Alex Capron

On Not Taking “Yes” for an Answer

The Journal of Clinical Ethics

Legal Studies Working Paper Series Engendering Rape Engendering Rape Engendering Rape

This Article highlights a systematic bias in the academic, correctional, and human rights discour... more This Article highlights a systematic bias in the academic, correctional, and human rights discourse that constitutes the basis for prison rape policy reform. This discourse focuses almost exclusively on sexual abuse perpetrated by men: sexual abuse of male prisoners by fellow inmates, and sexual abuse of women prisoners by male staff. But since 2007, survey and correctional data have indicated that the main perpetrators of prison sexual abuse seem to be women. In men's facilities, inmates report much more sexual victimization by female staff than by male inmates; in women's facilities, inmates report much higher rates of sexual abuse by fellow inmates than by male or female staff. These findings contravene conventional gender expectations, and are barely acknowledged in contemporary prison rape discourse, leading to policy decisions that are too sanguine about the likelihood of female-perpetrated sexual victimization. The selective blindness of prison rape discourse to count...

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Field Notes

Hastings Center Report, 2009

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Six Decades of Organ Donation and the Challenges That Shifting the United States to a Market System Would Create Around the World

Law and Contemporary Problems

Since the beginning of human kidney transplantation six decades ago, and especially since the fir... more Since the beginning of human kidney transplantation six decades ago, and especially since the first heart transplant and the creation of deceased-donation programs forty-five years ago in the United States, the Western model for organ donation has been one of unpaid giving. Such a donation typically occurs for what are termed "altruistic" reasons, meaning that the organ donor is not acting for material gain. Proposals in the developed countries to overcome the shortage of human organs for transplantation by creating a market or providing other financial incentives or benefits to donors are unlikely to increase the net number of organs available, would spread to Western countries the exploitation of poor and vulnerable organ sellers that has occurred for decades in a number of developing countries, and would undermine the still tenuous progress made over the past decade in those countries, responding to the principled stand of intergovernmental and professional organization...

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Preventing Trafficking in Organs for Transplantation: An Important Facet of the Fight Against Human Trafficking

Journal of Human Trafficking, 2015

Most countries now have national legislation that outlaws both human trafficking and organ traffi... more Most countries now have national legislation that outlaws both human trafficking and organ trafficking. However, international conventions and domestic laws alone have not been enough to stop the trade in organs. As of 2007, a conservative estimate was that 5% of the approximately 100,000 organs transplanted annually were derived from exploiting the poorest and most vulnerable people in society; anti-trafficking efforts have since reduced, though not eliminated, this practice. The Declaration of Istanbul (DoI) was created in 2008 to engage medical professional societies to collaborate with governments and others in combating organ sales, transplant tourism, and trafficking in human organs. In 2010, the Declaration of Istanbul Custodian Group (DICG) was formed to actively promote and to monitor the implementation of the DoI principles. The removal of prohibitions on organ purchases, which is now being promoted in some wealthy nations, is unlikely to shorten transplant waitlists (because organ sales crowd out voluntary, unpaid donation) and would be based on the false view that such sales do not exploit the sellers. To combat such exploitation, the DICG advocates for ratification and enforcement of the new "Council of Europe Convention against Trafficking in Human Organs," as a complement the Palermo Protocol to the United Nations organized crime convention that prohibits human trafficking for organ removal. To increase ethical organ donation by living related donors, the DICG encourages countries to adopt means to cover donors' financial costs, which now discourage donation. It also works with the World Health Organization to encourage ministries of health to develop deceased donation to its maximum potential toward the goal of achieving national self-sufficiency in organ transplantation so that patients do not need to travel to foreign destinations to undergo organ transplantation using kidneys and partial livers purchased from

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Organ markets: problems beyond harms to vendors

