The Call for "Organ Conscription" Begins
I have always said that if you want to see why things seem to be going so wrong in bioethics, just look at the professional literature at the most elite levels, in which a more candid view is presented than may appear in popular media. The bioethics blogs can also be illuminating.
Case in point, a blog out of Oxford called "Practical Ethics," which is the name of a truly ghastly Peter Singer book, although there appears no connection to Singer, except on the idea level.
A recent entry discussed organ donation. First, look at what the author considered to be a "spurious" concern:
It is also easy for debate about organ donation to be side-tracked by spurious issues or concerns. So some people fear that they will not receive full treatment by doctors so that their organs can be used to save others.Given the "quality of life" ethic that seem to be gaining momentum in bioethics and medicine, along with futile care theory and the drive for health care rationing, that hardly seems to be an irrelevant concern.
Then the author opines that we should permit killing for organs, perhaps even organ conscription:
There are two alternatives. If consent for organ donation is as important as it is made out to be, then debate about organ donation should be welcomed. There should be a detailed information available to the community about the circumstances in which their organs may be donated, and what that involves. The community should be reassured that decisions about the declaration of death and the withdrawal of life support are made independently of decisions about eligibility for organ donation. To both respect patient autonomy, and allay community concern, individuals could be given several options about organ donation, including alternatives not currently available such as donation of organs prior to death. This would allow them to have greater control over the process of their death and the use of their organs.I believe and hope that this remains a minority view. But the fact that it is considered a matter of respectable discourse is cause for concern. If you want to destroy the people's faith in the entire system, this is how to do it.
Alternatively, we may come to think that the benefit of organ donation is so great that we should reject the the current charade of informed consent for organ donation. After all, at present thousands of patients per year die for want of an available organ. Yet every day potentially life-saving organs are buried or burned because their owners did not make their wishes clear during life, because their families could not come to terms with the idea of donation, or because doctors failed to approach families to ask them for permission. Consent is relevant to what happens to us while we are alive. But once we are dead, our organs cannot benefit us, while they could save the lives of up to 6 others. Perhaps it is time to contemplate mandatory organ donation after death?
Labels: Organ Donation. Killing for Organs. Organ Conscription.
posted by Wesley J. Smith @ 6:00 AM
64 Comments
64 Comments:
This person obviously hasn't developed the suave manner that will come later. I'm guessing the writer is a graduate student or at least a very young professor. The gloss is missing.
Notice the unintentionally humorous whip-lash shift: First he suggests that people should be reassured that decisions about removal of life support are made entirely independently of decisions about organ donation, so that people will not be worried about consent.
But in the next paragraph, the author tells us that maybe we should give up the "charade of informed consent." But if it's a charade, then we can't truthfully reassure people that they will receive treatment independent of donation, that their wishes will be respected, and so forth.
The current regime for post-mortem organ donation is one of "implied refusal." That is to say, if a person has not signed a donor consent form/donor card (depending on jurisdiction), she is deemed to have refused to donate her organs post-mortem. I don't know what the situation is in the US if the next of kin gives permission anyway, so I'll pass on that. Similarly I'll pass on what happens if the decedent had signed a consent form but the next of kin objects.
What would be wrong with a regime of implied consent? Under such a regime, a person would be deemed to have consented to post-mortem organ donation unless she had signed a declaration "opting out." I don't see how this would infringe on anybody's autonomy or violate anybody's rights.
Ah, yes, implied consent. Check out the comments section on the blog Wesley links: They talk quite frankly about how "implied consent" is just a step on the way to organ confiscation. Well, hey, at least they're honest.
No, other people don't have the implied right to use someone else's body. And here's an interesting point: I have written explicitly in my living will that I do _not_ consent to donate organs. But if I were brought in from a car accident, how would they know? They wouldn't, until they got hold of the person who knows my wishes and has my DPA for healthcare. Implied consent--no thanks.
Btw, I think there's another contradiction on that blog,b ut I don't have time to check it out right now.
Slippery slope arguments are unconvincing unless there is substantial evidence that the slipping will actually occur. Most such arguments, including Lydia's, ignore the significant differences between the starting point and the presumed end point, as well as the complex chains of causality in between.
As to the mechanics of letting the ER people (or whomever) know about one's choice: in some places, people who have elected to become donors carry a donor card in their wallet and/or are registered in a donor registry. Operating an opt-out system the same way wouldn't be rocket science.
To provide some context for all of this--according to the US Department of Health and Human Services* (hardly a bunch of lefties, I would think):
- About 3,700 transplant candidates are added to the national waiting list each month.
- Each day, about 77 people receive organ transplants
- However, 18 people die each day waiting for transplants that can't take place because of the shortage of donated organs.
- There are now more than 92,000 people on the waiting list.
- Experts suggest that each of us could save or help as many as 50 people by being an organ and tissue donor.
