The field of medical ethics is one is of severe complexity, diversity and covering a wide range of topics in the medical world. Within medical ethics it is especially important to consider religious principles and the effect they have on the options for religious believers and effects on faith. One of the key issues for debate, considered to be the most controversial and varying is organ transplantation and organ donation. Religious principles and ethical values directly affect the outcome of an organ transplantation or donation, and for many faiths they should be upheld in all circumstances, even in a matter of life or death. Many medical developments in organ donation are often very controversial and use cutting edge research and development which many religious believers deem unacceptable and religious principles should be upheld. In the words of Albert Einstein ‘science without religion is dumb, religion without science is deaf’. Science and religion therefore must co-operate and coincide in the complex field of organ donation.
The first successful transplantation was in 1945 however the idea of transporting tissue or organs from a deceased or living donor has been around since the 3rd century. There are many religious faiths that would reject organ transplantation. There are a huge number of people waiting for a donation organ, as of April 2012 there are currently 7288 people waiting for an organ in the UK, however in the year 2011-2012, 3960 organ transplantation did take place. There has also been a 50% increase in organ donations given since 2008 (as of April 2013) , however it is estimated that 1000 people die every year in the UK waiting for an organ, even though one single person has the ability to change 6-10 peoples’ lives.
An import issue and development of the organ transplantation/medical ethics is the use of an ‘opt in’ system which is applied in the UK. Willing donors must register online or through a form via the NHS to become a donor. You can choose which organs you wish to be donated, many feel that they do not wish to donate their eyes, more so their vital organs such as the heart or a kidney. It can also be the expressed wish of the relatives of the deceased to give consent of behalf of them. With the average of 9 thousand people needing and organ each year and only a third of this receiving one many feel that the system needs drastically changing in order to save more lives. One option is to go for an ‘opt out’ system like that of Italy and France; there has been extensive research by the Taskforce who note a direct correlation between high donation rates and an ‘opt out’ system. As Britain the lowest donation rate in Europe this seems to be a feasible approach in order to save more lives. The system would mean that you would have to actively ‘opt out’ of donation your organs.
However a third of people who donate organs already feel that an opt out system would take the altruistic nature of the UK system. The argument for an ‘opt out’ system is one which is hotly debated in the UK, most recently, The Welsh Assembly held a bill vote on it. It is imperative to understand different religious beliefs when looking at this issue in particular.
Sanctity of life is a primary Christian principle which is important to investigate when looking at organ transplantation and human life. It is defined simply as “life is of intrinsic value and should be respected and protected”. This shows the theist view to be that life is sacred regardless of religion or race etc. and as we are created “in the image of God” who is omnipotent and omnnibelvelent it is our job to preserve the life that God has given us, as he (god) is the only one who can give or destroy life. Therefore it is predominantly Pro-life on debates on organ donation and other topics to do with Human life.
The main argument is revealed ethics of sanctity of life, which is based on the bible teaching of genesis for ‘god breathed into man’s nostrils the breath of life.’ It reinforces the god is responsible for all human life and that it should be a sacred thing. As he said ‘your body is the temple of the holy spirit’ it is our job to keep it safe and protect it from harm in all and every circumstance. Vitalists believe that humans are ‘set apart’ from other creatures in the world and animals as humans possess a soul. There is no point at which it could be justified to terminate human life.
Therefore they would be in favour of someone on life support even if in a vegetable state and state it would be wrong to take their organs as we as humans, do not have the power to give and take life. As God is the only giver and taker of life it would seem that sanctity of life is a hindrance to the idea of organ transplantation as it would 1. Support those on life support and withhold vital medicines and 2. Disagree with organ donation as it is giving the gift of life which only god can give. However there is also the belief (weak sanctity of life) that it is a moral decision as a Christian to “choose life” (Deuteronomy commandment) and preserve it, whilst also saving a life, would grant us passage to heaven. Furthermore when you ‘preserve’ the temple via organ donation you are saving god’s gift from dying with them.
From this perspective then an ‘opt out’ system would be favourable as we are taught to “love thy neighbour”, exercise agape and preserve others’ lives. Christians are entailed to look after our fellow human, to encourage a good soul which is worth of being made in the ‘image of god’. It does therefore not have any impact on my topic of an opt out system as it would be seen as a moral duty for everyone to help one another and by being automatically ‘opted in’ we are proving the goodness of humans and increasing the number of lives which are saved.