The American journal of bioethics : AJOB, 2014

For more than a quarter century, the World Health Organi-zation (WHO) has encouraged nations to b... more For more than a quarter century, the World Health Organi-zation (WHO) has encouraged nations to ban the purchaseor sale of human organs for transplantation from living ordeceased donors (WHO 2010). Most countries now imposecriminal penalties on organ commercialism, and the Coun-cil of Europe Convention against Trafﬁcking in HumanOrgans, which received ﬁnal approval by the Committeeof Ministers on July 9, 2014, extends the offense of organtrafﬁcking to include the actions of brokers in advertisingfor and recruiting organ vendors, as well as physicianswho knowingly transplant a vended organ (Lopez-Fragaet al. 2014). In the past decade, professional bodies such asthe Declaration of Istanbul Custodian Group have activelypromoted the adoption and implementation of laws to haltorgan commercialism and transplant tourism (Danovitchet al. 2013). Nonetheless, as Julian Koplin (2014) describes,a vocal group of liberal philosophers and free-marketadvocates has argued that the shortfall in the supply oforgans (particularly kidneys) for transplantation could beovercome through a “regulated market” (Matas, Hippen,and Satel 2008). The market proponents portray the trade-off in terms of principles, between promoting liberty andextending human lives, on the one hand, and protectinghuman dignity and preventing commodiﬁcation of thehuman body, on the other. They conﬁdently predict thatpaying for organs would achieve the former, while loss ofthe latter would not prove harmful to society or individuals.But proposals to establish a regulated market in organs canalso be viewed in consequentialist terms. Indeed, Koplinprovides strong evidence that regulated markets will not infact safeguard kidney vendors from physical, psychological,social, and ﬁnancial harms—in other words, that they posereal threats to people, not solely to principles.Beyond those strong reasons for rejecting proposals torepeal the prohibitions on organ purchases, three objec-tions that Koplin notes merely in passing deserve furtherexploration. First, regulated organ markets would be veryexpensive and complex to administer and risk creatingreal or perceived unfairness. Second, ample evidenceexists that the form of regulated organ purchases beingproposed would not increase the net supply of organs fortransplantation. Finally, regulated markets contain theseeds of their own undoing and would soon devolve intounregulated markets.“REGULATED MARKETS” FOR ORGANS WOULDBE VERY EXPENSIVE AND COMPLEX TO ADMINISTERSome proponents of using payments to increase thesupply of organs have actually accepted the conclusionof the Declaration of Istanbul that in the resource-poorcountries where organ commercialism has been concen-trated, buyers have targeted “impoverished and other-wise vulnerable donors,” which has led “inexorably toinequity and injustice” (Declaration of Istanbul 2008).Yet, they contend, such problems would not arise inwealthier countries where the ﬁnancial incentivesoffered to organ vendors—principally to living personswho are selling one kidney, but also to the next of kinof deceased persons who permit removal of any trans-plantable organs—could be chosen so as not to appealto the very poor, who want immediate cash. This is theheart of “regulating” the market in organs, namely, thatpayments would be in a deferred form, such as adeposit into a retirement or college account for futureuse, and that the amount would be set at a level appro-priate to the risk and inconvenience involved—calcu-lated at $15,000 by Gary Becker, the late Nobel laureatein economics—rather than an amount generatedthrough the interplay of demand and supply.Beyond the expense that such a payment would add tothe total cost of transplantation (namely, $1,500,000,000more to clear the U.S. kidney transplant waiting list), theﬁrst objection to a ﬁxed price is that it would not appealequally to all groups in society. In order to offer a ﬁnancialincentive that would be as attractive to high-income as tomiddle- or low-income people, the amount paid wouldhave to vary according to each person’s income (orwealth). This would require potential organ sellers to dis-close private ﬁnancial information and administrators toinvestigate these submissions. To induce donation, adver-tisements would have to promise “You’ll get your fairreward,” rather than offering a set incentive to everyone.

Public Trust and Institutional Culture

Hastings Center Report, 2014

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Osteoporosis Panel Summary

Journal of Bone and Mineral Research, 2003

THIS CONFERENCE BROUGHT TOGETHER clinical investigators; epidemiologists; representatives of gove... more THIS CONFERENCE BROUGHT TOGETHER clinical investigators; epidemiologists; representatives of government regulatory agencies, industry, and Institutional Review Boards; government scientists; ethicists; and concerned laypersons to address critical issues in the development of new therapies for osteoporosis to prevent bone fractures. The meeting was not intended to achieve consensus. Rather, the American Society for Bone and Mineral Research wished to highlight emerging concerns. Doing so now is timely because additional potentially effective approaches to the problems of diagnosis of osteoporosis and prevention and treatment of fragility fractures are being developed. The problem of osteoporosis is likely to become even greater as the world population ages. This panel report will summarize some of the key issues developed at the conference. Detailed analyses of these issues are presented in the accompanying manuscripts.

Ethics committees in the United States

Notizie di Politeia, 2002

Ethical Issues Regarding Research Biobanks: Aims, Methods, and Main Results of a Qualitative Study Among Intemational and US Experts

Archive institutionnelle de l&amp;amp;#x27;Universit�� de Gen��ve - Institutional Repository ... more

Legal Rights and Moral Rights

Ethical Issues in Human Genetics, 1973

Field Notes

Hastings Center Report, 2009

Capron. Legal Consid of Studies in Children

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On Not Taking " Yes " for an Answer

Does the practice of questioning the decision-making capacity of patients who disagree with recom... more Does the practice of questioning the decision-making capacity of patients who disagree with recommended medical interventions amount to paternalism on the part of physicians who would not have raised questions about competence had these patients accepted the recommendation? Brudney and Siegler provide a nuanced argument why the practice can be both pragmatically and ethically justifiable, particularly if physicians follow a "decision tree" that they recommend for cases where disagreements occur. Nonetheless, the history of this subject shows that bioethicists have long been worried that the "outcome approach" (challenging patient's capacity because of substantive disagreements with their choices) undermines respect for autonomy, and the more refined version from Brudney and Siegler still creates some further concerns about the resulting inadequacies in communication and comprehension in the physician-patient relationship.