Maybe I'm missing something here, but I would think that anyone who purports to be "pro-life" would make it a priority to sign a donor card.
*http://www.4woman.org/faq/organ_donation.htm
But we already have proof of the slippery slope applying-- even WITH consent being required. I believe this very blog has covered the man who was killed so that his organs would qualify for transplant.
That's just one that was CAUGHT.
Why is no-one arguing on the merits of the implied consent itself, and instead only bring up how big of a demand there is? If it's the right thing to do, wouldn't it be the right thing even if demand was already met? That would bring a wider range of organs, and thus higher quality... but folks aren't arguing on that basis.
Any time someone won't argue for the merits of their own idea, be very cautious. Especially when they're talking about taking something from others.
This entire argument sounds exactly like the "death with dignity" movement-- starts with "oh, only those who are in excruciating physical pain that can't be fought otherwise, and who will never recover before death are going to be killed" and it moves on until suicide for depression is legal.
Foxfier, the maxim is, abusus non tollit usum--just because something can be, or has been, abused, does not mean that it must be, or always is. Abuse does not, in itself, justify denial of use.*
And I frankly don't see how you are able to divorce the need for organ transplants from the merit of an implied-consent regime. It strikes me that saving over 6,500 lives per year is a fairly meritorious argument.
I wonder: apart from the hypothetical slippery slope, are there any reasons why we would not want to put in place a system that:
- Could save thousands of lives a year
- Respects individual autonomy; and
- Violates nobody's rights
*Translation from Wikipedia
Makarios, _they_ are the ones saying this is a step along the line. I didn't make that up to make a "slippery slope argument." I'm pointing out what the very folks in the vanguard of "bioethics" say they are up to. You can read it for yourself. This is an empirical statement: This is where this is, in fact, headed.
The other point I was thinking of from the blog post is this: It starts out by talking about people who are arguing that "dead donors" aren't really dead, but it never returns to that. Yet the author needs to return to that concern, given his own argument for organ conscription. His argument turns on the idea that you have no right to say what happens to your body after you are dead. But if organs are being taken from people who are not really dead, then obviously that argument doesn't apply.
Makarios-
just because I have something that someone else can use doesn't mean that it should be put on me to say "no, you can't take this." The assumption should be that I be allowed to give it, but it should not be assumed that I will.
That is why arguing "but 16 people die every day!" is lacking.
Lydia: It seems like the "they" to whom you are referring is one commenter on one blog. Hardly a groundswell.
Foxfier: What do you suppose happens to tissue that's removed from patients during surgery? In some cases, these have become the basis of extremely valuable strains of cell culture, and the courts have ruled that the patient has no proprietary rights to the property.
And to argue against an opt-out regime by saying that "The assumption should be that I be allowed to give it, but it should not be assumed that I will" is what we call "begging the question." You're raising the question in a way that assumes that it has already been answered--a form of circular reasoning.
Makarios, I could be wrong, but isn't part of the release you sign for surgery a paragraph that says they can take and use the tissue removed in surgery? I seem to recall having seen that in the fine print.
One thing I find interesting here, in a detached sort of way, is this: So much liberal reasoning on ethical issues over the past generation has depended on the proposition that one owns one's body. (Consider the abortion argument that the woman "has a right to do what she wants to do with her own body.") When the presumption of ownership of one's body interferes with organ supply, however, it goes out the window. Now the presumption is supposed to be that your body is available to anyone else who wants to use it. This isn't applied to anything else that belongs to you. You don't have to have a sign on your car that says, "You can't take this" in order for it to be theft for someone else to drive off in your car. No "presumed consent" there.
Oh, btw, the "commentator" is the author of the post. He is commenting on his own post. In his post, he suggests commandeering of organs and getting rid of the "charade of consent." In the comments he says that presumed consent is a step along the way.
Practically speaking, it isn't hard to see why this would be so. Do I really need to spell out why? Surely intelligent people can figure that out for themselves.
Makarios-
it *has* already been answered, since the answer was that we have the Organ Donor registration option.
Which is already being abused.
Re: "it's only one person on a blog"-- argument from ignorance. "I have only seen one, therefore there is only one."
Look around, even just on this blog; you'll find bio-ethicist who are suggesting things even worse, such as the mercy killing of the disabled for their organs.
As usual, science fiction got there first.
Caught in the Organ Draft
"Naturally they don't ask a draftee to give up his heart or his liver or some other organ essential to life, say his medulla oblongata. We haven't yet reached that stage of political enlightenment at which the government feels capable of legislating fatal conscription. Kidneys and lungs, the paired organs, the dispensable organs, are the chief targets so far. But if you study the history of conscription over the ages you see that it can always be projected on a curve rising from rational necessity to absolute lunacy. Give them a fingertip, they'll take an arm. Give them an inch of bowel, they'll take your guts. In another fifty years they'll be drafting hearts and stomachs and maybe even brains, mark my words; let them get the technology of brain transplants together and nobody's skull will be safe. It'll be human sacrifice all over again. The only difference between us and the Aztecs is one of method: we have anesthesia, we have antisepsis and asepsis, we use scalpels instead of obsidian blades to cut out the hearts of our victims."
