Considering the complexity of finding a match, waiting lists, as well as other such mechanics. While places such as Sweden have a lower wait period because you're "opted in" automatically and have to "opt out" which is the reverse in the US. However, considering the individualistic nature of the US and the concept of sacrifice for "someone you love," should we allow for people to kill themselves to have an organ match?
I'm seeing that within extreme circumstances where time is of the essence, that questioning whether the option to "early euthanize" the donor so that the transplant patient may live. While a Swedish "opt out" system would be able to mitigate the issue of organs.
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I agree with euthanasia in principle under certain circumstances > Dr. Phillip Nitschke, of Exit International has some very compelling thoughts.
....but I've heard some nasty stories from Switzerland regarding rich types who euthanize their rich old family members for financial gain.
I don't see this as being much different.
If someone wants to sacrifice themselves why should anyone else stop them? If they want to badly enough they could do something to kill themselves to make their organ available which would then also risk damaging that organ and the others which could be used to save lives. I'd rather let the person sacrifice themselves on an operating table than walking up to the ER entrance and blowing a hole through their own head.
You're going to need to be more specific about what you mean here. The only organ a person would have to die to give up (barring other medical conditions) is going to be the heart. Lungs, liver, kidneys can all be donated without harm (in the general sense).
So if we're talking about hearts, in what scenario would this self-sacrificing person donate those hearts? There are all sorts of ethical problems here with this. I doubt you'll get very many 'take me instead!'s with the average person (except in a dramatic sense, but it's hard to get family to donate non-life dependent organs), but that the real issue is whether or not end-of-life patients would be willing to be euthanized for this.
My real issue with this is that doctors should be minimizing harm. Causing the death of another patient, who would otherwise survive on their own, to save one who would not is a challenging decision.
I'm personally for 'opt-out' organ donation, however. The issue of whether or not you save a life after your death shouldn't be made when you're frustrated with the MVA.
You're going to need to be more specific about what you mean here. The only organ a person would have to die to give up (barring other medical conditions) is going to be the heart. Lungs, liver, kidneys can all be donated without harm (in the general sense).
So if we're talking about hearts, in what scenario would this self-sacrificing person donate those hearts? There are all sorts of ethical problems here with this. I doubt you'll get very many 'take me instead!'s with the average person (except in a dramatic sense, but it's hard to get family to donate non-life dependent organs), but that the real issue is whether or not end-of-life patients would be willing to be euthanized for this.
My real issue with this is that doctors should be minimizing harm. Causing the death of another patient, who would otherwise survive on their own, to save one who would not is a challenging decision.
I'm personally for 'opt-out' organ donation, however. The issue of whether or not you save a life after your death shouldn't be made when you're frustrated with the MVA.
Now this scenario is highly convoluted (as it is from TV), but there was an episode of House MD, where a father was in a coma for several years, his son ends up sick. House, manages to wake the father temporarily with a boat load of drugs. By the end of the episode they figure out that to save the son the father needs to donate his heart, but the father is alive and wont go back into a coma yet for another few hours which the son does not have. So... House happens to let the father know what to do to kill himself with risking the least damage to his heart and presto! the son gets to live and the father does not end up back in a coma.
Are we to believe that there are not other situations where maybe someone is alive but would rather let their loved one live instead? Maybe some inmates would rather give their kids organs than sit in a cell for 10+years? Or someone with a degenerative condition that does not effect the heart like early onset Alzheimers.
Are we to believe that there are not other situations where maybe someone is alive but would rather let their loved one live instead? Maybe some inmates would rather give their kids organs than sit in a cell for 10+years? Or someone with a degenerative condition that does not effect the heart like early onset Alzheimers.
In my opinion, to put it simply, there would have to be a lot of safeguards around this practice for me to be completely comfortable with it. It's messy, and the sort of edge case you describe is so rare that it's almost not worth talking about. There are a lot of ethical considerations here, but I would say I might be convinced to support it if:
- There are literally no other transplant organs to be had and the individual is in immediate danger
- The patient is deemed competent to make the decision
- The social and ethical ramifications are explained in full
I mean, I'd really need to require that all other options and resources have been exhausted first.
Are we to believe that there are not other situations where maybe someone is alive but would rather let their loved one live instead? Maybe some inmates would rather give their kids organs than sit in a cell for 10+years? Or someone with a degenerative condition that does not effect the heart like early onset Alzheimers.
