Bioethics and the egalitarian conceit

Sally Satel takes a well deserved shot at the presumptious busybodies known as bioethicists:

On valentine’s day two years ago, Paul Wagner, a 40-year-old Philadelphia purchasing manager, gave Gail Tomas, a total stranger, his left kidney. Wagner met Tomas, a 65-year-old former opera singer, on the internet, at Her daughter had posted an ad asking some magnificent stranger to save her mother. “It was there that I read about a lady in my city, Philadelphia, who was desperate for help,” Wagner said. “It has been one of the best decisions I have ever made.” This story had a happy ending. Yet it unfolded amid controversy over whether ethical norms were violated.

Exasperated by the efforts of sick and needy patients to find donors for themselves, Dr. Douglas Hanto, a transplant surgeon at the Beth Israel Deaconess Hospital in Boston, complained “it will undermine trust in the whole system.” By “system,” Hanto was referring to the national transplant list. Today, there are over 83,000 people in line for a kidney in the United States. In places such as New York and California, the wait can be up to eight years. Unless a friend or a relative offers a kidney, people such as Tomas languish on dialysis, awaiting an organ from a deceased donor. They die at the rate of 13 per day because an organ did not arrive in time — hence the frantic plea of Tomas’s daughter to anyone who would consider donating to her mother.

A few years ago, Hanto, a former head of the ethics committee of the American Society of Transplant Surgeons, had his hospital turn away a fragile patient named Lisa Cunningham, a 40-year-old former social worker with a young son, whose prospective donor read about her plight in a local newspaper. Arthur Caplan, a prominent bioethicist at the University of Pennsylvania, condemned donor solicitation online as “an outbreak of impatience combined with a me-first attitude,” he told a reporter.

Me first? Cunningham was not snatching a kidney away from someone else. Except for the story about her, there would have been no offer in the first place. Moreover, every so-called Good Samaritan donor who gives to someone like Cunningham or Tomas removes them from the queue, and so others move up a slot. No one is harmed while someone is saved.

Caplan is a bioethicist; his titles imply an expertise in ethics. Hanto served as the chair of the Ethics Committee at the American Society of Transplant Surgeons. Yet what are we to make of their willingness to issue life-and-death pronouncements involving other people? Well, we know a few things about them. First, that they share an absolutist approach to egalitarianism: If all cannot benefit, then none should benefit. Second, as ethicists they presume to know how despairing patients should conduct their private affairs. And third, they appear to have few qualms about conveying to desperately ill people a message of hopelessness: Be passive, dying patients — wait your turn and take no initiative to save your own life.


3 Responses to “Bioethics and the egalitarian conceit”

  1. Tinos Says:

    I think I’d be more inclined to donate if I’d get a big lump of cash in return!

  2. skepticlawyer Says:

    I know people go on about ‘immoral markets’ and such, but there’s part of me that suspects there must be some sort of market solution to this.

  3. rog Says:

    Whilst France, Spain and Belgium (and maybe Portugal?) have laws in place that presume that a recently deceased is a voluntary organ donor this has had a backlash – they argue that it isnt the State that decides what happens to your body it is the individual.

    Years ago in France 2 corneas were taken without consent and the respective families kicked up a real hullabaloo which put the organ donation program back considerably. Now countries that do not have the ‘presumed consent’ laws, like Holland, are hunting around for organs in countries that do have them, like Belgium. This is putting pressure on other countries to adopt ‘presumed consent’ laws.

    There is no logic to the situation, it is a very emotional subject that needs to be handled with care.

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