Post #1:
"Slippery slope arguments are unconvincing unless there is substantial evidence that the slipping will actually occur."
Post #2:
"just because something can be, or has been, abused, does not mean that it must be, or always is. Abuse does not, in itself, justify denial of use."
So, we've got to provide an argument, substantiated by facts, as to why there will be a slippery slope but we're not allowed to use ANY fact or history to make that argument, that must be full of facts, is that what you're trying to say?
That's exactly the type of "scholarly logic" that makes us so wary of those who deny slippery slopes.
Lydia (and others): It looks as if we're going to have to agree to disagree about slippery-slope arguments. Neither of us is about to convince the other.
Ken: No, that is not what I'm trying to say. Please re-read my posting.
Re. the analogy of the vehicle: You don't have to have a sign on your car that says, "You can't take this" in order for it to be theft for someone else to drive off in your car. No "presumed consent" there. And this is currently the situation for cadaver organs as well. We know that. What is being proposed is a change in this situation for the purpose of saving thousands of lives every year. The vehicle analogy essentially says, "This is the way things are now, and therefore this is the way things should be." Again, circular reasoning.
And, if abuse does not justify denial of use, then I would suggest that it is even more the case that the suggestion that something be abused does not justify denial of use. So a blogger suggests an abuse of a proposed change to the system--does that mean that the proposed change is necessarily bad? Can anyone here say "Safeguards?"
I'm still waiting to hear any arguments against an opt-out regime, other than "slippery slope" or "that's not the way we're doing it now."
Offline for the day. I'll check in again tomorrow.
Excuse me, Makarios: Do you, or do you not, believe that a person's relationship to his own body entitles him to *at least* as much say in what happens to it--while he is alive or after he is dead--as he has say in what happens to his car or his cat? There was no circular reasoning involved. I was pointing out that the left typically holds that one owns one's body. I have my own idea on that subject, but taking that premise, which underlies so many other liberal ideas, as a starting place, we should at least be able to conclude that presumed consent is out, as it is out for others of one's possessions. That is a matter of seeing what follows from the premise, "Your body belongs to you." You may think you can patronize people around here by talking about circular reasoning, but I actually know a thing or two about circular reasoning, and I don't do it. Pay better attention.
I'd say "this change is likely to result in the murder of people for their organs, which would result in even fewer donors" is a pretty good argument, if you refuse to accept ownership of one's body.
Are we allowed to kill a person's pet if it is threatening somebody's life? Are we allowed to steal a person's car in order to save another person's life?
If the answer is yes, then isn't ownership irrelevant? Because even if you own your body, it's still acceptable for others to use it against your will if it is for a greater good. That is especially true once you are dead, because you are not going to become upset about your body being used against your will.
Are we allowed to kill a person's pet if it is threatening somebody's life?
Depends, actually. Most states require that the animal actually attack, not that it be "threatening." That would be reaction to an action on the first person's part-- since the owner would be counted as responsible for their pet.
Are we allowed to steal a person's car in order to save another person's life?
False analogy-- as well as still being a crime. Stealing a car to save someone's life would be temporary use.
A more exact analogy would be proposing that, on your death, the government gets everything you own-- including half shares in marriage goods, if you're married. These goods would then be used to feed, cloth and house the poor. Able to opt-out.
Just think of how many lives would be saved!
And no way would it POSSIBLY be abused, no siree!
Foxfier, there is a major difference between the government gaining control of marital assets and property upon your death and the government gaining control over the disposition of your organs upon death.
The difference is that cash money and property are useful to other people in your family and your organs are not (except in very, very rare cases). It is perfectly consistent to argue that the government should not be allowed to take your property from you following death while also holding that they should be allowed to use your organs to save lives after you are dead. Money is valuable and useful to your family in a way that organs are not.
There are other disanalogies between organs and money, but that should be enough for now.
As an aside: Isn't it interesting how fired up some of you get about autonomy with regard to organs, but you completely dismiss autonomy when the topic turns to PAS?
Matteson, I could turn that right around: Isn't it funny how some of you get so het up about autonomy and the right to make decisions about one's own body when it comes to suicide (and abortion, and prostitution, and ...), insisting indeed that one's body _belongs to oneself_, but throw one's control over one's own body and the claim that one owns one's body out the window when you want to take people's organs against their wishes?
