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May 23rd, 2005

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12:04 am - Issues to be decided by my dominion
I've decided to finally tackle a few issues I've been wrestling with for a while -- more than a year in fact. There are three issues to be decided, and in looking them over, to my mind they seemed related, so I've decided to deal with them all at once.

They have to do with cloning, organ donations and other ethical dilemmas associated with transplants. One of the reasons it has taken me this long to decide upon these questions is that I have a very dear friend who has undergone a heart transplant in recent years, so some of these issues are very real to me and I felt it necessary to give them quite a bit of thought before coming to my decisions.

Cash for Colons?

The Issue

Hospitals have requested that they be allowed to pay people for donating blood and other bodily organs, such as kidneys.

The Debate

1. "We remain critically short of blood plasma and various organs," says TheEntwife One hospital administrator Stephanie Rifkin. "Especially hearts. A good heart is hard to find. But if we were allowed to pay for donations, we'd get more of them and could save more lives. Plus the donor takes home a few hundred poplars in compensation. Unless it's a post-mortem donation, of course. In that case we'd pay the family."

2. "Great idea," says social commentator Roxanne Mombota. "Except for one thing. You know who's going to be selling their organs? Poor people! They'll be so desperate for money that they'll sell their own kidneys. Well, a kidney. This is just another way for the rich to buy themselves a better life at the expense of the poor. It must be outlawed."

Compulsory Organ Harvesting Proposed

The Issue

A group of emergency room doctors has petitioned the government to introduce mandatory organ donations.

The Debate

1. "It's not as crazy as it sounds," says Dr. Beth Hanover. "Every day, people die because we don't have the organs to save them. Well, that and widespread under-funding of the health system. But the point is, if the government allowed us to take organs from dead people, we could save hundreds of lives a year. And come on, it's not like dead people need them."

2. "You keep your damn hands off my organs!" says alarmed hospital patient Johann Mombota. "They are my organs, and I'll do with them what I like. The government has no right to my body."

Cloning Research Promises New Breakthrough

The Issue

Scientists using cloned human embryos for research are on the verge of a medical breakthrough.

The Debate

1. "It's really very exciting," says lab head Colin Jong-Il. "Until now, we've kept very quiet, to avoid being targeted by lunatic fringe groups who for some reason think it's wrong to clone human embryos. It's too early to promise anything, but we hope that one day we will have genetic cures for a whole range of debilitating illnesses. I certainly hope the government will support our work."

2. "Well, if you have to be part of a lunatic fringe group to object to this barbaric practice, I'm a lunatic," says placard-waving protestor Miranda Longfellow. "Of course it would be nice to cure these unnamed diseases, but at what cost? They're messing with the sanctity of human life. It's wrong, and the lab should be shut down immediately."

As usual, the choices available are very black-and-white and my prefered choices are either nowhere to be found or somewhere in between the two radically different options.

~~ sigh ~~

In the Cash for Colons? issue, I see no harm in people selling their blood -- something that used to occur in the past with US blood banks, from what I've heard, although I'm not sure it still occurs. My trepidations start when organs are for sale.

The second opinion in this debate makes a very valid point -- many impoverished persons will be tempted to sell body parts. In fact it already occurs -- although it's not usually referred to as a "sale". Instead, the euphemism of "making a donation" to the person providing the organ is used, much in the same way the term is used for surrogate mothers or those who give up a child for adoption. To my mind, one is still selling an organ or a child, euphemisms be damned -- if it walks like a duck and it quacks like a duck . . .

Recently a report hit the newswires of the case of Shefali Begum of Bangladesh. The Dhaka slum-dweller and mother, desperate to feed her child after she was abandoned by her husband, offered one of her eyes for sale in a newspaper. “I desperately looked for a job to live with my two-and-half-year-old daughter, Meem, but I could not find any . . . and decided to sell one of my eyes. What do I do with both eyes while my daughter will die for want of milk and food?” It was reported that she hoped to get enough to set up business as a street vendor or toy seller.

This is a real-world current example of the consequences of having body parts for sale. It would also make one of the email hoaxes of the recent past a reality. The one I refer to is the report that fill-in-the-blank, while traveling in fill-in-the-blank city/country (usually a third-world place, but not always), got slipped a mickey and later awoke in a hotel bedroom/bathroom, covered in blood and missing a kidney. In a world where organs are for sale, this can easily become a reality, particularly for travellers to certain parts of the world. There are places I've traveled to where violent street crime is common -- places where even stopping at a red light can get one robbed. If the price for an organ is high enough, there is economic incentive to kill and maim victims. (In parts of Africa, human body parts are valued by traditional sorcerers and people have been killed to satisfy the market's demand for these items, as recently as a few days ago in Dar es Salaam, Tanzania.)

On the other hand, being able to "compensate" the organ donor or the donor's family might well mean that more people and families would be willing to donate. I personally have no issue whatsoever with post-mortem organ donations -- particularly since the afore-mentioned dear friend would not be alive now without one. My qualms are more for organs like kidneys or livers, where the donor lives afterwards and where the economic incentive might prove to be the deciding factor for someone undergoing financial stress. To my mind, that economic incentive might lead to the making of poor decisions.

Making organ donation compulsory, however, as in the Compulsory Organ Harvesting Proposed issue, might possible alleviate the problem. How? By the simple effect of "flooding the market", thereby lowering the price for organs, if not eliminating it altogether for non-living donors.