In my opinion, to put it simply, there would have to be a lot of safeguards around this practice for me to be completely comfortable with it. It's messy, and the sort of edge case you describe is so rare that it's almost not worth talking about. There are a lot of ethical considerations here, but I would say I might be convinced to support it if:
- There are literally no other transplant organs to be had and the individual is in immediate danger
- The patient is deemed competent to make the decision
- The social and ethical ramifications are explained in full
I mean, I'd really need to require that all other options and resources have been exhausted first.
Do you think a lot of people would choose to essentially kill themselves if those things were not already true?
I find it hard to imagine a situation where someone would go "Well your son is going to die in the next 3 weeks if we don't find a transplant" and then they immediately decide to off themselves.
I'm more for preventing the situation where someone knows that the only chance is if they die so they kill themselves in much more violent ways.
Do you think a lot of people would choose to essentially kill themselves if those things were not already true?
You know, I'm always amused by comments like this because they assume human beings are rational creatures. My answer is yes, I think it could be a problem if it wasn't laid out clearly in advance. We are talking about desperate people here, there would need to be very strict controls in place, and in some cases the chances of survival even with the transplant aren't really worth the death of loved one.
Do you think a lot of people would choose to essentially kill themselves if those things were not already true?
You know, I'm always amused by comments like this because they assume human beings are rational creatures. My answer is yes, I think it could be a problem if it wasn't laid out clearly in advance. We are talking about desperate people here, there would need to be very strict controls in place, and in some cases the chances of survival even with the transplant aren't really worth the death of loved one.
People are not that desperate until after the transplant bank comes up empty and time is short... nobody is "suicidal desperate" when they have 2 months yet and there is still a chance that an organ will become available.
I'm not opposed to forcing a waiting period and a psych evaluation or something (outside of an emergency). But like I said before... if someone is that desperate that they are willing to die to give up and organ... they are going to do it no matter what the laws are. (unless the law said you have to throw away the organs of someone who commits suicide)
In my opinion, to put it simply, there would have to be a lot of safeguards around this practice for me to be completely comfortable with it.
I guess my question is, why do you feel you need to be comfortable with it for it to be legal? The idea of someone offing themselves to donate their organs gives me the heebie jeebies, but I still support their right to do so. Why is this anyone's decision other than the person donating his or her organs?
I understand the concerns about desperate or mentally unstable people being allowed to take their own lives, but:(1) desperate and mentally unstable people will find a way to do it anyway, regardless of the law; and (2) why can't we leave this up to the ethics of the medical profession? Surely doctors (rather than politicians) are better suited to make this kind of call.
To me I dont understand what the issue is and why someone can tell me I cant donate to a family member, even if it means killing myself. I believe the bigger issue is some faceless group deciding for me and my family.
In my opinion, to put it simply, there would have to be a lot of safeguards around this practice for me to be completely comfortable with it.
I guess my question is, why do you feel you need to be comfortable with it for it to be legal? The idea of someone offing themselves to donate their organs gives me the heebie jeebies, but I still support their right to do so. Why is this anyone's decision other than the person donating his or her organs?
I understand the concerns about desperate or mentally unstable people being allowed to take their own lives, but:(1) desperate and mentally unstable people will find a way to do it anyway, regardless of the law; and (2) why can't we leave this up to the ethics of the medical profession? Surely doctors (rather than politicians) are better suited to make this kind of call.
To answer your first question, it's because I actually have experience in bioethics and the issues surrounding this type of problem. It's not as simple as you'd like to think.
To answer the second part, I am trying to talk about it from the ethics of the medical profession. Doctors aren't strictly better suited to make this kind of call, either (unless they've got ethical training or a background in allocating scarce resources). The fact of the matter is when given a decision like this Doctors don't always make the best decisions (see: Hurricane Katrina). They generally will avoid this kind of question, and ask for guidance, and we want these kinds of standards applied evenly. Because if there isn't a cohesive ethical framework for decision making in place, we have this applied unevenly and we get a lot of social equity problems. Hospitals have the infrastructure in place right now to decide who gets transplants, but not for determining who is competent to make the decision to die to donate or even how to go about making that decision.
My personal opinion, believe it or not, is actually to support this, because similar practices (in regards to vent allocation in pandemics) will be the only way to maximize lives saved. My professional opinion is far more reserved on the implications and potential abuses.