I also wish to point out to Makarios, if he is watching this discussion, that the arguments Joshua and Matteson are using would, of course, support not simply presumed consent but the slightly more radical act of taking organs _against_ someone's wishes. If I, for example, put a card in my pocket that says I do not want my organs taken, Joshua analogizes this to my property's "harming" someone else (as with a dog who hurts someone else), and both of them clearly think that I am simply being selfish and that the government has the prima facie right to use my organs rationally where they are needed, without my having the prima facie right to make that decision. There is no slippery slope anywhere in the picture.
No, I don't think that you can "turn that right around" because I do not think that in either case you have a right (strongly construed) to determine the disposition of things after you are dead. There is a prima facie right to do so, but that right is overridden in some cases. That's the nature of prima facie rights.
In the organ case your right may be overridden if your organs could save lives and you are dead. I would say that you are being selfish and that you are harming someone (although not a particular someone) when you withhold your dead body's organs and direct them to be burned/buried with your corpse. After all, what use has your corpse for those organs?
In the money/property case your right could be overridden in the case that you direct your good to be put to some harmful purpose. This is why I argue that your money/property may be passed on to your family, but that it may not be used to do harmful things like support terrorists or some such.
The difference is that cash money and property are useful to other people in your family and your organs are not ... Money is valuable and useful to your family in a way that organs are not.
Ah, so property rights only exist if the property is useful to the owner?
And I suppose you get to choose what is useful enough to allow folks to keep their rights? I mean, past the first few million, money isn't really that useful....
Please, explain why your logic of taking organs is different than the logic of taking anything else that belongs to a person.
Isn't it interesting how fired up some of you get about autonomy with regard to organs, but you completely dismiss autonomy when the topic turns to PAS?
Yep, because not mandating helping folks express a mental illness in a deadly fashion is utterly logically equivalent to giving the government the right to your body.
If people actually *want* to off themselves and they're dead set at it, they will.
If the law of the land permits "assisted" suicide, people *will* be preyed on, and they *will* be murdered for someone's benefit. We already have folks being killed to clear up hospital beds in other countries, and that now-famous Oregon woman who got a letter from the gov't saying treatment for her cancer wasn't covered-- but they were willing to pay for killing her.
Well said, Matteson. As Wesley is fond of saying, no right is absolute.
Lydia and Foxfier: different words, same old arguments. Let's try something new. I suggest that an "opt-out" regime for post-mortem organ donation would provide the added benefit of introducing a certain symmetry that is lacking in the current system. Consider the following proposal:
1. There is universal implied consent for post-mortem organ donation.
2. Anyone may opt out of the implied consent regime by filing a declaration of refusal with a central registry.
3. Anyone who files such a declaration becomes, ipso facto, ineligible to receive an organ transplant.
This seems to me to be, as I said, symmetrical. After all, someone who insists on living by the sword ought not to complain if s/he winds up dying by the sword.
Comments?
Makarios-
I'll answer your proposal after you answer an argument.
The logic of organs and possessions is different because we are assuming that the person is DEAD. No life = no possessions.
I think there is a pretty easy line to draw between things which are even potentially useful to someone and things which are not-even-potentially-useful-to-a-person. AKA, organs are not useful at all to a corpse.
(We clearly disagree re: futile care, and that is off-topic, so let's save that for another thread.)
Matteson, you seem quite unaware that people _do_ have the right to dispose of their property after they are dead. By will. The state doesn't just get to decide that they are harming someone by disposing of their property by will in a wasteful manner. I note that your analogy was to someone's disposing of his property by having it put to some harmful purpose. Once again, you fail to distinguish actively harming someone from withholding something that *you think* it is selfish to withhold. We can easily imagine cases where one's money was left to an incredibly rich person who did not need it and would spend it wastefully. But the idea of property is that the state doesn't thereby have a right to override the will and leave it to someone who really needs it. Nor does it follow that you are harming the poor person by leaving it to the guy who will spend it on video games, burn it, or whatever.
Nor is it clear to me that the two of you (Matteson and Makarios) actually agree. It seems to me that Matteson is pushing for taking organs _against_ a person's wishes, or at least that the right of the state to do this would follow from what he is saying, since that person is merely being selfish and harmful to others by trying to withhold his organs.
Lydia,
You're right about what I am saying. I think that organ donation is the moral minimum. I don't think I have been mysterious on that count. Makarios is suggesting something different than I am, though I might be willing to settle for an opt-out system if I can't motivate a donation-as-moral-minimum argument.
You seem "quite unaware" of a difference between legal rights and moral (or human) rights. If you want to talk about legal rights then you are just endorsing the status quo. If all you are saying is "people have a legal right to dispose of their goods so mandatory organ ‘donation’ is incompatible with current law" then I might agree, but it would depend heavily on whether we count organs as “goods” or not. I suspect that you wouldn’t want to say that organs and other bodily tissues are “goods.” What I have been saying is that there isn’t a moral right to decree that bad things be done with your property after your death.
