Principle consistency is not practice justification: why Maseks critique of the dead donor rule proves less than it appears

Commentary

Masek’s recent paper offers a disciplined challenge to the dead donor rule (DDR).1 Unlike critics who rely on consequentialism or deny donors’ moral status, Masek works within non-consequentialist ethics to mount a consistency argument: the principles used to justify the DDR—do-no-harm, do-not-kill and double effect—would, if applied consistently, also prohibit kidney donation, fetal surgery, domino liver transplants and lethal palliation. Since those practices are widely accepted, these principles cannot bear the weight placed on them.

The argument is largely successful against its targets. The fictional cases are philosophically effective, particularly the replacement liver case, in which the DDR requires replacing a dying patient’s liver solely to avoid technical violation of the rule—serving no medical, existential or relational good for anyone. I grant that DDR proponents can no longer rest comfortably on any single principle Masek examines without confronting the contradictions he identifies.

But the argument proves less than it…

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