The Ethics of Organ Transplants: The Current Debate

By Arthur L. Caplan; Daniel H. Coelho | Go to book overview

19. Families' Self-Interest
and the Cadaver's Organs:
What Price Consent?

Edmund D. Pellegrino

It is tragic for an eligible recipient to die for want of a lifesaving organ. The profession and society are under a clear moral compulsion to seek ways to prevent such deaths. But it would be equally tragic, even in order to save lives, to resort to such a morally dubious and destructive policy to increase the supply of donated organs as Peters suggests. His proposal that a $1000 death "benefit" be offered to motivate families to consent to removal of organs from their deceased relatives is logically, ethically, and practically flawed.

In his sincere and understandable commitment to save lives, Peters follows an oversimplified line of reasoning: people die waiting for organ transplants. Organs are scarce because we have relied on altruism to motivate donors. Therefore, self-interest must replace altruism as a motive. With the obstacle of activism out of the way, Peters believes that an adequate supply, and even a surplus, of organs can be expected; that minority groups would benefit; that the "coercion" he sees in our reliance on altruism would be eliminated; and that altruism itself would be preserved.

Peters' argument is based on a faulty interpretation of altruism. Altruism is not a value imposed on donor families. No one can be coerced into altruism because altruism requires a free and conscious recognition of other persons in the way we conduct ourselves. 1,2 It is a fundamental virtue of, good societies and good persons. It is not valid only in a context of plenty. Physicians are not free unilaterally to eliminate altruism from decisions to donate organs. To create a deliberate conflict between altruism and self-interest is to reduce our freedom to make a gift to a stranger. 3 This, as Titmuss3(pp12-13) shows

____________________
Originally published in JAMA 265, no. 10 ( March 13, 1991): 1305-1306.

-205-

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