I most definitely do distinguish between “actively harming” and “selfishly withholding.” These are separate actions. I just do not see a morally relevant difference between them in this case. I believe that my line was drawn between at-least-potentially-useful things and not-even-potentially-useful-things. Property such as houses and cash are in the former category and we should say that they are protected from governmental seizure. The organs of the deceased are in the latter category because they are absolutely useless to the corpse. It is not a matter of my deciding that one thing is useful and the other is not. It is a matter of fact that organs are of zero use-value to a corpse. If you have some fact to the contrary, please enlighten me.
but it would depend heavily on whether we count organs as “goods” or not.
Most reasonable folks would agree that one's own body is a bit more than "goods."
Possibly of peripheral relevance, but, for what it may be worth: my understanding of the law in the U.S. is that a person's right to dispose of their worldly goods in their wills is not absolute. Courts have occasionally voided the provisions of people's wills on public-policy grounds, for example.
Another possibly peripheral point: Again, I don't know about the U.S., but, under common law, property in a dead body vests in the next of kin. Again, the rights here are not absolute. The coroner, for example, may take the body, examine it, and retain parts of it, for coronial purposes. This is, presumably, in the public interest.
Would it be fair to suggest that, in at least some cases, the public good trumps whatever ownership rights may attach to a dead body, or parts thereof?
(I've had two versions of a longer comment disappear into the ether so will keep this short as a test.)
Again, Makarios, I would point out that both your argument in this last comment and your lauding of Matteson's arguments support the conclusion that there is no need to give people an opt-out clause. Your proposal of an opt-out clause seems to be, even on your own arguments and those you approve, merely a concession on the part of the government, which would be _morally justified_ in conscripting the organs in the name of the public good. In that case, worries about organ conscription without opt-out seem perfectly justified, not in terms of anythign that could be called a "slippery slope fallacy" but rather by the logic of the very position of the people (including you and Matteson) making the proposals.
Lydia, let me see if I understand you correctly. Are you saying that if I make an argument in support of A, and this argument also supports B, that I must therefore support B? If so, this is a patent fallacy. If I make an argument in favour of gun control, the same argument might also be made by a person who supports gun confiscation, but this does not necessarily mean that I support gun confiscation. It is necessary to look at the entire picture, and to make distinctions.
There is a significant difference between an opt-out regime and flat-out conscription. There are a number of differences, actually, but the one I'm thinking of is that an opt-out regime provides some balance between the public good on the one hand, and individual autonomy on the other. Straight conscription of cadaver organs provides no such balance. And it is here that I part company with those who would call for conscription.
If so, this is a patent fallacy.
Which one?
I'll have to confess to you, Lydia, that I do indeed support "the slightly more radical act of taking organs _against_ someone's wishes".
Under a utilitarian viewpoint (which I am proud to espouse), the right course of action is that which leads to the maximum amount of happiness, life, autonomy and other moral goods. Disobeying the will of a dead person leads to no reduction in these (except that some living people may be upset by this act as precedent), and if this act results in many people living longer or happier lives, it could very well be justifiable.
Makarios, it depends on whether the argument really, logically does support that more radical position. If it does, then to be consistent, you should admit that it makes _sense_ (given your other views) to hold that more radical position and that you are merely adopting the more moderate position in order not to sound extremist, freak people out, etc., not because you have some principled reason to hold the line there.
Oh, by the way, we are all very carefully forbearing from addressing the fact that people on both sides of the organ donation issue have raised questions about whether vital organs such as a heart are at least sometimes and maybe often taken from people who are not really dead. Given that _all_ the arguments both for presumed consent and for organ conscription assume a dead donor and in fact lean heavily on the assumption of a dead donor, surely these concerns ought to be rather urgent in the minds of those making the arguments. If there are even worries about this matter (which there are, voiced in increasing numbers and from many quarters), that should in and of itself put a bit of a damper on this enthusiasm for taking organs from people without there consent and a fortiori _against_ their wishes to the contrary.
"Their." Shoot.
Foxfier, I don't know what "a bit more than goods" means. It might not be important if here, but keep that in mind if we ever get to talkin' about organ sales.
Lydia, you are right that we've been talking about cadaver organs here. Abuse of a system does not tell against a theory unless there is no way to curb the abuse, and I really doubt that this is the case here. Taking someone's heart while they are alive (and unconsenting) sounds like murder to me. This is compatible with my argument that donation is the moral minimum.
Matteson-
same way that a child is a bit more than a pet; the level of importance is significantly higher, even if you don't personally see the value.
We currently have a system that requires that the person be dead before their organs are taken; it is being abused. Why the heck should we think that making it manditory with maybe an opt-out option would remove this problem?
