Organ Transplantation - the Legal and Ethical Issues in Presumed Consent - Personal Statement Example

? Organ transplantation: the legal and ethical issues in presumed consent al affiliation Organ Transplantation: the Legal and Ethical Issues in Presumed Consent Organ transplantation involves the removal of internal organs from one person, and the transfer of those organs to another person whose organs are failing. For transplantation to take place, organs can be procured from both living and the dead donors, although the latter seems to produce higher volume transplantation than the former. However, when choosing the organ to be donated it is highly important to consider whether the donor is alive or deceased. Rithalia et al. (2009) state that in the UK most cases involving alive donors are reported in the donation of kidneys. Most of the other organs come from deceased people. Despite the benefits of organs’ transplantations, this procedure has its share of limitations. For example, as Voo, Campbell, & De Castro (2009) state, the organs available for transplants are usually in short supply, yet the number of people in need of transplants is ever increasing. This translates into a long waiting list, while demand continues to grow and more people die from organ failure. As Lawson (2008) states, the problem with the current healthcare setting is that organ transplantations rely so much on informed consent that many unnecessary deaths are occurring, yet good organs, which can be used to save people’s lives, are being buried and cremated. Presumed Consent during Organ Transplantation To increase the supply of organs, medical practitioners have been forced to use various means to obtain organs. As Voo, Campbell, & De Castro (2009) state, the conventional method is “opt-in”, in which a person voluntarily donates his/her organs to needy patients. Using this method, the donor should authorize the removal of organs after his/her death, by, for example, carrying a donor card, or being a member of the national registry (Price, 2000). However, since these donations still do not meet the growing demand, practitioners tend to use the “presumed consent” method. According to Liddy (2000), presumed consent assumes that everyone wishes to donate their organs after death, unless the person has “opted out” of the system. This is despite the absence of a clear indication that the individual donating the organs have given their consent for the procurement process. According to Lawson (2009), the presumed consent system allows for organ procurement after the death of a person, unless the deceased had objected to this procedure before their death. This scenario, according to Voo, Campbell, & De Castro (2009) creates an “ethical crisis”, where critics argue that the deceased may not have known the laws governing organ donations, and would not have, therefore, objected. Legal and Ethical Issues Affecting Presumed Consent during Organ Transplantation On legality grounds, Ammann (2010) writes that from a legal standpoint, every adult of sound mind should have the ability to make decisions concerning any actions towards one own body. It is, therefore, argued that the presumed consent model violates free and informed decision making; thus, undermining personal autonomy. In addition, some critics argue that presumed consent is not legal since it assumes that every person who does not opt-out of the system wishes to donate their organs after death. This, however, is not the case, considering that majority of people are ignorant about such an option and may, therefore, be unwilling to donate, yet fail to opt-out. As a result of not opting-out, such people may end up donating organs even though they never intended to become donors (Liddy, 2000). Presumed consent can either be “hard opt-out” or “soft opt-out” depending on the available legislations, as well as ethical considerations (Ammann, 2010). The hard system does not consult the family, while the soft one considers the wishes of the family before starting on the organ procurement process (Ammann, 2010). Since the presumed consent system operates on “opt-in” and “opt-out” basis, Ammann (2010) writes that in Canada, for example, in case a person had not consented to donate before their death, a surrogate judgment is appointed on behalf of the deceased. In some other countries, however, the presumed consent method, according to Voo, Campbell, & De Castro (2009) also tends to downplay the role of family of the deceased in making decisions. Unlike in the informed or explicit consent system where the bereaved family has to be informed about the decision by the deceased to donate organs, the presumed consent method does sometimes overlook the role of family, in the name of simplifying the transplantation procedure. Rithalia et.al (2009) state that in Austria, for example, organ procurements are done without actively involving the family, unless the deceased had opted-out of the process. Ethical arguments hold that presumed consent could dent the rapport between physicians and families of patients receiving palliative care. If, for example, physicians use the “hard opt-out” option to procure organs, the bereaved families insulted thus creating a discontent between them and the physician (Ammann, 2010). Opponents of presumed consent, therefore, propose that the general public be informed about the opt-out option, and that family members be consulted during presumed consent processes. These critics propose a national database with the names of all individuals who have opted-out, which can be accessible from all major transplantation centers in the UK. This would ensure that the personal files of everyone are available for all physicians everywhere, to ascertain their willingness to donate their organs or otherwise. However, other analysts argue that the cost of contacting every citizen and offering them the opt-out choice is too high. Arguing against a national database, these analysts point out that the process would require a very expensive and complex IT system, that is not currently