Introduction

In the 1990s I became heavily focused on the ethical and legal aspects of living donor organ transplantation, gaining a PhD from De Montfort University on the subject and authoring a number of publications including a groundbreaking monograph entitled Living Donor Organ Transplantation: Key Legal and Ethical Issues (Garwood-Gowers, 1999). By the late 2000s I was beginning to think in much more detail about the links between different forms of medical practice that were either less than optimally therapeutic or non-therapeutic. I began to perceive a pattern of dilution of protection of human beings across these areas being not just advocated at times in the discourse but also reflected in practice and at times even permitted by governance and law. I wrote a chapter entitled ‘The right to bodily security vis-à-vis the needs of others’ for the edited collection Autonomy and Human Rights in Healthcare (Garwood-Gowers, 2008) which exposed this and began to make the normative case against it. Since then I have more explicitly refined my focus to the medical context and recognized that what I am essentially reflecting on is a phenomenon of use of human beings in this context, or what I initially described as medical use of the human body and have now come to describe in this book as medical use of the human being. This phenomenon may be longstanding, but it has not been overtly recognized as a phenomenon before my work in this area and consequently never actually systematically addressed as such. The key reason it needs to be is that discourse, practice, governance and law that is specific to different forms of use (such as in contexts like transplantation, general medical research, human tissue research and so on) is ‘out of whack’ with the overarching norms of health law, human rights and, I will argue, ethics that they ought to be conforming to. And the key reason why this disjuncture is ‘screaming’ to be written about in detail is that it is ultimately a problem of lack of respect for human worth. The norms themselves point to the need for such respect but to a very significant extent use context specific discourse, practice and to some extent even governance and law reflects an agenda of diluting emphasis on respect in order to bring about greater use. I have found the disjuncture not just interesting but disturbing. That turned writing this book into something of a mission. This was a blessing since, whilst I generally find writing a joy, this is the most intellectually rich and multifaceted piece of work I have created, and 2there were some moments of difficulty and confusion when it became like the emotional equivalent of pulling one’s teeth out.