A demand for organ donors is growing immensely at an alarming rate. Previously, there has been a great difference between the number of donors and the organs required. Consequently, the aggressive campaigns have been launched to encourage people to donate organs as well as participate in a battle to protect humanity. Fortunately, a meteoric development of the modern technology has contributed to the current success in saving lives through a transplantation of organs. Nevertheless, when organs are unavailable, it does not make any differences whether the classy technology exists or not.
The prickliest issue present among physicians and ethicists is establishing how more organs can presently be procured for the transplantation. The purpose is to make a gap narrower between the required organs and the donated organs. The innumerable moral and ethical questions are raised while exploring such questions. They must be addressed before settling a conclusion. Autonomy, presumed refusal, presumed consent as well as a mandated choice are just a few options to deal with this supply-demand issue. Whatever the case, autonomy must be maintained in any regulation concerning the donation of organs. However, how autonomy is viewed and defined, it is likely to change when a presumed consent policy is put into consideration.
The presumed consent policy aims at acquiring transplant organs by obtaining consent from a patient. Physicians assume that the patient agrees to organ procurement if he or she does not decline to it. Unless they explicitly refuse, their tissues, blood, and organs are used for both a research and organ procurement. In this system, the patient who seems hesitant or stops a physician from using his or her organs, or tissues for a donation or any research is compelled to express his or her will concerning his materials. Many health practitioners have used patients’ biological materials without their consent with different justifications. It included a notion that the materials had already been detached from the patient’s body and, therefore, had been incapable of causing any harm to the donor. There are few comments against and for this policy. However, understanding what the patient’s autonomy entails is paramount at this point.
Autonomy is a multi-faceted idea that must be well defined and understood before embarking on discussions pertaining to organ procurement. Autonomy is defined as a self-determination or self-governance. Such a definition is quite broad and vague. Nevertheless, it is clearer especially when considering the fact that people are considered autonomous when they personally make some decisions that affect them and act on a basis of such decisions. In some circumstances, an individual will understand the facts regarding his or her decision than in others. In the former case, an individual makes a more autonomous judgment than in the latter one.
An autonomous solution may be performed only if an individual has understanding, intentionality as well as freedom from both internal and external constraints. In other words, an action must be preceded by an intention if it has to be considered autonomous. As it is not possible for a person to accurately understand all information before making a decision, it can be said that for an individual to make an autonomous decision, he or she must have a sufficient level of understanding. The use of internal and external constrains are the forms of coercion being used to compel a patient to donate an organ.
As earlier stated, a presumed consent system coerces the patient who hesitates or declines to donate his or her biological materials to state his or her will for the materials. If the will is not expressed, a physician will be free to use the patient’s material for transplant. A patient’s organ may be extracted unless the patient overtly declines from donating it. From this statement, it may sound as if organ donation is an implicit duty. However, such an inference does not agree with the rules of inviolability and indisposability of a human body. These principles neither forces a person to give his or her organs nor does it equate the nonexistence of will of decline to consent. The principles further stipulate that the family of the deceased may permit a removal of an organ from the deceased’s body, irrespectively of the absence of the expressed will from the deceased (Kurosu, 2008).
People live in the society, each enjoying the benefits offered by the society. From such a viewpoint, it is everyone’s duty to repay the society. If this argument is extended to the use of patients’ biological materials for donation, the citizen is a potential recipient. Thus, it is the donating patient. This reciprocal philosophy in organ procurement demands that if a citizen can receive an organ from another person, then similarly, he or she should be willing to donate his or her organ to help another person. However, such a philosophy is very controversial because the spirit of reciprocal donation seems strong among relatives and family members. However, it does not concern the rest of the society.
Another concern regarding organ procurement is a view of life and the human body. It is unclear whether an organ ought to be regarded as a possession or a material. The organ is not just a material. If people have a feeling that organs should neither be extracted from the body nor donated to others, they cannot donate any of their organs. This idea shows that organ donation is solely based on an individual’s understanding of the human life and body (Gill, 2004).