@bocephus -> There are several reasons why it's not just your decision. First, the doctor responsible for killing you (not just withdrawing care like most scarce resource scenarios, but actually killing you) is going to be profoundly affected. Second, because whoever you decide to save is going to affected for the rest of their lives. The third is the potential for abuse.
As far as that 'faceless panel' - The people making the decision would be your doctor and an ethics panel, and they're not making the decision for you, they're approving or denying the decision for your doctor. If you're going the patient assisted suicide route, at minimum you need that kind of control over a doctor's actions or things get Kevorkian-esque. In medicine, one doctor alone should never be responsible for that kind of decision.
Why don't I just head on down to the prison, offer to pay a chunk of money to the next of kin of anyone who will let me take their organs, then turn around and sell those organs to the families of patients needing transplants? Maybe I can do the same with homeless people and the mentally ill. After all, it's not the government's business if someone wants to sell me their organs.
Why don't I just head on down to the prison, offer to pay a chunk of money to the next of kin of anyone who will let me take their organs, then turn around and sell those organs to the families of patients needing transplants? Maybe I can do the same with homeless people and the mentally ill. After all, it's not the government's business if someone wants to sell me their organs.
And what would be so wrong with that?
Criminals and people with little hope for bettering their future would be able to help their families have a better future and save lives.
@bocephus -> There are several reasons why it's not just your decision. First, the doctor responsible for killing you (not just withdrawing care like most scarce resource scenarios, but actually killing you) is going to be profoundly affected. Second, because whoever you decide to save is going to affected for the rest of their lives. The third is the potential for abuse.
As far as that 'faceless panel' - The people making the decision would be your doctor and an ethics panel, and they're not making the decision for you, they're approving or denying the decision for your doctor. If you're going the patient assisted suicide route, at minimum you need that kind of control over a doctor's actions or things get Kevorkian-esque. In medicine, one doctor alone should never be responsible for that kind of decision.
You could just skip the doctors all together. Problem solved.
Usually when there is a panel of any sort that has to approve or disapprove of an action, especially when said action is effected by timing, have a tendency to miss the mark.
If I was in that situation the paramedics would find me in a bath full of ice with my head blown off and a note on the door what to do and who to contact. No need for anyone to be effected like you mention.
And before anyone says I am talking crap or they couldnt do it, every one has the ability to kill, its just what would it take to do it. For some its much less then others.
Yup, I agree, we should definitely harvest the organs of the downtrodden.
Harvest is a pretty charged term here.... it's not like I am suggesting we round up all the homeless and slaughter them for organs. But if someone comes in willing to give up his/her life to save the life of someone else why stop them? Isn't that what the police, military and secret service volunteer to do every day? I don't see this as that much different. If a Secret Service agent is willing to take a bullet to save the president's life what would be so different with that same agent giving up his organs to save the president's life?
@Tiax and Fluffy: There is a reason we don't allow trafficking of human organs in the general market. If you go down that road, things get messy really quickly (and I don't mean in terms of gore).
If I was in that situation the paramedics would find me in a bath full of ice with my head blown off and a note on the door what to do and who to contact. No need for anyone to be effected like you mention.
And before anyone says I am talking crap or they couldnt do it, every one has the ability to kill, its just what would it take to do it. For some its much less then others.
Well, that'd be your choice. Like I said, personally I feel like if that's what you feel you need to do, do it. Ethically it isn't really any different than throwing yourself in front of a train to save someone else. Of course, in both scenarios you leave a hell of a mess for someone else to clean up. Having had to clean up of pieces of people, I recommend less messy ways to go.
It's just when we're talking about the actual medical system is when things become more complicated. You are welcome to jump in front of that train, but just don't expect a doctor to push you if you want them to. To you, the life of your child or loved is worth more than your own, but a to a doctor both your lives are equal. The idea is redundancy and having checks in place, individual doctors have a tendency to miss things, which is why I stressed that there would need to be an ethical framework in place for how this is handled.
@Tiax and Fluffy: There is a reason we don't allow trafficking of human organs in the general market. If you go down that road, things get messy really quickly (and I don't mean in terms of gore).
@Tiax and Fluffy: There is a reason we don't allow trafficking of human organs in the general market. If you go down that road, things get messy really quickly (and I don't mean in terms of gore).
Ok I'll bite.... How do things get messy?