There can still be made various objections, on religious grounds, by some members of the populace. I would be more comfortable if there were a way for people to "opt-out", but as usual, there is no middle ground available in the choices . . .

Which brings me to the third issue, Cloning Research Promises New Breakthrough. There are tons of ethical issues related to cloning. There is also the hope, though, that cloning technology can lead to medical miracles. One of these is the possibility of stimulating stem cells into growing a complete new organ, or even a limb. This would eliminate a lot of the issues of organ transplants, since the new organs would be grown using the patient's own DNA and therefore be completely compatible, rendering rejection a non-issue and making the transplantee's life much more pleasant, since powerful anti-rejection drugs like Prednisone would no longer be needed.

The caveat, however, is that the stem cells -- at least at present -- can only be gotten from human embryos, and harvesting them destroys the embryo. In other words, a potential human being must die in order that other human beings might have a better quality of life. Without getting sidetracked by the ethics of abortion, to me this boils down to a question of what is the worth of a human being? For those who espouse Jeremy Bentham's philosophy of Utilitarianism (where what is morally obligatory is that which produces the greatest amount of happiness for the greatest number of people -- "the greatest good for the greatest number", in other words), the answer would seem to be clear. The needs of the many (those who benefit from the fruits of cloning research) outweight the needs of the one (the embryo that is destroyed for its stem cells). One should die that many should live. A devil's bargain, if ever there was one . . .

The preferred solution to my mind is fairly simple, although again it involves the ethics of abortion, which I'd rather not go into at this time. Given that under current US law abortion is legal, and that the "products of conception" are routinely discarded, wouldn't it make sense to try to make the existences of these unwanted embryos more meaningful by using them as a source for stem cells, instead of incinerating them? Their deaths are a given -- their mothers do not wish to carry them to term, for whatever reason. To my mind their deaths might serve a useful purpose in this manner, much as those whose organs are given to others once they are dead. The main difference being, of course, that the embryo has no choice in the matter, whereas an organ donor (or at least the donor's family) does.

If I could consider these three issues as part of a whole, and make a decision for my dominion that ties them together in an organic whole, I would. What I would like is for compensation to be given to those who choose to donate organs and/or blood, to encourage donations, but for there to be some safeguards that would act against the economic incentive for the less-well-off to sell their bodyparts. What form they would take I'm not sure, but I really don't like the idea of the destitute maiming themselves for money. I'd make organ donation obligatory BUT with an "opt-out" clause for those with strong moral or religious objections to the removal of organs and other tissues from the dead. I would also encourage medical research, including that which involves cloning and the use of cells from former embryos BUT those embryos could only be gotten from those whose deaths were already assured -- i.e. embryos from abortions or unwanted embryos from those who undergo fertility treatments/in vitro fertilization and have "leftovers" that they are unwilling to donate to another infertile couple.

Those are the decisions that I would LIKE to make for my dominion.

But I can't.

It's that black-and-white choice thing again.


So what I've decided to do is:

A. Allow there to be monetary compensation for those who donate organs (or for the families of donors)
B. Have compulsory harvesting of the organs of the dead
C. Support cloning research involving embryos

While I'm not 100% happy with these choices, I think that they are in the overall best interests of the population of my dominion.

Call me a Utilitarian.
Current Mood: thoughtfulthoughtful
Current Music: "The Cup of Life" by Ricky Martin

(2 seeds eaten | Eat a pomegranate)


[User Picture]
Date:June 1st, 2005 09:27 pm (UTC)
Interesting points to ponder, I am a recipient of a donor tissue, and I feel that although we shouldn't regulate the sale of organs, guidelines should be put into place to protect the health of all.
Giving up a kidney to a person who is in dire need would get you on the 6 o'clock news, but if that same person got $25,000.00 for it then they would be a villain. Shouldn't the outrage be the same? If it isn't then how is selling a kidney to help get out of a dire financial situation any more evil than passing a collection plate around after a great sermon? Is whoring the word of god less evil? Or is the alleged saving of a soul sellable but the actual saving of a life not?
When we put too many laws in to govern behavior, we lose too many of our freedoms.
Oh, and great topic!
[User Picture]
Date:June 2nd, 2005 06:23 am (UTC)

Glad you like this topic!

To me, "cash for kidneys" is not an intrinsic evil -- it simply sets up conditions where some will choose to commit foolish or even evil acts for an economic motive -- acts that would not otherwise have occured were the afore-mentioned economic incentive not there.

What I'm more concerned with, personally, is situations that I mentioned like that of Shefali Begum of Bangladesh or the men who killed the boy for his "parts" in a human "chop shop" in Dar es Salaam, Tanzania. Economic motives for murder or maiming oneself are things I personally find abhorrent. As the links to current news stories illustrate, that stuff happens NOW -- if "cash for kidneys" were more common, there would be many more stories like this, unfortunately. Tourists to high-crime areas (like Brazil -- where stopping at a red light can get one robbed) would have to worry then about not just losing some cash and/or jewelry, but also potentially one or more body parts, if they weren't killed outright for "spare parts". The desperately poor, when faced with a choice of starvation for themselves or their families, might choose to gain a temporary economic advantage at the cost of permanent disfigurement and disability.

A similar skewing occurs currently in the US all-volunteer armed forces. The socio-economic level of most military personnel is not very high, since those higher on the social and economic ladder have options available to them that those lower do not and those lower on said ladder may feel as though the Army/Navy/Marines/Air Force is a way to escape their current financial constraints via a military career -- potentially at the cost of death or disability in this time of war.


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