252 M. Coombs and M. Woods
Case 2: Bioethical Commentary
This story highlights how the welfare of the individual intersects with
the allocation of scarce resources during end of life and donation, and
whether beneficence and the allocation of scarce resources are competi-
tive values. Tesh’s story is also one of huge tragic proportions: not only
did Mark and Lisa lose their daughter in a very short space of time (“It
all happened so fast”), the decision about organ donation is an addi-
tional burden at a time of enormous grief and emotional turmoil.
In circumstances where death is sudden and unexpected, it is unclear
how next-of-kin decision-makers can be considered in an emotionally
stable and reasoned state of mind, even if, as in Tesh’s case, family mem-
bers are willing to assist with the greater social good (Hazlett 2016 ). As
Tesh’s parents noted: “We didn’t hesitate at all. Our daughter Tesh was a
very giving person and was always willing to help others.” Nevertheless,
it should be noted that family can regard such requests as insensitive
and uncaring, and as such there is a danger in promoting a rational, rea-
soned, and utilitarian position at the expense of alternatives.
In circumstances surrounding organ donation from a brain dead
organ donor, it is important to assess the donor’s physiological state and
maintain organ health before organ retrieval, in order to minimise the
‘inefficient’ use of scarce resources. This was apparent in Tesh’s story due
to the delays in retrieval. However, artificially controlling bodily func-
tions after brain death has been confirmed may be seen by some as a
challenge to the family and the deceased’s welfare. This therapy on the
part of the intensive care unit staff not only has significant resource
implications but substantial ethical ones as well. Procuring organs from
a deceased person can disrupt (or in this case even interrupt) ‘both the
act of dying and the activity of accepting the death of those we love’
(Cohen 2006 ).
There must be room to employ a caring, relational ethic that rec-
ognises the need for great compassion and care of both the dying per-
son and their family. Such an approach need not be in opposition to
alternative ethical approaches, but must serve as a necessary adjunct to
both the standard framework of principles employed by clinicians, and
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