanier Memorial Hospital and Jason Ivey v. Andrews et al, 901 So. 2d 714 (Ala, 2004).

    Google Scholar 

  48. Adams et al v. King County et al, 164 Wn.2d 640 (Wash 2008).

    Google Scholar 

  49. Drever v. State of New York, 948 N.Y.S.2d 550 (N.Y. 2014).

    Google Scholar 

  50. Burgess v. Perdue and State of Kansas, 721 P.2d 239 (Kan. 1986).

    Google Scholar 

  51. Siegel v. LifeCenter Organ Donor Network, et al, 969 N.E.2d 1271 (Ohio 2011).

    Google Scholar 

  52. A B and Others v. Leeds Teaching Hospital NHS Trust and Cardiff and Vale HNS Trust, [2004] EWHC 644 (QB).

    Google Scholar 

  53. Joyner v. The State of New York, (2001), #2001-013-518, Claim No. 88536.

    Google Scholar 

  54. Carey v. New England Organ Bank, 446 Mass. 270 (Mass. 2006).

    Google Scholar 

  55. Bushlow v. INOVA Health Systems Hospitals, t/a Fairfax Hospital, 40 Va. Cir. 121 (Va. 1996).

    Google Scholar 

  56. Klar L. Tort law. 5th ed. Toronto: Carswell; 2012.

    Google Scholar 

  57. Osborne PH. The law of torts. 4th ed. Toronto: Irwin Law; 2011.

    Google Scholar 

  58. Mustapha v Culligan of Canada Ltd., 2008 SCC 27, [2008] 2 SCR 114.

    Google Scholar 

  59. Lodge v. Fraser Health Authority 2009 BCCA 108.

    Google Scholar 

  60. Vanek v. Great Atlantic & Pacific Co. of Canada (1999) 48 O.R. (3d) (Ont. C.A.).

    Google Scholar 

  61. Malette v Shulman, 2006 BCSC 1295, [2006] B.C.J. No. 1976.

    Google Scholar 

  62. Belanger-Hardy L. Thresholds of actionable mental harm in negligence: a policy-based analysis. Dalhousie LJ 2013; 36:103.

    Google Scholar 

  63. Healey v. Lakeridge Health Corporation, 2011 ONCA 55, 103 OR (3rd) 401.

    Google Scholar 

  64. Kotai v Queen of the North, 2009 BCSC 1604, [2009] BCJ No 2332.

    Google Scholar 

  65. Quigley M. Nudging for health: on public policy and designing for choice architecture. Med Law Rev. 2013;21(4):588–621.

    Article  Google Scholar 

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Acknowledgements

The authors acknowledge the financial contribution of Health Canada, and the Provinces and Territories, as well as the financial support of the Canadian National Transplant Research Program (CNTRP) and the Canadian Institutes of Health Research (CIHR). The views expressed in this chapter do not necessarily represent the views of the Federal, Provincial or Territorial governments, the CNTRP or CIHR. We also acknowledge the excellent research assistance of Nir Harrel and Matthew Connors.

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Authors and Affiliations

  1. Faculty of Law, University of Ottawa, Ottawa, Canada

    Jennifer A. Chandler & Vanessa Gruben

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  1. Jennifer A. Chandler
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Correspondence to Jennifer A. Chandler .

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Editors and Affiliations

  1. Department of Family and, The Hospital for Sick Children, Toronto, Canada

    Rebecca A. Greenberg

  2. Dept. of Pediatrics, Winnipeg Regional Health Authority, Winnipeg, Canada

    Aviva M. Goldberg

  3. Department of Philosophy I, University of Granada, Madrid, Spain

    David Rodríguez-Arias

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Chandler, J.A., Gruben, V. (2016). The Ethics of Persuasion: Evaluating the Ethical Limits on Attempting to Persuade Families to Donate the Organs of Deceased Family Members. In: Greenberg, R., Goldberg, A., Rodríguez-Arias, D. (eds) Ethical Issues in Pediatric Organ Transplantation. International Library of Ethics, Law, and the New Medicine, vol 66. Springer, Cham. https://doi.org/10.1007/978-3-319-29185-7_4

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