Is organ conscription ethical and should people receive compensation for the process?

While scientific research has resulted in an enormous breakthrough in treating heart, liver, kidney, and intestine disorders by discovering procedures to transplant organs, the concept of organ conscription remains a dilemma in the modern society. Organs such as the heart and liver require a donor to die for a successful transplant. Transplant organs are acquired through donation and sale. Recently, there has been a shortage of organs for transplant making treatment hard. McCormick et al. (2018), states that in 2018, 4,351 patients were on the waiting list, and 223 patients died while waiting for transplants. The situation has led to the suggestion of an opt-out organ donor system referred to as organ conscription. The concept refers to the harvesting of all usable organs from deceased people with or without their consent.  There are many issues surrounding the topic and up to date the government, doctors, and the society are unable to resolve the dilemma. In his article on organ conscription titled,” How the Dead Can Save the Living”, Shcwark outlines the benefits of organ conscription. He supports the idea that the concept is just but should include a just compensation ("Organ conscription: How the dead can save the living," n.d.)  However, the concept violates a lot of ethical principles and promotes immorality such as human trafficking and murder in the society. Therefore, human rights and constitutional laws are broken as a result.

Moral and Ethical Concerns Surrounding a Policy of Organ Conscription

The concept of organ transplant is based on the principle of utility, which states that an action is right as long as it results in happiness to the people and society.  It compares the advantages and disadvantages of the concept in question using standard outcome measures, which helps determine the overall good. Organ conscription allows organ transplant to the patients, which results in total recovery. Therefore, it contributes to happiness in society and provides overall benefits to the patient (Wilkinson, 2011). However, it results in human trafficking due to organ trade in the black market. Selling and buying of organs is prohibited in most countries through different Acts and policies such as the Anatomical Gift Act and National Transplant Act of 1984 In America. Organ conscription promotes illegal organ trade as vendors are promised massive compensation such as money and are often deceived by being offered some of the procurement fee as deposit. In most cases, the surgery for organ procurement is substandard and paid vendors face social stigma for selling their body parts. They therefore undergo physiological and emotional torture. Similarly, some victims are enticed and killed and their organs harvested for sale. Therefore, the concept of organ conscription results in more harm than benefit in the society.

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The principle of beneficence, suggests that physicians have a moral obligation to act for their patients' benefit. It also includes the principle of non-maleficence, which implies that physicians are obliged not to inflict harm on the patient intentionally (Avant and Swetz, 2020). Healthcare workers have an obligation to act as advocates for their patients’ wishes and decision. Organ conscription denies the doctors an opportunity to execute their duties to their patients. More so, it compromises the professional codes of ethics for doctors which suggest that healthcare providers' principal obligation is to offer healthcare services to human beings in full respect of human dignity. Human beings are not mere objects and therefore, despite their condition, they should be handled with care.

Organ conscription encourages the thought human beings are objects and their organs are usable. The doctors are consequently obligated to provide high-quality care to all patients. However, during organ harvesting, they perform substandard surgery and in most cases to do not offer the high quality care to vendors especially in the case of human trafficking. The ethics codes also suggest that physicians should use scientifically based procedures to administer treatment to their patients. Their decisions should be accompanied by scientific evidence at all times. Physicians have the freedom to choose their patients however, in an emergency; they are required to offer the best services to the patients. Having undertaken service to a patient, the doctors do not need to neglect them unless they have discharged (Epstein and Turner, 2015). The ethical code of conduct requires the doctor to observe all laws, honor the profession, and uphold dignity. In some cases the doctors are required to harvest organs from patients who are in the end-of-life care. National Center for Biotechnology Information (n.d.) indicates that a lot of patients whose life support is withdrawn undergo organ conscription. However, majority of the organs are burned or buried. The case of Ruben Navarro, a-25- year old man who was in intensive care but was removed from life support is a depiction of what the extremes gone for organ harvesting. His mother consented to withdraw life support from him and enrolled him for an organs donation program. His death did not take place in the expected duration and therefore, was ruled out for organ donation (National Center for Biotechnology Information, n.d.). His organs were therefore, not harvested but his life was lost. The surgeon involved was arrested and convicted for abusing dependent adult. Withdrawing life support from the patient is illegal and is classified as murder in some circumstances and has legal implications.