We currently have folks who are registered organ donors whose paperwork is lost until it's too late to salvage organs-- with a an assumed donor law, what's to keep paperwork from being "lost" if the person is a perfect match?
This is starting to sound like a communisim argument-- it works GREAT in theory, but when you introduce humans to the situation, it goes south.
"We currently have a system that ...is being abused. Why the heck should we think that making it manditory [sic]...would remove this problem?"
You're just being obtuse here. The correct response to an abused system is to improve the safeguards on that system. The incorrect response is to say that a system has had problems and therefore we should ditch the whole enterprise and ignore the moral requirements involved.
What we need to do is fix the system so that it is very difficult to abuse. It doesn't really seem like this is what you want to argue though.
It looks to me that you want to argue that a person has no obligation to "donate" their organs, and I heartily disagree. It is a pretty commonly accepted tenet of ethics that you should help others if you can do so at little or no cost or effort to yourself.
I have no idea what you are talking about in the next paragraph, so I'm going to ignore it for now.
The correct response to an abused system is to improve the safeguards on that system.
Yeah. Like requiring that there be paperwork saying that the person agrees to give their body parts away, in the event of death. And prosecute those who violate said system.
Oh, wait! That's the system we have! The one you want to throw out, to choose the presumption of state ownership!
It is a pretty commonly accepted tenet of ethics that you should help others if you can do so at little or no cost or effort to yourself.
Evidence, please.
For once, evidence, instead of assertion.
Lydia wrote: to be consistent, you should admit that it makes _sense_ (given your other views) to hold that more radical position and that you are merely adopting the more moderate position in order not to sound extremist, freak people out, etc., not because you have some principled reason to hold the line there.
Lydia, you have moved from putting words in my mouth to imputing motives to me. This not only is discourteous, but it also detracts from whatever point you may be trying to make.
Now, please reread the analogy that I set out earlier, regarding gun control. Some of the same arguments that are used in support of gun control can also be used in support of gun confiscation. This does not, repeat not, repeat not, mean that anyone who uses such arguments in support of gun control actually favours gun confiscation, but is "merely adopting the more moderate position in order not to sound extremist, freak people out, etc."
And the piece about the dead-donor rule is simply an attempt to change the subject. The problems around this, if such problems there be, would obtain regardless of whether the systems is opt-in, opt-out, or conscription.
Foxfier--mark this date on your calendar: I find myself agreeing with your doubts about the assertion that "It is a pretty commonly accepted tenet of ethics that you should help others if you can do so at little or no cost or effort to yourself." This is by no means settled, and there are ethicists who argue convincingly that beneficence is purely a virtuous ideal, and by no means obligatory. And, of course, a great deal depends on context as well.
Makarios, you have to get specific. For example, one of your arguments here has been, as I understand it, that the common good limits our right to refuse the use of our organs, because that right is not absolute (a phrase you particularly emphasized in this context, about some rights not being absolute). But this just simply doesn't support presumed consent with an opt-out. In theory everyone could opt-out. Presumed consent with an opt-out can be held as a line only if we really believe that people have a _right_ to opt-out that _should not_ be overridden.
Sure, there are people who argue against beneficence, but I didn't think that I would find them here on a blog which espouses human exceptionalism and keeping human beings alive against their will because human life is precious.
In any case, if you are going to reject beneficence as an obligation then it is odd that you are at all interested in a bioethics blog since it is one of the major tenets of medicine. (Beachamp and Childress have a nice (but not completely uncontroversial) book on this topic.)
At the very least you should give a counterargument to my "assertion" (which in this case is really a very short argument)that one should help others (in this case save their lives) when they can do so at literally no cost to themselves. That is the very weakest sort of beneficence that I can think of.
If you're just not interested in beneficence then perhaps you should state your arguments. It looks so far like you are saying "I don't want to be an organ donor because I don't want to be an organ donor, and you can't make me." It doesn't seem callus to say that this sounds analogous to "I don't want to save lives by donating things which are utterly and completely useless to me after I die." If you are just arguing from selfishness then I guess we're done here.
Matteson-
You are moving from "it is good if people choose to do this" to "there should be government force to ensure that people do this good thing."
You also are flatly ignoring the abuses we keep pointing out, and seem to be in love with attacking the person, rather than the argument.
"You are moving from "it is good if people choose to do this" to "there should be government force to ensure that people do this good thing.""
That's sort of true. I"m moving from "It is good that people do this" to "People must do this." It is a jump, but it's not a very big one given the stakes. Laws enforce moral claims all the time.
I'm not ignoring that there are abuses. I'm denying that the brute fact that some abuses occur should cause us to ignore the moral force of beneficence.
You still haven't said anything regarding why you want to (or think it's ok to) ignore the demands of beneficence in this case.
You still haven't said anything regarding why you want to (or think it's ok to) ignore the demands of beneficence in this case.
For starters, forced charity is no charity at all.