However there are many who would contest this. Elizabeth Buggins reviewed the issue and stated that an opt out system should not be implemented for ‘doctors cannot be trusted’ with a body which is so sacred to protect it and put organs of God into good use. It would also bring into the question of those organs which reject the body and what happens to them. With an influx of organs due to the opt out system many may be wasted or sold on the black market which is not ‘protecting the temple’ of god. Personally in my opinion I would disagree with an opt out system on these grounds, but promote organ donation in all its glory. Thus giving the individual the choice to give life .I believe therefore that sanctity of life is of the utmost importance discussing my topic and organ transplantation as it gives the question of whether in a Christian country such as the UK people should have the choice to opt in, especially when looking at revealed ethics which as two very opposing sides and looking at life as sacred.
Another key principle when discussing Medical ethics and organ transplantation is Person hood. It asks the question “what is a person” (John Wyatt). Personhood was first purported in the later part of the 20th century and was originally a shocking concept as it gives the idea that a human could indeed not be a person. Peter Singer initially proposed that a person was “a being with capacity for enjoyable experiences, for interacting with other and having preference on continued life”. The two conflicting views are that of John Locke and Peter Singer vs. the ancient Christian views.
Christians are guided by the principle that being a person is not determined on your mental or physical state and that humans are set about from the other beings for they have a soul and that we will never stop being people. Furthermore there principle of a person is that of a living being state that has a soul and was summarised by theologian Gilbert Meildener as “he was with us in the womb and will be there with us in the tomb” meaning that in Gods eyes we are forever human.
John Locke however opposes this and defined as person as “a thinking intelligent being with reason and reflection.” Therefore bring a person is someone who has the ability to choose and value their own life. Singer objects to the Christian view as a crime of Specimim as it would discriminate against animals, and ultimately we should not be ‘set apart’. On a scientific level it has been proven that humans and chimpanzees share 98% of their DNA with one another. How can we be set apart from something so like ourselves? However to agree with Locke’s principle would denounce babies and people with Alzheimer’s. It would therefore important to define what a person as opposed to a non-person. E.E.Cummings backs this view by stating that ‘un-being dead is not being alive’ and that some people are not worthy of people called a person, such as those in prisons. Under personhood the idea of xenotransplantation – the transplantation of animal organs to humans would be rejected as animals are just as much ‘persons’ as human beings. Moreover this would pose another religious opponent of Hinduism, which sees the cow as sacred.
Moreover this is applied to organ donation in the sense that do we prioritise those who are classes as a person over that of a ‘non person and if someone is indeed classed as a non-person can we freely take their organs without their consent? Singer believes that “killing a person is far worse than killing a non-person”, which means that he, discriminates on the grounds of brain function and mental ability. If this was applied to organ donation then babies organs could freely be removed in order to save some that is a classed as person. This would intern over time limit the earth’s reproduction.
Another thing to consider it with personhood is when does a person stop beaming a person, is it when they loose consciousness or when they are completely brain dead and cease to function. Singer said that a person stops being a person when consciousness is lost but how would we be able to predict if that person would later regain consciousness, we cannot ever predict the outcome of a situation. Most recently in the news Argentinean mother baby was declared stillborn April 2012 but then a few hours later the baby was discovered to be alive. This is why personhood is so important to explore when looking into medical ethics.
Christian ethics is a big part of the debate on organ transplantation as it comes from the need to understand and interpret ethical issues from a point of God. Thomas Aquinas said that love is the reason that we are made and unites under a common ground with god. Love alone will lead to fulfilment and should be the guiding principle in life. This therefore supports the UK’s opt in system and giving an organ is seen as the gift of life. To make it almost compulsory in the opt out system, would be seen be taking the virtuous manor away. However this can be opposed by many Christians who follow the key commandment of ‘love thy neighbour’, then we should follow Christ’s lead like he did when he died on the cross for our sins. To donate is to improve or even save a life of another. If society where to follow this train of thought then the ‘opt out’ system would be a vital, but on an individual level an ‘opt in’ system seems like a much loving thing to do.
If indeed society where to follow this line however then many feel that their rights would be over looked and relies on everyone to have Christian beliefs. In ‘The Brothers of Karamazov’ Ivan says ‘without god everything is permitted’ which advocates people to act in an immoral way. This poses the question of the non-believer who states that they have no reason to act morally if they do not believe in a god or a heaven. Why should atheists have to opt in or opt out?
