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Providing healthcare services entails dealing with relationships between people and therefore involves a wide range of ethical dilemmas. Ethical issues surrounding the practice of post-mortem organ donation are among the key problems at the confluence of healthcare and ethics. The purpose of this paper is to analyze the ethical dilemma presented by Angelo and Lefler (2016). The source presents the case of an unidentified individual whose brain death has been documented at the hospital. To provide a thorough discussion of the ethical issues, this paper presents the chosen case, identifies the dilemma, applies the theory of utilitarianism to it, and presents my opinion.
The Case and Ethical Dilemma in It
Ethical issues related to organ donation after cardiac or brain death become extremely significant when it comes to cases that involve patients whose identity cannot be established. The article by Angelo and Lefler (2016) discusses the case of an elderly African American woman who was found in a state of insensibility. The patient turned out to have suffered an ischemic stroke and cerebral edema, and she died despite the efforts of emergency doctors. Local police used different methods to ascertain her identity, but all attempts were unsuccessful. When the patient’s brain death was confirmed, the information was reported to an organ procurement organization. Taking into account the absence of official decision-makers such as the patient’s relatives, the hospital administrator was expected to sign the document, stating that there was no evidence proving that the patient would argue against becoming a donor. As follows from the facts of the case, the power imbalance is an issue here since the deceased patient is deprived of decision-making power.
With the phrase “ethical dilemmas,” specialists in different fields mean various problems related to decision-making processes that involve two potential solutions that are both acceptable and legally compliant. In reference to this case, the ethical dilemma is related to the fact that the hospital administrator needs to disregard the necessity of informed consent for organ donation. The patient’s identity was not established, and therefore there is no information concerning the views or religious beliefs that this person held. Therefore, it is possible that the decision to include the patient in the list of organ donors would run counter to her personal opinion. The issue is significant for healthcare because making organ donation decisions on behalf of unidentified patients violates their rights but increases other people’s chances to survive.
Problem Analysis: Utilitarian Approach to Ethics
There are two competing moral claims involved in the case. First, there is the view that all decisions should be made with regard to the principle of utility – according to this, an action can be called morally appropriate if it makes positive changes to some people’s lives and therefore promotes happiness. The second claim involved in decision-making refers to the need to respect the patient’s right to autonomy under any circumstances. In terms of prima facie obligations, all healthcare specialists are committed to respecting their clients’ dignity, autonomy, and special needs. However, given that no sources of information about the patient were found, this principle yields to the principles of utilitarianism, according to which the appropriateness of certain actions is defined based on the degree to which they maximize well-being (Dalal, 2015).
The principle of utility is at the heart of this ethical theory, and it will be used to inform and defend my position related to the dilemma. Given the popularity of the theory, there are different ways to explain the term. However, according to Bentham, it can be described as the extent to which the positive consequences of an action outweigh the suffering that it causes (De Lazari-Radek & Singer, 2017). Although the theory is widely criticized when it comes to the ways to measure utility, there are numerous situations in which the lines of conduct that provide maximum utility are obvious. Such cases primarily refer to situations in which action is vital, and this is why organ donation is inextricably connected with utility.
As for my personal position on the issue, I acknowledge that making decisions on organ donation using so-called “surrogate” decision-makers is not fully consistent with the principle of patient autonomy. At the same time, given the consequences of using the deceased patient’s body for transplantation purposes, this decision can be regarded as valid and beneficial. The key pillars of the chosen theory do not run counter to the use of the surrogate decision-maker’s consent in the absence of official representatives of the patient.
First, when speaking about utility, theorists refer to the benefits for sentient beings (De Lazari-Radek & Singer, 2017). In this case, one or more potential recipients and all people who suffer mentally due to their health issues present a large group that will benefit from the decision. Unlike the deceased person, all these people possess sentience and therefore fully recognize that their life situation faces imminent disaster. In addition, if we deny the possibility of an afterlife, the patient cannot experience negative feelings anymore. Also, she does not have representatives who would feel insulted due to the decision to use her organs for transplantation. It can be assumed that the patient’s religious affiliation is not extremely important since all widespread religions emphasize doing good to others. Considering that brain death involves the loss of bodily functions, it is widely recognized that dead people cannot be wronged, and avoiding harm to the assumed donor is another argument that increases the utility of the chosen action (Nair-Collins, 2017). In general, dilemmas similar to the one under analysis occur due to our unwillingness to dehumanize others (even dead people) and perceive them as resources or objects.
Among the benefits deriving from my position on the issue is the ability to decrease the gap between organ demand and supply that is still growing (Pesavento, 2015). Furthermore, using the bodies of unidentified patients who die even though everything has been done to save them would help to positively impact the situation with the illegal organ trade. However, when it comes to negative consequences related to the position, some ethicists compare these cases to body-snatching, and such controversies are always detrimental to social health (George, 2016). Also, the patient’s relatives may come forward and initiate judicial examinations. Finally, being based on a materialistic worldview, the position is expected to face criticism from religious people.
In the end, the case shows that any decisions concerning organ donation when patients are unidentified have both positive and negative consequences. Applying the principles of utilitarianism, it is possible to justify the use of surrogate decision-makers in such cases. As for contradictions, the belief that the end justifies the means can be used to normalize even immoral acts, but it does not seem to apply to this case since not all people involved are able to suffer. In general, the issue attracts a lot of attention, and policies related to organ donation decisions are not the same in all hospitals. Considering the situation with illegal organ trafficking, these policies may need to be reviewed.
Angelo, M., & Lefler, D. S. (2016). Applied ethics in health care administration: A case study of organ donation in an unidentified person. Journal of Hospital Administration, 5(4), 44-48.
Dalal, A. R. (2015). Philosophy of organ donation: Review of ethical facets. World Journal of Transplantation, 5(2), 44-51.
De Lazari-Radek, K., & Singer, P. (2017). Utilitarianism: A very short introduction. Oxford, United Kingdom: Oxford University Press.
George, C. (2016). Who decides whether to harvest a John Doe’s organs? Houston Chronicle. Web.
Nair-Collins, M. (2017). Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation. Kennedy Institute of Ethics Journal, 27(4), 525-559.
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Pesavento, T. (2015). Facing organ donor shortage, patients forced to get creative [Blog post]. Web.