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Organ Conscription and Greater Needs

Published online by Cambridge University Press:  15 December 2022

Alexander Zambrano
Alexander Zambrano*
Affiliation:
Department of Philosophy and Bioethics Institute, Loyola Marymount University, Los Angeles, California, 90045, USA
*
Email: zambranoalex11@gmail.com
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Extract

Since its inception, the institution of postmortem organ transplantation has faced the problem of organ shortage: Every year, the demand for donor organs vastly exceeds supply, resulting in the deaths of approximately 8,000 individuals in the United States alone.1 This is in large part due to the fact that the United States, for the most part, operates under an “opt-in” policy in which people are given the opportunity to voluntarily opt-in to organ donation by registering as organ donors.2 In the United States, a person’s organs will not be removed for transplantation purposes unless she has registered as a donor or her family gives their consent for organ removal.3 Jointly, these policies generate a situation where we do not retrieve as many organs as we could.

Type
Responses and Dialogue
Information
Cambridge Quarterly of Healthcare Ethics , Volume 32 , Issue 1 , January 2023 , pp. 123 - 133
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

1. Organ, Eye, and Tissue Donation Statistics; available at https://www.donatelife.net/statistics/ (last accessed 12 Dec 2017).

2. Some U.S. states, however, operate under a Mandated Choice policy. Under Mandated Choice policies, people are presented with the choice to become an organ donor or not and are required to make a decision in order to obtain a new driver’s license or ID at the DMV. For discussion, see Spital, A. Mandated choice: A plan to increase public commitment to organ donation. JAMA 1995;273(6):504–6CrossRefGoogle Scholar.

3. This is according to the U.S. Revised Uniform Anatomical Gift Act. See Acts: Anatomical Gift Act 2006; available at http://www.uniformlaws.org/Act.aspx?title=Anatomical%20Gift%20Act%20(2006) (last accessed 10 Dec 2017).

4. Rithalia, A, McDaid, C, Suekarran, S, Myers, L, Sowden, A. Impact of presumed consent for organ donation on donation rates: A systematic review. BMJ 2009;338:a3162 CrossRefGoogle ScholarPubMed.

5. Abadie, A, Gay, S. The impact of presumed consent legislation on cadaveric organ donation: A cross-country study. Journal of Health Economics 2006;25(4):599–620 CrossRefGoogle ScholarPubMed.

6. Horvat, LD, Cuerden, MS, Kim, SJ, Koval, JJ, Young, A, Garg, AX. Informing the debate: Rates of kidney transplantation in nations with presumed consent. Annals of Internal Medicine 2010;153:641–9CrossRefGoogle ScholarPubMed.

7. Delaney, J, Hershenov, D. Why consent may not be needed for organ procurement. American Journal of Bioethics 2009;9(8):3–10 CrossRefGoogle Scholar.

8. Spital, A. Conscription of cadaveric organs: We need to start talking about it. American Journal of Transplantation 2005;5:1170–1CrossRefGoogle Scholar.

9. Spital, A, Erin, CA. Conscription of cadaveric organs for transplantation: Let us at least talk about it. American Journal of Kidney Diseases 2002;39:611–5CrossRefGoogle Scholar.

10. Harris, J. Law and regulation of retained organs: The ethical issues. Legal Studies 2002;22(4):527–49CrossRefGoogle ScholarPubMed.

11. Harris, J. Organ procurement: Dead interests, living needs. Journal of Medical Ethics 2003;29:130–4CrossRefGoogle ScholarPubMed.

12. Silver, T. The case for a postmortem organ draft and a proposed model organ draft act. Boston University Law Review 1988;68:681–728 Google Scholar.

13. One might, for example, consider objections to organ removal that are grounded in some deep religious belief or tradition to be the kind of objection that a soft conscription policy should allow. For discussion see Hester, M. Why we must leave our organs to others. The American Journal of Bioethics 2006;6(4):W23–8 CrossRefGoogle ScholarPubMed.

14. Wilkinson gives the argument this title. See note 10, Harris 2002, at 527–49.

15. See note 11, Harris 2003, at 130–4.

16. Wilkinson, TM. Ethics and the Acquisition of Organs. Cambridge: Cambridge University Press; 2011 CrossRefGoogle Scholar.

17. See note 10, Harris 2002, at 535.

18. See note 11, Harris 2003, at 131.

19. See note 11, Harris 2003, at 131.

20. This reconstruction of the Greater Need Argument is largely derived from Wilkinson’s statement of the argument, which accurately reflects the argument found in Harris’s work. See note 16, Wilkinson 2011, at 110.

21. See note 16, Wilkinson 2011, at 21.

22. See note 16, Wilkinson 2011, at 113.

23. See note 16, Wilkinson 2011, at 113–15.

24. See note 16, Wilkinson 2011, at 116.

25. Hamer, CL, Rivlin, MM. A stronger policy of organ retrieval from cadaveric donors: Some ethical considerations. Journal of Medical Ethics 2003;29:196–200 CrossRefGoogle ScholarPubMed, at 199.

26. Feinberg, J. Harm to Others. New York: Oxford University Press; 1984 Google Scholar, at chap. 1.

27. Griffin, J. Well-Being. Oxford: Clarendon Press; 1986 Google Scholar, at 13.

28. See note 11, Harris 2003, at 132.

29. Pitcher, G. The misfortunes of the dead. American Philosophical Quarterly 1984;21(2):183–8Google Scholar.

30. Feinberg, J. The rights of animals and unborn generations. In: Blackstone, W, ed. Philosophy and Environmental Crisis. Athens: University of Georgia Press; 1974 Google Scholar.

31. See note 17, Wilkinson 2011.

32. Boonin D. Dead Wrong: The Ethics of Posthumous Harm (ms); New York: Oxford University Press, 2019.

33. See note 29, Pitcher 1984, at 184.

34. The backwards causation worry can be put as follows: According to Pitcher, the event that harms Ben takes place after he is dead. At the same time, however, it is Ben, while he is alive, that is the subject of the harm brought about by his partner burying his remains. Both of these claims appear to imply that living Ben suffers harm before the event that harms him takes place. But this seems to require the possibility of backwards causation, for the cause of Ben being harmed—the event of his partner burying his body—occurs temporally after Ben is alive and allegedly in a harmed state. But, the objection goes, backward causation is impossible, and since the posthumous harm view requires it, posthumous harm is impossible as well.

35. See note 29, Pitcher 1984, at 187.

36. There might be several different objections leveled at the posthumous harm view, most notably: how is it that a person can be in a harmed state before the event that harms her actually takes place? It seems that the common-sense view of the timing of harm is that a person is not in a harmed state until the event that harms her occurs. But the posthumous harm view, as it is stated by Pitcher and Feinberg, is committed to the claim that Ben was in a harmed state when he was alive because the event of his partner burying him rather than cremating him was going to occur in the future. Call this the timing objection. Given the space allotted to me and the goals of this paper, I cannot address this objection in full detail; however, see note 32, Boonin (forthcoming); see note 16, Wilkinson 2011 for detailed responses to the timing objection.

37. See note 7, Delaney, Hershenov 2009, at 4.

38. See note 16, Wilkinson 2011, at 116.