The problem would be the inevitable problems that come with any market: crime.
Off the top of my head, there would be issues with:
- The provenance and quality/health of the organs.
- Organ theft, or with people being extorted for their organs.
- 'Nobodies' being exploited, abused and killed for their organs (I.E. the homeless).
The illegal organ trade is a problem worldwide, and by essentially legalizing it you compound those problems.
If we want to up the available organs up there, I'd like to see us make organ donation an 'opt out' requirement.
@Tiax and Fluffy: There is a reason we don't allow trafficking of human organs in the general market. If you go down that road, things get messy really quickly (and I don't mean in terms of gore).
Ok I'll bite.... How do things get messy?
The problem would be the inevitable problems that come with any market: crime.
Off the top of my head, there would be issues with:
- The provenance and quality/health of the organs.
- Organ theft, or with people being extorted for their organs.
- 'Nobodies' being exploited, abused and killed for their organs (I.E. the homeless).
The illegal organ trade is a problem worldwide, and by essentially legalizing it you compound those problems.
If we want to up the available organs up there, I'd like to see us make organ donation an 'opt out' requirement.
-When legalized the health of the organs can be tightly controlled by real doctors. Most surgeons care a lot about their success rate... they aren't going to transplant the heart of a crack addict lightly.
-Again when you legalize something like this you can actually control it... Force waiting periods and psych evaluations if necessary.
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
-When legalized the health of the organs can be tightly controlled by real doctors. Most surgeons care a lot about their success rate... they aren't going to transplant the heart of a crack addict lightly.
So in your scenario, people will have to show up to a hospital in order to donate? This is where the provenance part comes in, if we can accurately trace back an organ to an individual, that's fine.
-Again when you legalize something like this you can actually control it... Force waiting periods and psych evaluations if necessary.
Saying you can 'control it' is a little optimistic, but in general, if we're talking strict regulations, that we can weed out the most obvious abuses, yes.
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
I'm not sure you understand how this works, especially with your attempt at being facetious. It's literally just a blood type match, which is not hard to get done, and this is a seller's market. If one wealthy person doesn't match the organ you just stole, there are dozens of others willing to pay, too. And, quite frankly, if someone is desperate enough, they may not care how good a match the organ is.
You're going to have illegal operations going on with shady doctors giving transplants. Organ trafficking isn't just the guy waking up in a tub of ice, it's the doctors and medical staff getting paid to do an illegal operation (or simply not caring where the organ came from), it's the people who are identifying the vulnerable, etc.
And people aren't as well compensated as you'd think, and the long-term repercussions aren't worth the small amount of cash influx. When you're talking tens or hundreds of thousands of dollars in profit per organ going to the traffickers.
-When legalized the health of the organs can be tightly controlled by real doctors. Most surgeons care a lot about their success rate... they aren't going to transplant the heart of a crack addict lightly.
So in your scenario, people will have to show up to a hospital in order to donate? This is where the provenance part comes in, if we can accurately trace back an organ to an individual, that's fine.
-Again when you legalize something like this you can actually control it... Force waiting periods and psych evaluations if necessary.
Saying you can 'control it' is a little optimistic, but in general, if we're talking strict regulations, that we can weed out the most obvious abuses, yes.
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
I'm not sure you understand how this works, especially with your attempt at being facetious. It's literally just a blood type match, which is not hard to get done, and this is a seller's market. If one wealthy person doesn't match the organ you just stole, there are dozens of others willing to pay, too. And, quite frankly, if someone is desperate enough, they may not care how good a match the organ is.
You're going to have illegal operations going on with shady doctors giving transplants. Organ trafficking isn't just the guy waking up in a tub of ice, it's the doctors and medical staff getting paid to do an illegal operation (or simply not caring where the organ came from), it's the people who are identifying the vulnerable, etc.
And people aren't as well compensated as you'd think, and the long-term repercussions aren't worth the small amount of cash influx. When you're talking tens or hundreds of thousands of dollars in profit per organ going to the traffickers.
There is actually more to it than just blood type. Blood type is all that is required for blood but antigens are believed to be important in tissue donations.
"One of the tests you will have before you go on the waiting list is HLA typing, also called tissue typing. This test identifies certain proteins in your blood called antigens. Antigens are markers on the cells in your body, which help your body, tell the difference between self and non-self. This allows the body to protect itself by recognizing and attacking something that does not belong to it such as bacteria or viruses.