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Preventing Trafficking in Organs for Transplantation: An Important Facet of the Fight Against Human Trafficking

Most countries now have national legislation that outlaws both human trafficking and organ traffi... more Most countries now have national legislation that outlaws both human trafficking and organ trafficking. However, international conventions and domestic laws alone have not been enough to stop the trade in organs. As of 2007, a conservative estimate was that 5% of the approximately 100,000 organs transplanted annually were derived from exploiting the poorest and most vulnerable people in society; anti-trafficking efforts have since reduced, though not eliminated, this practice. The Declaration of Istanbul (DoI) was created in 2008 to engage medical professional societies to collaborate with governments and others in combating organ sales, transplant tourism, and trafficking in human organs. In 2010, the Declaration of Istanbul Custodian Group (DICG) was formed to actively promote and to monitor the implementation of the DoI principles. The removal of prohibitions on organ purchases, which is now being promoted in some wealthy nations, is unlikely to shorten transplant waitlists (because organ sales crowd out voluntary, unpaid donation) and would be based on the false view that such sales do not exploit the sellers. To combat such exploitation, the DICG advocates for ratification and enforcement of the new "Council of Europe Convention against Trafficking in Human Organs," as a complement the Palermo Protocol to the United Nations organized crime convention that prohibits human trafficking for organ removal. To increase ethical organ donation by living related donors, the DICG encourages countries to adopt means to cover donors' financial costs, which now discourage donation. It also works with the World Health Organization to encourage ministries of health to develop deceased donation to its maximum potential toward the goal of achieving national self-sufficiency in organ transplantation so that patients do not need to travel to foreign destinations to undergo organ transplantation using kidneys and partial livers purchased from Alexander M.

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the Transformation of Research with Human Beings

The modern history of experimentation with human beings is notable for its ethical lacunae, when ... more The modern history of experimentation with human beings is notable for its ethical lacunae, when even the clearest directives fail to prevent violations of subjects' rights and welfare. One such lacuna occurred during the 25 years between 1947, when the Nuremberg Code was articulated in the judgment passed on the men who had performed medical experiments in the Nazi concentration camps, and 1972, when the revelation of the 40-year-long Tuskegee Syphilis Study shocked the public and pushed Congress to adopt legislation that eventually transformed the governance of human subjects research. The work that Henry Beecher and Jay Katz did on the ethics of human experimentation beginning in 1964-which was mutually supportive but also divergent in its premises and prescriptions-played a prominent role in the policy-making processes. Beecher, whose detailed disclosure of the ethical lapses of leading researchers in his renowned 1966 New England Journal of Medicine article initiated the policy reform process, proved less influential in shaping those reforms than Katz. Ultimately, Beecher was one of the last and best exemplars of "medical ethics," while Katz-in his service on the Tuskegee Syphilis Study Ad Hoc Advisory Panel and in his testimony before, and work with, the Senate Health subcommittee-was an early University Professor,

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Public Trust and Institutional Culture

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SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD

Since the beginning of human kidney transplantation six decades ago, and especially since the fir... more Since the beginning of human kidney transplantation six decades ago, and especially since the first heart transplant and the creation of deceased-donation programs forty-five years ago in the United States, the Western model for organ donation has been one of unpaid giving. Such a donation typically occurs for what are termed " altruistic " reasons, meaning that the organ donor is not acting for material gain. As transplantation has spread around the world, the model of unpaid donation has not uniformly followed it into settings that are socially, medically, and legally very different. Nonetheless, over the past twenty-five years, the principled stand of intergovernmental and professional organizations has come much closer to making noncommercial organ donation truly the universal ethical norm. But its hold remains tenuous, and hence the gains made in protecting vulnerable, desperate organ sellers against exploitation could be easily lost.

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Organ Markets: Problems Beyond Harms to Vendors

Koplin is correct that allowing organ sales results in net utility losses to those who sell an or... more Koplin is correct that allowing organ sales results in net utility losses to those who sell an organ (typically, a kidney). Permitting organ sales also harms society, by undermining the development of deceased donation, by crowding out living related donation, and by placing pressure on poor persons to sell an organ when they do not wish to but are expected to in order to obtain public assistance or private loans.

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