vital organs, economics, and Christian theology

From Gilbert Meilaender in his most recent essay on this topic in First Things. (Meilaender has written at length on the subject-- within First Things-- and elsewhere.)

In The Patient as Person, published almost forty years ago, when transplantation technology was still in its early stages, Paul Ramsey considered different ways of procuring organs for transplant. One might invite people to “opt in,” to donate organs to be used after their death (or, in the case of a paired organ such as the kidney, even before death). One might require people to “opt out” if they did not wish to have their organs taken after death for transplant, presuming consent unless they (while living) or their next of kin (after their death) specifically declined to ­consent. Or one might establish some kind of system whereby organs needed for transplant could be bought and sold (though he was thinking only of cadaver organs).

The third of these possibilities should, Ramsey believed, be rejected altogether. But his verdict with respect to the first two was more nuanced, a comparison of their relative merits and demerits. “If giving is better than routinely taking organs to prolong the lives of patients needing transplants, then it must also be said that routinely taking them in hospital practice would be better than for us to make medical progress and extend treatment to patients by means of buying and selling cadaver organs. That society is a better and more civilized one, I have said, in which men join together in a consensual community to effect these purposes, than a society in which lives are saved routinely, without the positive consent and will of all concerned to do so. It must also be said, however, that a society would be ­better and more civilized in which men are joined together routinely in making cadaver organs available to prolong the lives of others than one in which this is done ostensibly by consent to the ‘gift’ but actually for the monetary gain of the ‘donor.’”

Fine points-- all. But it is not inherently clear why a more civilized society allows people to die from a shortage of organs, caused by a lack of charity and a government prohibition on the sale of organs.

Moreover, it is not at all clear why all parties should benefit materially except those who give the organ. (All the parties gain financially except those who give and receive the organ.) If we're going to mandate altruism, why not altruism from the doctors and hospitals as well?

I recalled this passage when reading of the recent proposal by Gordon Brown, prime minister of Great Britain, to deal with what he called “an avoidable human tragedy” by encouraging more people to “donate” organs. Britain’s National Health Service, Brown suggested on January 14, 2008, should move to a system in which organs of the deceased would be taken for transplant, with their consent presumed, unless before death they had opted out or, after death, their family members objected to such use of their organs.

Ramsey’s comparative analysis might remind us that the prime minister’s proposal is not the worst we can envision. Ours is a world in which an increasing number of voices support some form of payment for organs (or, sometimes, for organs from specific populations, such as prisoners nearing death)—thereby turning potential donors into vendors and the body into a collection of parts that are available and alienable if the price is right. This would, Ramsey seemed to think, and I am inclined to agree, be worse than what Mr. Brown has in mind.

Nor, I think, will it do to object to Mr. Brown’s ­proposal on the ground that my body is my property alone, no part of which should be taken or used ­without my explicit consent. There are, after all, ­occasions—if, for example, an autopsy is deemed ­necessary—when we allow the needs of the larger ­society to override the bodily integrity of a deceased individual. More important, though, is that “property” does not seem to be the right way to think of my body’s relation to me. Thinking in those terms may, in fact, leave us defenseless in the face of arguments supporting a market in organs....

An autopsy is a weak reed on which to base that argument!

Meilaender continues from there on the theological challenges of even giving an organ. Provocative, but I'll let you follow the link if you want to read more...