The "Kidney Cult:" Should Choice be Everything in Health Care?

Several years ago, the Montana Supreme Court basically ruled that whatever a patient wants to do with a willing medical provider should not be impeded by the government. Not surprisingly, as I mentioned here at SHS, it bred a lawsuit to create a state right to assisted suicide in the Big Sky State. Many bioethicists share this autonomy ubber alles view, which I see as an offshoot of personhood theory and libertarianism, both of which generally hold that persons should be allowed to engage in whatever actions they see fit with regard to their own bodies so long as others are not harmed.

I take a different view, as readers of SHS know. I certainly believe autonomy is important, but not the be all and end all. Society has a right to put reasonable limits on "choice" in order to protect the common good and prevent individuals from harming themselves. This puts autonomy and paternalism into a dynamic tension, that will move one way on a particular issue and then the other on the next.

There is a religious group in Australia that puts these issues into vivid focus. From the Wall Street Journal story:

Ashwyn Falkingham wanted to donate one of his kidneys but didn't know anyone who needed one. With the help of a Web site, he met a woman in Toronto who was seeking a transplant. The two were a medical match, and he traveled from his home in Sydney, Australia, to Canada for final testing and, he hoped, for the surgery. It's a "simple thing that can help someone," says Mr. Falkingham, now 23 years old.

But it wasn't simple, largely because Mr. Falkingham is a member of a tiny religious group calling itself the Jesus Christians. The group's 30 members, who eschew many of society's conventions, have embraced kidney donation: More than half have given a kidney. They describe the act as a gift of love that implements Jesus's teachings. But critics, particularly parents of members, call the group a cult and charge that members are under undue influence of its charismatic leader.

So, should his kidney be taken as a matter of honoring his autonomy or denied as a matter of protecting him from possible coercion and protecting his health? And if he can be stopped, what about a friend of mine who gave a kidney to save an unrelated person's life (and had some difficulties recovering)?

I agree with this approach:

Many hospitals aren't interested in donors who don't have an established, personal relationship with the recipient. That is partly because of fears that such donors may be secretly--and illegally--paid. Other concerns: Stranger donors may be psychologically disturbed, unrealistically hopeful that donating a kidney will improve their own lives, or likely to back out.

I think that on this issue, the burden should be on the would-be giver to demonstrate that the decision to give a kidney is freely and voluntarily made for purely altruistic reasons. It seems to me the only way to prevent potentially irreversible harm being done to someone who acted in the heat of the moment or under some form of coercion or undue influence and later get giver's regret.