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6. But see Schramme, T. Should we prevent non-therapeutic mutilation and extreme body modification. Bioethics 2008;22(1):8–15.CrossRefGoogle ScholarPubMed

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9. Feinberg, J. The Moral Limits of the Criminal Law, Vol. III: Harm to Self. New York/Oxford: Oxford University Press; 1986Google Scholar, at 9–10.

10. Feinberg accepts paternalistic reasons for public policy, e.g., taxes on the sale of cigarettes. See note 9, Feinberg 1986, 23–4.

11. It is worth observing that J. S. Mill’s position is different: “Choices depending on the assistance of others are not strictly within the definition of individual liberty.” In Mill JS. On Liberty. Indianapolis: Bobbs-Merrill; 1956 [1859], at 120.

12. Mill, JS. Principles of Political Economy. Robson, JM, ed. Toronto: University of Toronto Press; 1965Google Scholar, as referred to by Hardin, R. The utilitarian logic of liberalism. Ethics 1986;97:47–74Google Scholar, cf. 13. See also note 11, Mill 1956, chap. 4, for a similar argument about the (six-day) work week. In the nineteenth century volenti was frequently invoked in defense of laissez-faire capitalism. See Gow, JL. The defence of volenti non fit injuria. Juridical Review 1949 Apr;61:37–62.Google Scholar

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14. “The person who causes bodily harm with the consent of the harmed person only acts illegally when his action in spite of the consent is against bonas mores” (“wider den guten Sitten”). German penal code, § 228.

15. “Such violence is injurious to the participants and unpredictably dangerous.” Lord Templeman (House of Lords, March 1993). But he continues: “Society is entitled and bound to protect itself against a cult of violence. Pleasure derived from the infliction of pain is an evil thing.”

16. The traditional defense of such diversions is that they are regulated in order to minimize the likelihood of serious harm. But that is normally also true of SM practices. See Athanassoulis, N. The role of consent in sado-masochistic practices. Res Publica 2002;8:141–55.Google Scholar

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18. Walton, C, ed. Charlesworth and Percy on Negligence. 12th ed. London: Sweet & Maxwell; 2010Google Scholar: 3-111-3-113.

19. See note 9, Feinberg 1986, 27.

20. See note 9, Feinberg 1986, 59.

21. Locke, J. Two Treatises of Government. Cambridge: Cambridge University Press; 1988Google Scholar, at I. 42, cf. II. 6, II. 172.

22. Raz, J. The Morality of Freedom. Oxford: Clarendon Press; 1986Google Scholar, at chap. 14.

23. See note 16, Athanassoulis 2002, glossing Mill.

24. See note 8, Kleinig 1979.

25. See note 4, Veatch 2000, 196–8.

26. Glannon, W, Ross, LF. Do genetic relationships create moral obligations in organ transplantation? Cambridge Quarterly of Healthcare Ethics 2002;11:153–9.Google Scholar

27. English, J. What do grown up children owe their parents? In: O’Neill, O, Ruddick, W, eds. Having Children. New York: Oxford University Press; 1979Google Scholar. The remaining problem is whether we should allow parents to make decisions about the “donation” of bone marrow or a kidney by a young child to a sibling. See Fleck, LM. Children and organ donation: Some cautionary remarks. Cambridge Quarterly of Healthcare Ethics 2004;13:161–6Google Scholar, and other contributions to the same symposium.

28. See note 27, English 1979; Elliott, C. Doing harm: Living organ donors, clinical research and the Tenth Man. Journal of Medical Ethics 1995;21:91–6CrossRefGoogle ScholarPubMed; Ross, LF, Glannon, W, Josephson, MA, Thistlewaite, JR Jr. Should all living donors be treated equally? Transplantation 2002;74:418–21.Google Scholar

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30. Fabre, C. Whose Body Is It Anyway? Justice and the Integrity of the Person. Oxford: Clarendon Press; 2006Google Scholar, chap. 5. But Fabre underestimates the costs, both of living donation to the donors and of coercing people to “donate.” For a convincing refutation see Eyal, N. Is the body special? Review of Cécile Fabre, Whose Body Is It Anyway? Utilitas 2009;21:233–45Google Scholar. I agree with Fabre, however, that most of us have perfect Samaritan duties to donate our organs postmortem. See Den Hartogh, GA. Farewell to Non-Commitment. Den Haag: Raad voor de Zorg; 2008Google Scholar, at chap. 7; available at http://www.ceg.nl/data/file/Engelse%20versie%20Afscheid%20van%20de%20vrijblijvendheid.pdf (last accessed 7 Feb 2012).

31. Gezondheidsraad. Nieuwe Wegen naar Orgaandonatie. Den Haag: Gezondheidsraad; 2003; Ankeny, RA. The moral status of preferences for directed donation: Who should decide who gets transplantable organs? Cambridge Quarterly of Healthcare Ethics 2001;10:387–98Google Scholar, at 392. For similar reasons the Dutch Health Council has advised against the adoption of a program of living donor list exchange. See Den Hartogh, GA. Trading with the waiting list: The justice of living donor list exchange. Bioethics 2010;24.4:190–8Google Scholar. Hilhorst defends the partiality of directed donation by pointing to the generally accepted partiality of the donation to intimates, but this overlooks the distinction between motivated and unmotivated partiality. See Hilhorst, MT. Directed altruistic living organ donation: Partial but not unfair. Ethical Theory and Moral Practice 2005;8:197–215Google Scholar. It is, moreover, doubtful whether a policy of allowing directed donation would result in better outcomes, as both Hilhorst and Wilkinson claim. Hilhorst 2005 and Wilkinson TM. Racist organ donors and saving lives. Bioethics 2007;21:63–74. Probably some number of Samaritan donors would prefer to donate directly, which would involve an efficiency loss; see Pennings, G. Directed organ donation: Discrimination or autonomy? Journal of Applied Philosophy 2007;24:41–9CrossRefGoogle Scholar. There is also a real danger that people will be deterred from contributing to a system they perceive as unfair, see Ross, LF. The ethical limits in expanding living donor transplantation. Kennedy Institute of Ethics Journal 2006;16:165–6Google Scholar. And even if the policy would create a net gain in utility, it might at the same time create a net loss for particular groups, probably those already worse off.

32. See note 28, Ross et al. 2002, criticizing the article “Consensus Statement on the Live Organ Donor,” published on behalf of the (American) National Kidney Foundation and the American Societies of Transplantation, Transplant Surgeons and Nephrology. JAMA 2000;284:2919–26. Steiner and Gert 2000 (see note 4) argue that centers may refuse heroic donors only “because the public will become unavoidably suspicious.” But surely we should be more concerned about the good reasons the public may have for such suspicion; see Spital, A. Ethical issues in living organ donation: Donor autonomy and beyond. American Journal of Kidney Diseases 2001;38:189–95.Google Scholar

33. See note 3, Spital 2004, discussing the famous case of Mr. Patterson. The surgeon involved in this case commented: “If you choose to walk through fire for your kid, that’s great. But if you choose to take me with you, that’s different.” As quoted in Ross et al. 2002 (see note 28).