Bioethics Discussion Blog: Organ Donation: Who, How,Why and also What are the Ethics? (2)

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Tuesday, February 22, 2005

Organ Donation: Who, How,Why and also What are the Ethics? (2)

One of the ethical issues that face the transplant program in the United States involve “who”gets to donate an organ and “who” gets to receive the organ. Of current ethical concern pertaining to “who” gets to donate is the condemned prisoner on death row. The other ethical concern pertaining to “who” gets to receive the organ is the convicted criminal. There are other ethical “who”s which I will note later.

There is always discussion with regard to increasing the pool of potential organ donors. There has been a suggestion made for a proposal or law which would allow a prisoner condemned to die to have the sentence changed from death to life imprisonment by, for example, a kidney donation. The concerns are summarized in white papers written by the ethics committee of UNOS (United Network for Organ Sharing), the U.S. government designated organ procurement network. The committee wonders whether the “proposals would be coercive to particular classes of individuals--minorities and the poor” which may well represent the classes most likely found on death-row. Further, “would the reduction in sentence apply to the offer to donate, or would it only be honored if the act of donation took place? If the act of donation would exclusively qualify for the reduction in sentence, then the law or policy would discriminate against individuals found to be medically unsuitable to donate organ.” Additionally, concern is expressed about the reaction of jurors deciding punishment if they were aware of the possibility of trading an organ for reduction of sentence from death to life in prison. “…potential jurors could be influenced and ultimately impose the death penalty more often with a potential societal benefit in mind. Jurors might hope that the convicted persons would choose to trade their kidney for their life. This would present a gross inequity for those unable or unwilling to donate a kidney and who might otherwise have not received a death sentence.” Another issue would be if physicians were involved in the execution process itself in order to procure healthy organs for transplant. This would represent unprofessional and unethical behavior on the part of those physicians. Can you think of some more ethical problems with prisoners as organ donors?

With regard to convicted prisoners receiving organs, the UNOS ethics committee paper reminds us of the view that “convicted criminal status should be irrelevant in the evaluation for candidacy as a potential transplant recipient. This position assumes that convicted criminals have been sentenced only to a specific punishment, i.e., incarceration, fines, or probation. However, the convicted criminal has not been sentenced by society to an additional punishment of an inability to receive consideration for medical services. This argument also emphasizes that criminals not sentenced to death are expected to return to society and be deemed worthy of equal treatment in the receipt of other items/services distributed by society.” However, the medical and psycho-social criteria that are used to evaluate any potential recipient for organ transplant would equally apply to the prisoner.

Finally, I might add a couple more “who”s to the list of ethical issues that have been written about regarding organ transplant. Should a parent give permission for their minor child, who may be at an age without the capacity to make their own decision, to donate a kidney for a needy sibling? And with regard to “who” gets the organ, if the recipient is specifically designated by the donor to receive the organ, should this trump other worthy patients on a transplant recipient list? Should a patient use the Internet to try to directly contact potential donors and bypass the UNOS system to obtain the needed organ? And if you were a Supreme Court justice and because you were a Supreme Court justice, would you expect to get a kidney, bypassing others on the list? To the last question, the answer from UNOS is a resounding “NO”. Although the example of a justice is not mentioned, all patients on the list are to be justly evaluated. ..Maurice.

1 Comments:

At Monday, February 28, 2005 5:39:00 PM, Blogger James J. Murtagh, Jr. MD said...

I want to congratulate Dr. Bernstein. This is a great blogging site!

Although I use the internet a lot, I have never blogged, so I am having trouble adjusting to it. But I have to hand it to you Maurice, you have gathered a lot of fine comments here.

I was shocked that doctors were not responding to "Million Dollar Baby." This movie is going to be imprinted on our patients minds for decades. It is going to cause untold suffering for patients and their families. Loved ones will wonder if the loving thing to do would be to sneak in and disconnect their loved ones.

There is a humane way to discontinue therapy. This is every patient's right. It is barbaric to suggest the only way out is to bite your tongue and bleed to death or have a loved one sneak in and inject adrenaline. Why did Eastwood ever choose adrenaline anyway?

Doctors and patients have to work together and discuss together what makes sense for a patient and what a patient wants. This movie shows Swank talking to everyone but a doctor. There isn't even a conversation before her leg is amputated. Does Eastwood suggest a leg can be amputated without getting any consent? Surely this character would not have consented to any operation if she wanted to die.

It is not in our power to keep someone alive if they make a decision otherwise. I honor Christopher Reeves as a hero who decided to continue in trying circumstances, but Reeves would never have forced his choice on anyone else.

Every doctor and every patient in the country should be up in arms. It shows we haven't done our job. Apparently, only a handful of people understand the right to refuse treatment.

We have a lot of work to do. We have to educate the public. That is the silver lining. Hopefully we will use this movie to start an overdue discussion, and make sure every patient and every citizen understands their rights.

Thanks!

 

Post a Comment

<< Home