Giving the government ownership of peoples' bodies is a flat-out horrific thing, no matter the justifications.
I'm not ignoring that there are abuses. I'm denying that the brute fact that some abuses occur should cause us to ignore the moral force of beneficence.
So you're A-OK with murder in the course of taking organs, because those organs might-- MIGHT-- save somene's life. Silly to worry about it, because the other lives will eventually balance out to the good. Let's make it so there's even fewer safeguards against the abuse-- which is what the opt-in system comes down to.
Matteson wrote: Sure, there are people who argue against beneficence, but I didn't think that I would find them here on a blog which espouses human exceptionalism and keeping human beings alive against their will because human life is precious.
Got it in one! Fierfox is arguing against obligatory beneficence with regard to post-mortem organ donation, but I suspect that most of the people who comment on this blog would argue FOR obligatory beneficence when it comes to things like intervening in suicide attempts. Essentially wanting to have it both ways. Which is why I raised it.
For starters, forced charity is no charity at all.
Giving the government ownership of peoples' bodies is a flat-out horrific thing, no matter the justifications.
That's why I've never said charity and I've mostly put "donate" in quote marks. Donate isn't the right word in a situation in which organs are harvested without their former owner's permission.
As for it being horrific, I don't know about that. In general I would say you're right. In this case I don't think that a corpse is a person, and I don't think that taking its organs amounts to it giving up anything at all.
So you're A-OK with murder in the course of taking organs, because those organs might-- MIGHT-- save somene's life. Silly to worry about it, because the other lives will eventually balance out to the good. Let's make it so there's even fewer safeguards against the abuse-- which is what the opt-in system comes down to.
No. No I'm not, and I don't know why you would claim that unless you just want to demonize my position. Nothing I have said have anything to do with this claim you make above.
Makarios-
1) My name isn't that tough. Try to get it right.
2) If you think preventing the taking of a life is charity, rather than part of a legal framework to preserve a society, you're even more confused than I thought.
Matteson-
No. No I'm not, and I don't know why you would claim that unless you just want to demonize my position.
I am pointing out the over-view of the very things you have said.
Fact: on the opt-in program, there are abuses which cost those, who opted to donate, their lives.
Fact: you say that these abuses are not big enough to counter the good that might come from presumed consent.
So: people are being killed right now, for their organs, because they are donors. You want to remove the safty of requiring paperwork proving you want to donate before that risk comes in to play. You say that the "abuses" do not outweigh the "moral force" of taking the organs.
Thus, you are saying that sure, folks are being murdered, but look at all the people who get organs!
That's why I've never said charity and I've mostly put "donate" in quote marks. Donate isn't the right word in a situation in which organs are harvested without their former owner's permission.
Then please stop using the word "beneficence".
In this case I don't think that a corpse is a person, and I don't think that taking its organs amounts to it giving up anything at all.
Shoot, the Jihadis don't think that *I'm* a person.
Look around here, it's very clear that "person" and "corpse" are abused terms.
http://www.wesleyjsmith.com/blog/2008/10/campaign-continues-to-permit-killing.html
for example.
No, foxfier. I'm not ignoring the fact that abuses occur. Nor am I saying that these abuses are outweighed by the people saved. Look back a few posts for what I'm actually saying.
Norm Barber gives numerous examples of abusive and questionable practices with organ "donation" and harvesting in Australia in his online book The Nasty Side of Organ Transplanting: The Cannibalistic Nature of Transplant Medicine (3d edition out in 2007). He also describes how it is in practice very, very difficult to get on the opt-out list for organ donation there. The slippery slope is upon us, contrary to all the glib assurances above.
There are two elephants in the room that those of you who advocate "presumed consent" fail to acknowledge:
1. There is a huge black market in human organs and tissue. Huge. And the public is noticing this fact more and more. Even in the US there has been a scandal involving body parts harvested from cadavers, including the late Alastair Cooke. Of course, everybody profits, even in legitimate markets, except the hapless donor—because, after all, he/she "made a donation" and paying him/her would be "immoral". (Obscene profits from organ transplantation are, by contrast, never "immoral". But I digress.)
The Chinese practice of grabbing organs from executed prisoners is well known. Organ tourism in India and other countries is well known. Brazil had to back down from a new presumed consent policy because of widespread distrust of doctors there in the wake of allegations (true or not) of children being kidnapped and stripped of organs. Such stories are common all over Central and South America, including Mexico.
To ignore the growing concerns about trafficking in human organs while trying to force donation through opt-out requirements will cause a backlash against donation.
2. Barber, among others, cites evidence that organ transplantation at best delays the inevitable and at worst causes worse problems for the recipient than he/she had before. Most tellingly, he cites studies saying that the longevity of diseased heart patients who wait for a new heart but do not get one is on par with the longevity of those who actually receive the heart transplant. And he rightly notes that antirejection drugs and the body's response to foreign tissue induces what is essentially AIDS in most organ recipients.