Your body also sees antigens on a transplanted organ that are different from its own and it sends white blood cells to attack the organ. When your body attacks the new organ, it is rejecting it. In order to help prevent rejection, you will take certain medicines called immunosuppressants. These are discussed in another section."
The article I got that from specifically mentions that they don't require any antigens to match for a kidney transplant and people have had rejections even with a full match (full in the sense that the 6 we know about matched), but they don't say anything about heart transplants, or other organs. I imagine that most doctors aren't going to do a heart transplant with no knowledge of the heart other than it's blood type.
And yes, I would say that organ donation would have to require the person donating to come to the hospital. What did you expect? Someone to just show up with a cooler? The doctors would have no idea what kind of condition that organ is in. For all they know the donor could have had a disease that will be spread to the recipient, or the organ could have suffered major damage before being extracted. Doctors like to maintain a high success rate. I also imagine rich people that can afford to buy a poor person's life would want to do so in a manner that results in the best chance for success. I mean sure... a low chance heart is better than no heart, but I imagine they'd prefer everything be done in a controlled environment where the success rate would be much higher.
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
So you agree it's exploitative, but that's cool because people are already being exploited, so what's a little more?
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
So you agree it's exploitative, but that's cool because people are already being exploited, so what's a little more?
I disagree with the notion that exploitation is something to avoid at all costs. Just because something *could* lead to exploitation does not mean we have to abandon it.
I'm seeing that within extreme circumstances where time is of the essence, that questioning whether the option to "early euthanize" the donor so that the transplant patient may live. While a Swedish "opt out" system would be able to mitigate the issue of organs.
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....but I've heard some nasty stories from Switzerland regarding rich types who euthanize their rich old family members for financial gain.
I don't see this as being much different.
You're going to need to be more specific about what you mean here. The only organ a person would have to die to give up (barring other medical conditions) is going to be the heart. Lungs, liver, kidneys can all be donated without harm (in the general sense).
So if we're talking about hearts, in what scenario would this self-sacrificing person donate those hearts? There are all sorts of ethical problems here with this. I doubt you'll get very many 'take me instead!'s with the average person (except in a dramatic sense, but it's hard to get family to donate non-life dependent organs), but that the real issue is whether or not end-of-life patients would be willing to be euthanized for this.
My real issue with this is that doctors should be minimizing harm. Causing the death of another patient, who would otherwise survive on their own, to save one who would not is a challenging decision.
I'm personally for 'opt-out' organ donation, however. The issue of whether or not you save a life after your death shouldn't be made when you're frustrated with the MVA.
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Now this scenario is highly convoluted (as it is from TV), but there was an episode of House MD, where a father was in a coma for several years, his son ends up sick. House, manages to wake the father temporarily with a boat load of drugs. By the end of the episode they figure out that to save the son the father needs to donate his heart, but the father is alive and wont go back into a coma yet for another few hours which the son does not have. So... House happens to let the father know what to do to kill himself with risking the least damage to his heart and presto! the son gets to live and the father does not end up back in a coma.
Are we to believe that there are not other situations where maybe someone is alive but would rather let their loved one live instead? Maybe some inmates would rather give their kids organs than sit in a cell for 10+years? Or someone with a degenerative condition that does not effect the heart like early onset Alzheimers.
In my opinion, to put it simply, there would have to be a lot of safeguards around this practice for me to be completely comfortable with it. It's messy, and the sort of edge case you describe is so rare that it's almost not worth talking about. There are a lot of ethical considerations here, but I would say I might be convinced to support it if:
- There are literally no other transplant organs to be had and the individual is in immediate danger
- The patient is deemed competent to make the decision
- The social and ethical ramifications are explained in full
I mean, I'd really need to require that all other options and resources have been exhausted first.
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Do you think a lot of people would choose to essentially kill themselves if those things were not already true?
I find it hard to imagine a situation where someone would go "Well your son is going to die in the next 3 weeks if we don't find a transplant" and then they immediately decide to off themselves.
I'm more for preventing the situation where someone knows that the only chance is if they die so they kill themselves in much more violent ways.
You know, I'm always amused by comments like this because they assume human beings are rational creatures. My answer is yes, I think it could be a problem if it wasn't laid out clearly in advance. We are talking about desperate people here, there would need to be very strict controls in place, and in some cases the chances of survival even with the transplant aren't really worth the death of loved one.
