Bioethicist Robert Orr, put it well, “the transplantation
endeavor in medicine has become, ironically, a victim of its own success.” For
decades, organ procurement organizations, state legislatures, and health
institutions have sought to increase donors to fill an ever-growing demand. There
are currently 113,301
individuals on the waiting list, yet there are only 17,569 total donations last
year. This gigantic demand overshadows asking ethical questions on policies like
authorizing an unconscious stranger to be an organ donor. (1)
Many policy proposals to increase donations, like opt-out
policies or financial compensation are criticized for violating the criteria of
voluntary and informed consent. However, questions about unconscious and
unrepresented patients are significantly more difficult.
Are bodies just property to be distributed?
Imagine this, an unconscious homeless woman is brought
into the hospital without identifying information, no one came in who knows her,
and there is no way to determine her preferences or values. Medical
professionals are only left to use what’s called the “best interest” standard,
abstractly deciding what medical decisions are too burdensome and which promise
an adequate benefit. This seems impossible.
However, all fifty states allow for someone at the
hospital (who has never met the homeless unidentified patient) to decide for
they should become organ donors.
While organ donation can be a social good, is this presumed
consent ethical? Since we cannot know what she would want, how can we decide if
that would be a benefit to the patient? Seems like donating your organs can
only be beneficial to you in a moral sense, knowing you are helping others. But
can we consent to a moral act for an unconscious patient we don’t know?
What’s revealing is that most states’ laws do not talk about
who can “consent” but who can “authorize” an organ donation. At the bottom of
the list of who may authorize the decision, below the spouse, parents, adult
children, etc., are “the hospital administrator” and “any other person having the
authority to dispose of the decedent's body.” (2)
Behind
the “gift” rhetoric, organ donation is legally an estate question. I.e. what do
we do with someone’s possessions when they are dead? If that's that the only
ethical question, then after she dies, we just have to make sure we’re distributing
her resources to benefit society best. (3)
Unjust assumption?
Ultimately, when looking at how this law affects people
like the unconscious homeless woman, we see this is unjust. Ethical guidelines
for medical research clarify that when weighing exposing an individual to
risks, participation in a scientific (not medical) endeavor is allowed even if
the individual will not immediately benefit from the trial. A central
bioethical document called The Belmont Report cites the argument that harms can
be outweighed if potential benefits may come to the population or community to
which the participant belongs. This raises a red flag for how we treat the woman
in our case since she is likely homeless, unemployed, and socio-economically disenfranchised.
This means she represents a population that is systematically excluded from the
receiving any organ donations.
To receive an organ donation, you must have a permanent
residence, an
accessible surrogate (to speak on your behalf), and proof
you can pay the post-operative financial costs. For these reasons, at least in part, the majority of
organ recipients are affluent, white,
and male. Assuming this
homeless unconscious woman would want to be an organ donor forces someone from a population that rarely benefits from organ donations, to become a means to
benefit the more socially supported and financially stable.
This injustice of this situation is compounded when you
consider how the lack of affordable housing, the discriminatory criminal justice
system, punitive financial institutions have contributed to her socio-economic
situation. Her homelessness, lack of preventative health care and lack of social
support do not exist in an ethical vacuum. Yet, the very political structures
and institutions that have failed her are now assuming she wants to
altruistically give her bodies back to this society. How can this be just?
What do you
think? Should we be able to donate a stranger’s organs?
(1) This happens hundreds of times a year, yet
does not receive much attention. One
significant exception was a case in 2016 that was covered by the Houston
Chronicle.
(2) In 2017 and 2019, a bill was filed in
the Texas Legislature to remove these individuals from the list of who could authorize
this decision. However, the bill has not yet passed.
(3)The one caveat to this view is that US
law does not treat decease human bodies merely as property. Networks of laws seek
to award cadavers sufficient respect and dignity. Since organ donation is not
widely consider abusive, undignified, or disrespectful, authorization on behalf
of incapacitated unrepresented patients seems just.
Comments
Post a Comment