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According to Gómez-Vírseda, de Maeseneer, and Gastmans (2019), the principle of autonomy states that actions are right as long as they respect personal decisions and wishes. Human beings have the freedom to make choices and they should be respected as long as they do not pose a danger to other people. Organ conscription is an opt-out organ donor system where all organs believed to be useful are harvested from the deceased with or without consent. The concept therefore, fails to respect autonomy as the donor is usually dead and without an advocate. The families’ decision and beliefs regarding their decision are not taken into consideration.  Despite the overall benefits associated with organ conscription, autonomy has to be respected and fulfilled.

Scrutiny of Fairness and Justness of Organ Conscription Policy

The regulatory requirements of organ transplantation focus on three elements: utility, fairness and justice, and respect for others. The elements result in an ethical framework for decision making. Utility refers to the overall benefits after considering the amount of harm posed. It analyzes the benefits of organ transplantation, including reducing suffering, saving a life, and improving life quality. It also analyzes the potential harms: death, long-term side effects of surgery, and other complications.  The utility determines the overall benefits of the process. Justice and fairness refer to the fair distribution of the benefits. It requires that patients are treated equally. Justice states that all people are entitled to fair access and organ transplant benefits (Rosoff, 2018). Respect for others refers to autonomy, which regards the right actions as those that respect other people's choices as long as they pose no harm to anyone else. The elements promote a framework for organ transplantation. Organ conscription results in unfairness and injustice in the society. Human trafficking is not just as itnvolves enticing vulnerable populations and harvesting their organs without consent. They are made to go through substandard medical procedures and some are murdered. The acts are forms of injustice and unfairness to the victims and their families. Often, a lot of patients are lined up waiting for organ donors to enhance their treatment. Human trafficking denies some potential donors an opportunity to donate their organs to patients willingly. Some patients therefore, die while waiting for a donor.  Illegally harvested organs are sold in the black market and only the wealthy people can afford to buy them. Patients with a poor background suffer inequality as they do not have resources to acquire organs. Similarly, the concept does not respect a deceased’ decision on organ donation. Their religious and cultural beliefs are undermined as they cannot advocate for their decisions. More so, consent is not sought from their family members and their thoughts and desires are not considered. Despite Shcwark’s article that advocates for a just compensation, organ conscription imposes injustice and unfairness in the society.

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The concept of consent supports the principle of autonomy, which regards the right actions as those that respect other people's choices. For an organ donation to take place, the donor must consent to donation before death. The consent must be documented and presented in case of a disagreement concerning the donation. If the patient dies before consent is obtained, the family members are responsible for giving the consent (Chandler et al., 2017). The concept promotes fairness and justice by respecting other people's choices. It protects physicians and people involved from legal consequences. Human trafficking does not regard the significance of concept. More so, organ conscription denies the healthcare workers and families their desire to respect the patient wishes and final decision. Obtaining the organ from the donor without their consent is regarded as organ theft and has legal implications. By doing so, disrespect is accorded to the donor, and pain is inflicted on their family. The act violates the principle of non-maleficence, which implies that harm should not be imposed intentionally.

Availability of Alternative Policies

Organs shortage continues to cause a headache in the health sector, globally. In most cases, people refrain from engaging in organ donation programs. The situation calls for alternative policies which will assist in increasing available donors. A policy that seeks consent for organ donation from the next of kin in required. The kin agrees to withdraw life support of the patient involved, and a qualified team is involved in documenting the consent and the cause of death. They immediately harvest the required organs. The mandatory consent policy is a law that requires every person of legal age to submit their consent or objection details to the relevant authority. The policy will help in tracking the donors. The policy of social responsibility requires the public to receive education regarding the significance of organ transplants. It creates awareness of organ donation's importance, which increases available donor organs (Etheredge & Watermeyer, 2018). These policies provide an ethical framework of organ conscription and donation.

Conclusion

Organ conscription is a dilemma and has a lot of ethical, moral, and legal issues surrounding it. While there are a lot of advantages associated with the concept, it is unethical as it results in immorality and injustice in the society. It undermines ethical principles, human rights, and constitutional laws. It facilitates human trafficking and murder in the society. It forces the doctors to undermine their professional codes of ethics and obligation to act as the advocates for their patients. Different organizations and governments across different nations should endorse and legalize alternative policies such as social responsibility and mandatory consent policies. The policies do not undermine human rights and moral principles.

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