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People are not that desperate until after the transplant bank comes up empty and time is short... nobody is "suicidal desperate" when they have 2 months yet and there is still a chance that an organ will become available.
I'm not opposed to forcing a waiting period and a psych evaluation or something (outside of an emergency). But like I said before... if someone is that desperate that they are willing to die to give up and organ... they are going to do it no matter what the laws are. (unless the law said you have to throw away the organs of someone who commits suicide)
I guess my question is, why do you feel you need to be comfortable with it for it to be legal? The idea of someone offing themselves to donate their organs gives me the heebie jeebies, but I still support their right to do so. Why is this anyone's decision other than the person donating his or her organs?
I understand the concerns about desperate or mentally unstable people being allowed to take their own lives, but:(1) desperate and mentally unstable people will find a way to do it anyway, regardless of the law; and (2) why can't we leave this up to the ethics of the medical profession? Surely doctors (rather than politicians) are better suited to make this kind of call.
To answer your first question, it's because I actually have experience in bioethics and the issues surrounding this type of problem. It's not as simple as you'd like to think.
To answer the second part, I am trying to talk about it from the ethics of the medical profession. Doctors aren't strictly better suited to make this kind of call, either (unless they've got ethical training or a background in allocating scarce resources). The fact of the matter is when given a decision like this Doctors don't always make the best decisions (see: Hurricane Katrina). They generally will avoid this kind of question, and ask for guidance, and we want these kinds of standards applied evenly. Because if there isn't a cohesive ethical framework for decision making in place, we have this applied unevenly and we get a lot of social equity problems. Hospitals have the infrastructure in place right now to decide who gets transplants, but not for determining who is competent to make the decision to die to donate or even how to go about making that decision.
My personal opinion, believe it or not, is actually to support this, because similar practices (in regards to vent allocation in pandemics) will be the only way to maximize lives saved. My professional opinion is far more reserved on the implications and potential abuses.
@bocephus -> There are several reasons why it's not just your decision. First, the doctor responsible for killing you (not just withdrawing care like most scarce resource scenarios, but actually killing you) is going to be profoundly affected. Second, because whoever you decide to save is going to affected for the rest of their lives. The third is the potential for abuse.
As far as that 'faceless panel' - The people making the decision would be your doctor and an ethics panel, and they're not making the decision for you, they're approving or denying the decision for your doctor. If you're going the patient assisted suicide route, at minimum you need that kind of control over a doctor's actions or things get Kevorkian-esque. In medicine, one doctor alone should never be responsible for that kind of decision.
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And what would be so wrong with that?
Criminals and people with little hope for bettering their future would be able to help their families have a better future and save lives.
You could just skip the doctors all together. Problem solved.
Usually when there is a panel of any sort that has to approve or disapprove of an action, especially when said action is effected by timing, have a tendency to miss the mark.
If I was in that situation the paramedics would find me in a bath full of ice with my head blown off and a note on the door what to do and who to contact. No need for anyone to be effected like you mention.
And before anyone says I am talking crap or they couldnt do it, every one has the ability to kill, its just what would it take to do it. For some its much less then others.
Harvest is a pretty charged term here.... it's not like I am suggesting we round up all the homeless and slaughter them for organs. But if someone comes in willing to give up his/her life to save the life of someone else why stop them? Isn't that what the police, military and secret service volunteer to do every day? I don't see this as that much different. If a Secret Service agent is willing to take a bullet to save the president's life what would be so different with that same agent giving up his organs to save the president's life?
Well, that'd be your choice. Like I said, personally I feel like if that's what you feel you need to do, do it. Ethically it isn't really any different than throwing yourself in front of a train to save someone else. Of course, in both scenarios you leave a hell of a mess for someone else to clean up. Having had to clean up of pieces of people, I recommend less messy ways to go.
It's just when we're talking about the actual medical system is when things become more complicated. You are welcome to jump in front of that train, but just don't expect a doctor to push you if you want them to. To you, the life of your child or loved is worth more than your own, but a to a doctor both your lives are equal. The idea is redundancy and having checks in place, individual doctors have a tendency to miss things, which is why I stressed that there would need to be an ethical framework in place for how this is handled.
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Ok I'll bite.... How do things get messy?
The problem would be the inevitable problems that come with any market: crime.