Supporters of this policy have argued that human beings sympathize with their fellow humans. They may be willing to donate their materials after death, irrespectively of whether such a desire for donation had been expressed before or not. However, if a patient declines from donating his or her organ, his wish ought to be respected. This argument rationalizes the presumed consent about organ removal from even children who cannot make autonomous decisions. When the individual’s understanding of the human body is put into consideration, the presumed consent is a factor that cannot be taken for granted. The point here is that people should not be forced to donate their organs for the use by others who desperately require them. This argument nullifies the presumed consent (Dennis, Hanson, & Hodge, 1993).
The presumed consent policy postulates that all patients should donate their biological materials for both a medical research and transplant. A literal understanding of this case suggests that there is no room for the donation refusal. However, the fact that the policy offers a room for refusal is the recognition that individuals have the will and right to their own autonomy. For winning the approval of the patient, the physicians and the medical staff ought to explain to him or her and other concerned individuals the use of the donated biological materials.
The conception that extracting organs from patients does not directly harm the patient and is beneficial to the society is a major reason the patient’s autonomy is not respected. The argument is that it is mean to let people, who would have otherwise survived, die just because the patient did not formally agree for the removal of his or her organ. Logically, it is inconceivable how the human being would be left to die yet his or her remedy would be acquired from someone who does not need an organ anymore. It would mean two deaths, one of which would have been prevented (Savulescu & Wilkinson, 2012).
Another reason why the patient’s autonomy may not be respected is that physicians are usually very busy and obtaining the consent from every patient is quite a hard task. The verification of such argument could be seen when considering the fact that sometimes a patient may be ailing beyond the level of cooperating with the doctor. In such a case, if the relatives of a deceased person allow the organ to be removed, the physician would be justified to extract it in order to save another life. It is not always that whenever biological elements are extracted and transplanted to other patients, some of them like blood are used by physicians to carry out a medical research. Its results consequently help many people. It is also factual that even if medical practitioners fail to obtain the consent from patients, the extracted materials have no direct harm to patients (Kurosu, 2008).
From an utilitarianism point of view, the presumed consent system is acceptable. Nevertheless, if the patient is unaware of the request document pertaining to the removal of biological materials for transplant, his or her materials may be used before he or she submits a document of withdrawal. In such a stage, it would be easy for physicians to explain how such materials are being used. Additionally, it is important to respect other people’s autonomy as well as their self-determination. Respecting autonomy involves considering the ethics of a decision-making process. Thus, some benefits ensuing from the presumed consent cannot validate the policy. Patients’ materials can neither be used for organ transplant nor a medical research in the absence of the informed consent unless there is a very crucial research to be conducted or a transplant to be done. In such a case, an approval from the ethics reviews the committee to validate an action (Orentlicher, 2009).
Unless the patient overtly refuses his or her organ or other biological materials to be used for the procurement or research, it is presumed that he or she has consented to the action. In case one refuses, then they must express their will, in case of a failure, their materials will still be used. In such a scenario, the system forces the patient to state his or her will in regards to his or her biological materials. Therefore, donating materials by the patient is not beneficial to the patient in question. This best explains why physicians ought to respect the patient’s autonomy. Compelling the patient to state his or her will in regards to his materials goes against the individual’s autonomy.
In a case where patients forget to submit refusal documents regarding the material donation, the materials in question will be used without their consent. Additionally, if a hospital misplaces the patients’ refusal documents, the biological materials will still be used. Such loss of documents shows that the patients’ autonomy has not been respected. If the patient wishes to refuse the presumed consent, he or she is given a document explaining the use of biological materials. After submitting a signed receipt to the receptionist, he or she is given a medical form to hand in to the medical department. In case the patient fails to conform to the presumed consent policy, he or she is stopped from signing the receipt. Consequently, the lack of such a receipt denies the patient access to the medical records. However, it is pitiful that most patients are unaware of the fact that signing this receipt consents for the use of their materials (Gill, 2004).
Ethically, the presumed consent system provides the insufficient safety in safeguarding the individual’s autonomy. Therefore, there is a conflict between the society’s beliefs on how it is supposed to care for the dying people as well as the need to transplant organs to the high number of people likely to benefit from them. This document has provided various explanations concerning why the patient’s autonomy would or would not be respected by the presumed consent policy for organ procurement.