Tuesday, October 19, 2010

The Right of a Liver

FINALLY. A post about biomedical ethics. I bet you all couldn't wait. Okay, so after some conversation today I figured it was right for me to discuss this whole problem with organ procurement, but first: obligatory background information!
So there are three possible approaches to how we should attain organs.
1.) Opt-In Program - Everyone is presumed to be opposed to donating their organs unless they go out of their way to say otherwise. The benefit is you never desecrate an unwilling body, but at the same time you wind up taking a lot of perfectly healthy organs of people too lazy/busy/'unwilling to deal with the concept of their own mortality enough to check a box on the back of their license' and burying them in the dirt while a sick person who could have used it suffers and possibly dies.

2.) Opt-Out Program - Everyone is presumed willing to donate their organs unless specifically noted otherwise. The benefit is that we can save the lives of more needy people, but the drawback is we wind up gutting poor grandma who just wanted to be buried in one piece next to her second husband, but never got a chance to drive down to the DMV and change it.

(Another important consideration is the fact that MOST people are willing to donate organs. So in cases where we're not sure what a person wished, they're statistically more likely to go for donating.)

3.) Organ Conscription - Regardless of what you prefer, we take your organs after you die if we need them. Benefits: OMG, SO MANY ORGANS YOU GUYS. Detriments: "Wait, did we really just completely disregard everything this guy wanted done with him when he died?"

Now, the third option at first glance seems absolutely reprehensible. How could we just completely cast aside a persons autonomy. In short, because they're not alive, they're dead.

Ultimately, we have two possible reasons for thinking its bad to take a persons organs against their wishes; either it's bad because the taking of a persons organs constitutes an invasion of their person, or it's bad because it's an act carried out against their wishes.

Now if it's the first case, then yes consent definitely should be considered. If it's the second however, we've muddied the waters a little bit. If the second case can be said to be true, then it seems that acting against the persons wishes is just as bad when we take without consent as when we leave without consent. All of a sudden, both errors in organ procurement (mistakenly leaving them in within an Opt-In framework v. mistakenly taking them within an Opt-Out framework) are equal. Since statistics favors organ donation, our null hypothesis should be that which commits fewer errors (Opt-Out).

Is it the case though? Consider: A man is rushed to the hospital. He's been heavily bleeding for far too long to not be worrisome to the staff. It's quite a mess, and if he doesn't get any more blood soon he's at risk of coming down with a rather severe case of 'deadness'. He's unconscious so he can't really respond to any questioning so the doctors decide to give him an immediate blood transfusion. He wakes up healthy hours later, completely bereft over his treatment: "I'm a Jehovah's Witness doctor! You made me break my covenant with God!"

Now, do we feel bad for the Jehovah's Witness because his body has been invaded? No. We understand that what was done had been the most assured way to see to it that safety was established. Rather, we feel bad that even though he's still alive, his wishes to avoid a blood transfusion were failed to be satisfied.

It's late at night and that may be a flawed example, but rest assured, at some basic level you do reach the point where the problem isn't that a body was invaded, but that the wishes of a person were acted against. Because of this, the errors accrued under an Opt-Out program are no worse than the errors of the Opt-In program (except that, again, there would be fewer in the Opt-Out program).

To take it one step further, people in favor of organ conscription usually contend not that the two errors are equal, but that leaving organs in the body which could go to a person in need is a heinous act, regardless of what the person who had previously used the body would have preferred. This is because not only are the two acts in and of themselves equal, but when you take into consideration the second order evils (a person freaking dies) it's indefensible to put a persons autonomy regarding what they want to do with their remnants ahead of the need of the sick and dying.

This is why I side with Organ Conscriptionists. Not only is it messed up that we put so much vitality into what is, essentially, an inanimate object, but a lot of the arguments from autonomy focus on the fact that those who object to organ donation will often times do so for religious belief. Poppycock I say! I entirely reject the notion that religious viewpoints are inherently sanctified because of ones 'freedom to religion'. If an argument leads to a deplorable belief (as I see the autonomy argument doing so), then whether or not the mindset adopted in reaching it is religious or secular is hardly relevant. However, that ties in quite a bit with the philosophy of religion, which is far too lofty to try to tackle at nearly two thirty in the morning.

Before I leave you, I just want you to see that ethics can be more than just discourse on what is hypothetically right and wrong. It can be and lead to action. In this case, it has made me not only check off the box on the back of my license (prior I never had a pen on me that could leave a mark on the teflon coated NY drivers license and was too lazy to get one) but to get started on a will which shall detail what exactly is to be done with my organs and limits my coma to 6 weeks before the mandatory removal of life support. I believe that my next post will be that will. Hopefully you all can help me flesh it out a bit

Until then, Good night.


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