Off the top of my head, there would be issues with:
- The provenance and quality/health of the organs.
- Organ theft, or with people being extorted for their organs.
- 'Nobodies' being exploited, abused and killed for their organs (I.E. the homeless).
The illegal organ trade is a problem worldwide, and by essentially legalizing it you compound those problems.
If we want to up the available organs up there, I'd like to see us make organ donation an 'opt out' requirement.
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-When legalized the health of the organs can be tightly controlled by real doctors. Most surgeons care a lot about their success rate... they aren't going to transplant the heart of a crack addict lightly.
-Again when you legalize something like this you can actually control it... Force waiting periods and psych evaluations if necessary.
-Are the poor not already being exploited in other ways? Whether through prostitution, drugs, who knows what else... we already exploit the poor. What would be worse? A family starves to death within 5 years or a father gives up his organs to a handful of rich families to give his family a huge chunk of change to hopefully be able to pull themselves out of squalor. Never-mind the fact that I imagine these situations would be incredibly rare... You'd have to have testing done just to find a match. Do you imagine the rich paying thousands of homeless people to come to the hospital to get tested to look for a match? Do you imagine gang leaders rounding people up to get tested against their will?
So in your scenario, people will have to show up to a hospital in order to donate? This is where the provenance part comes in, if we can accurately trace back an organ to an individual, that's fine.
Saying you can 'control it' is a little optimistic, but in general, if we're talking strict regulations, that we can weed out the most obvious abuses, yes.
I'm not sure you understand how this works, especially with your attempt at being facetious. It's literally just a blood type match, which is not hard to get done, and this is a seller's market. If one wealthy person doesn't match the organ you just stole, there are dozens of others willing to pay, too. And, quite frankly, if someone is desperate enough, they may not care how good a match the organ is.
You're going to have illegal operations going on with shady doctors giving transplants. Organ trafficking isn't just the guy waking up in a tub of ice, it's the doctors and medical staff getting paid to do an illegal operation (or simply not caring where the organ came from), it's the people who are identifying the vulnerable, etc.
And people aren't as well compensated as you'd think, and the long-term repercussions aren't worth the small amount of cash influx. When you're talking tens or hundreds of thousands of dollars in profit per organ going to the traffickers.
You may want to read this to understand how it works a little better:
http://content.time.com/time/health/article/0,8599,1912880,00.html
http://www.psychologytoday.com/blog/reading-between-the-headlines/201311/body-snatchers-organ-harvesting-profit
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[Primer] Krenko | Azor | Kess | Zacama | Kumena | Sram | The Ur-Dragon | Edgar Markov | Daretti | Marath
There is actually more to it than just blood type. Blood type is all that is required for blood but antigens are believed to be important in tissue donations.
"One of the tests you will have before you go on the waiting list is HLA typing, also called tissue typing. This test identifies certain proteins in your blood called antigens. Antigens are markers on the cells in your body, which help your body, tell the difference between self and non-self. This allows the body to protect itself by recognizing and attacking something that does not belong to it such as bacteria or viruses.
Your body also sees antigens on a transplanted organ that are different from its own and it sends white blood cells to attack the organ. When your body attacks the new organ, it is rejecting it. In order to help prevent rejection, you will take certain medicines called immunosuppressants. These are discussed in another section."
The article I got that from specifically mentions that they don't require any antigens to match for a kidney transplant and people have had rejections even with a full match (full in the sense that the 6 we know about matched), but they don't say anything about heart transplants, or other organs. I imagine that most doctors aren't going to do a heart transplant with no knowledge of the heart other than it's blood type.
And yes, I would say that organ donation would have to require the person donating to come to the hospital. What did you expect? Someone to just show up with a cooler? The doctors would have no idea what kind of condition that organ is in. For all they know the donor could have had a disease that will be spread to the recipient, or the organ could have suffered major damage before being extracted. Doctors like to maintain a high success rate. I also imagine rich people that can afford to buy a poor person's life would want to do so in a manner that results in the best chance for success. I mean sure... a low chance heart is better than no heart, but I imagine they'd prefer everything be done in a controlled environment where the success rate would be much higher.
So you agree it's exploitative, but that's cool because people are already being exploited, so what's a little more?
I disagree with the notion that exploitation is something to avoid at all costs. Just because something *could* lead to exploitation does not mean we have to abandon it.