At the risk of being tiresome, I will note that I have asked for a long time just why so many people "need" organs. Are doctors pursuing a "transplant-first" policy above trying to deal with the patient's problem without transplantation because of the potential profit? Barber adds fuel to the fire with his observations about outcomes without transplants.
By the way, I am not an organ donor—nor will I wish to be an organ recipient. This is all medical stuntwork for big bucks. I'm seriously thinking about taking Barber's suggestion and having the words "Organ Keeper" tattooed in large letters on my chest—and I don't generally like tattoos.
K-man:
1a) Are the profits from transplantation operations any greater than those from any other procedure? If so then the right response is to limit those profits rather than to toss organ transplantation.
1b) Black-markets and theft occur in response to scarcity. That's why there was a black-market on alcohol during Prohibition and there isn't one now. I think you're arguing against yourself here.
2a) I haven't seen your stats (and I doubt them) but even if life-span is similar between the two groups I would bet that life-quality isn't. Let me know if I'm wrong.
2b) I really don't think that docs are suggesting organ transplantation in order to make a profit. If the profit margin is higher here then refer to (1a) above.
"Medical stunt-work for big bucks?" Right.
Matteson:
1b) Millions in black market alcohol seized
2a) No-one is surprised you doubt it. Try chewing on the damage done to the person who gets a transplant that is rejected when you're looking at your assumptions that transplants fix everything....
email chn@intergate.ca and request "Word doc The Nasty Side Of Organ Transplanting" and argue with the data, instead of telling us you don't like it....
Foxfier,
That link is nearly 10 years old and totally uninformative. Try again. Perhaps you should include some information regarding what makes that alcohol illegal. Are there Canadian laws prohibiting alcohol or is it more like the tax-evasion cases that occur between states in the US regarding tobacco?
No medical procedure or product is without risk. That doesn't mean that they should be banned. Again, your argument is terribly flawed. Lots of people die in car crashes. We'd better get rid of those death machines too!
I'm surely not going to email some nameless stranger and demand some word document. Be serious.
Gee, prohibition was still around ten years ago? How did I miss THAT?
No medical procedure or product is without risk. That doesn't mean that they should be banned.
Who suggested banning it? I'm just pointing out that it's not a 100% gain, in response to your apparent assumption that quality of life after a transplant is always better than life without a transplant.
I'm surely not going to email some nameless stranger and demand some word document. Be serious.
Honestly, I didn't expect you to actually try to get the information, but I thought I'd tell you how you could get the information you requested anyways.....
Of course it's not a 100% gain, and I never said that it was. The poster above you suggested that organ transplants were some sort of profit-making fakery with no relation to actual benefits. I will dispute that until I see evidence.
Point me to a peer-reviewed journal that has published your statistics (or the poster above's) and I'll take a look. It's silly to think that I would email a stranger with an intergate.ca address. From what I can tell it's about like having a Hotmail address. Perhaps that's the sort of source that you accept as "fact," but I'd like a bit more than that thanks.
Hm, I notice you're ignoring any counter to your prior claim that "there was a black-market on alcohol during Prohibition and there isn't one now".
Gee, wait, that follows your prior pattern of ignoring things when you can't actually counter.....
Actually, I didn't take that as a counter-argument because it was so poorly stated. If you mean to say "I found an example of an instance of the words blackmarket and alcohol in the same heading" then I'll reiterate that I'm not very impressed with your example. I'd like to know why it was considered "blackmarket" in that instance.
Thus the questions regarding the article that you seem to have missed a couple of posts previous.
You're quickly reaching "troll" status here, Foxfier.
Matteson-
You're kidding, right?
Proof that there is illegal alcohol-- and that it's making headlines-- isn't proof that black markets don't only happen during prohibition?
Wait, I forgot-- anything that doesn't prove your point is ignored. My bad.
My argument is that scarcity is what creates black markets and Prohibition was an example. Perhaps it's not a perfect example, but I don't know what the laws are in Canada that were being broken.
It seems telling that you had to pull a 10 year old Canadian blurb to make your point.
Change the goods to whatever you like, but the fact is that there's rarely a black market for readily available goods.
Matteson-
My point is that you're factually wrong.
And when that is pointed out, you try to avoid it, rather than meeting it head on.
This is a pattern.
BTW- *profit* is what makes for a black market. Alcohol and tobacco being good examples as they have a heavy tax burden; thus, folks have a motive to use the black market to avoid those taxes.
You're right about profit creating black markets. My thought is that profit is generally driven up by scarcity because otherwise people aren't willing to pay enough for the black-marketeers to make sufficient profit to justify the risk.
High taxes on tobacco create a scarcity of cheap smokes. They're closely related points.
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