Christian ethics ultimately leads to a opt out system as the best answer for redeeming the soul. This in turn leads to Virtue Ethics which is an important source from Christians as it defines the qualities and characteristics of being a ‘good’ person. Love is considered the highest virtue from Christians in that they should “love god” and “thy neighbour”. We should strive for love as the main aim of our lives. Virtue ethics therefore supports the UK’s opt in system as it is seen as the gift of love and lift to give an organ, out of command of love.
Quality of life is also import and is often used in conjunction with ethical issues which emerge from medical ethics. It assesses a person’s quality of life under different factors. Felce and Perry defined it as “the satisfaction of a person’s needs values and goals through actualisation of their abilities and life style.” This means that we should look at the person’s quality of life and how it may improve in the future if given an organ. A utilitarian would argue that it should be whatever brings the greatest happiness for the greatest number. Peter Singer believed that we should look at how a person spends their time uses their time for high pleasures more so than lower pleasures and this would define quality of life. This would mean that someone who does higher pleasures more frequently would be more worthy of an organ. Many also argue that by looking at Quality of Life when choosing who should receive an organ would result in a discrimination of the old. For they may not lead a good quality of life due, but does this make them any less worthy of an organ? Peter Vardy argued that he could be a criminal but because he was young he in this case would receive the organ over someone who has had a big impact on society for the good but is old
A case study to show the importance of Quality of life in regards to organ donation is that of Elaine Stacy. Elaine died in 2010 after a car accident originally she was placed on life support but her family took her off. As an organ donor her organs went to many different people and changed their lives. It could be argued that the improvement of quality of life for the recipients for her organs is more important that her quality of life is she had indeed stayed on life support. However there is a problem in applying Quality of life to medical ethics as it is a teleological ethical theory – from the Greek work telos meaning end or purpose and is consequentialist. It is difficult if not impossible to predict the consequences of an action and how they may ultimately affect the quality of life for a person. So the validity of quality of life is raised. Many believe that organs should be given out to those who need them most regardless of the life they lead.
Moreover another important ethical value to consider when discussing medical ethics is Utilitarianism, which is constantly debated in regards to organ transplantation. Utilitarianism aims to maximise the pleasure that people receive and minimise the pain of an action. Mostly in its purest form it is concerned with ‘the greatest happiness for the greatest number’ (Frances Hutchenson). Many argue that creating the greatest good for the greatest number of people should be the guiding principle in life. However this leads to the Tyranny of the majority and may overlook individual rights of the people.
When considering who should receive an organ, utilitarianism would point to saving the person who causes the greatest pleasure from society and opposed to those who need it desperately. The utilitarian would also have to balance the wishes of the deceased and the wishes of the family when considering whether to go ahead with organ extraction. The family may want the patient to have the organs donated but the deceased may not or vice versa. Under utilitarianism the families view would be the one taken in account as it would cause them more pleasure than one who is dead. The preference would always be with saving lives as it would be ‘the most loving thing to do’. The utilitarian therefore believes that the opt out is the best option as overall it would see an increase in donations as the people would have to actively opt out causing more pleasure. However this leads to tyranny of the majority as stated and does not consider individual cases.
Kantian ethics is often considered highly in medical ethics and organ donation. It entails the view that humans are of intrinsic value like that of God himself. It supports the idea that humans should not be treated as ‘a means to and end’ and that all human life is scared and special which should be treated with respect, this coincides with some aspects of sanctity of life. Kant developed the theory of universalisability, the idea that if an idea can be universalised then it is deemed good. Kantian ethics is more based on the individuals personal opinion, rather than as a suggestion on the opt in opt out system.
In conclusion the objection for the opt out system is essentially, if this system was implemented many organs may be removed without consent or respect. In India especially there is a high rate of organs which do not need to be used, being sold on the black market (although there were laws passed in the 1980s in an attempt to stop this). This then violates their civil liberties and the principles for respect for autonomy. It can be argued that although removing organs from someone who does not want them removed is unfortunate they do indeed have the option to opt out and it’s for the greater good.
Many of the ethical theories attempt to divulge the developments of organ donation system in the UK, especially personhood and sanctity of life which I find to be extremely powerful in the argument of opt in opt out. However many fail to take in the patients autonomy. Organs as part of the body which we should have the choice over.to implement an opt out system restricts their autonomy greatly which should be a civil liberty. Therefore in my opinion the autonomy of a person is the most important thing when considering the new developments for organ donation. A person should have freedom of choice to opt in; it should not be a requirement. The principle of autonomy accepts that everyone person has the right to choose which is what I believe. In the end ‘it’s all a matter of personal choice’ (Paul Davis) whether you want to donate your organs and the government have no right to make it compulsory.