available. Bramhall (2011) adds that most of the citizens do not stand for the idea of having a national database containing all their personal information, which can be accessed from anywhere. Personal and Professional Values Personally, although I support the idea that presumed consent is the best solution to meeting the demand for organ transplantations, I think that the “hard opt-out” option is not the best way to achieve this target. I do not think it is fair that clinicians make the decision to remove the organs of a deceased person without their consent or that of their family members. In my opinion, the “soft opt-out” system which according to Voo, Campbell, & De Castro (2009) is used in Singapore is the best way to ensure a win-win situation. This method respects the wishes of the deceased as well as those of the family, thus ensuring a healthy relationship between the later and clinicians. From a professional perspective, I think clinicians should not be forced to perform organ procurement procedures under the presumed consent system. The clinicians should be left to decide whether or not they are comfortable with the process. Liddy (2000) writes that in some countries like Belgium, physicians are not forced to procure organs under the presumed consent system, if they are uncomfortable with the system. Impacts of Presumed Consent on Patients and the Incorporation of Core Values When dealing with possible donors, it is important that the clinician assures them that they are being given the best care possible, until such a time when the care is no longer useful. This helps in reassuring the patient that the clinician is not going to give them sub-standard care in an effort to hurry-up their death and retrieve their organs for donation. Additionally, Bramhall (2011) writes that recipients of these organs want to know that their donors gave the organs by their own will and not out of coercion. One of the core values that should be incorporated in dealing with presumed consent is that clinicians should be allowed to hold talks with end-of-life patients and their families in order to discuss organ donation options. This enables clinicians to build relationships with the patient and their family, thus minimizing the chances of misunderstandings in case of organ transplantations. In case of informed consent, the donor should be made aware of the procedures to be performed on their bodies, so as not to violate the post-humus wishes of the donor (Taylor, 2006). The Importance of Presumed Consent in Nursing Modern developments in medicine have led to advances that have prolonged lifetimes for people with critical conditions. One of these developments is the organs transplantation procedure that relies on advanced surgical technology, better drugs, and more expertise among practitioners, in giving people with degenerating organs a new lease of life. Voo, Campbell, & De Castro (2009) write that patients with untreatable deteriorating diseases have been able to lead better and more fulfilling lives, as a result of organ transplantations. Rithalia et al. (2009) add that most of the time organ transplantations are more effective than any other forms of treatment for organ failure, and are more cost-effective, especially in comparison to dialysis for people with renal failure. Generally, organ transplants lead to higher rates of survival by recipients, and presumed consent leads to more needy people being able to access organs (Healy, 2006). The Most Appropriate Approach in Dealing with Presumed Consent In as much as informed consent seems to be the most ethical and legal method of procuring organs, statistics show that not many people sign up for donation of organs after death. For example, Canada’s case poses a different legal issue, considering that family members have to be consulted about organ procurement even if the deceased had given their consent. According to Ammann (2010), this procedure poses the threat of the family overruling the decision made by the deceased and refusing to ascent to the organ procurement process. Accordingly, the next solution is to use presumed consent to meet the demand for organs. Nonetheless, the manner in which this system is applied matters a lot. If the clinicians employ the soft opt-out approach, it will be easier to convince families to allow for the organs of their deceased to be donated and possibly save a life somewhere. If the deceased had not opted-out and the family refuses to give their consent for organ donation, then presumed consent should not be applied. Verheije (2008) states that a public opinion poll conducted in the UK shows that 64 per cent of all respondents are in favor of the soft system in solving the organ donation controversy. References Ammann, M. (2010). Would Presuming Consent to Organ Donation Gain us Anything But Trouble? The Health Law Review, 18 (2). Bramhall, S. (2011). Presumed Consent For Organ Donation: A Case Against. Annals of the Royal College of Surgeons of England. 94(4). 270-272. Healy K. (2006). Do Presumed Consent Laws Raise Organ Procurement Rates? De Paul Law Review, 55:1017-1043. Lawson, A. (2008). Presumed Consent For Organ Donation In The United Kingdom. Journal of the Intensive Care Society, 9 (2): 116-118. Liddy, M. (2000). The “New Body Snatchers”: Analyzing the Effect of Presumed Consent Organ Donation Laws on Privacy, Autonomy, and Liberty. Fordham Urban Law Journal, 28 (3). Price, D. (2000). Legal and Ethical Aspects of Organ Transplantation. Retrieved from: www.cup.cam.ac.uk. Rithalia, A., Mcdavid, C., Suekarran, S., Norman, G., Myers, L., & Sowden, A. (2009). A Systematic Review of Presumed Consent Systems for the Deceased Organ Donation. Health Technology Assessment, 13 (26). Taylor, J. (2006). Personal Autonomy, Post Humous Harm, and Presume D Consent Policies for Organ Procurement. Public Affairs Quarterly, 20(4), 381-399. Retrieved 16 June 2013, from www.jstor.com. Verheijde, J. (2008). Presumed Consent For End-Of-Life Donation: A Legislation Undermining Values in a Multicultural Society. British Medical Journal, 336(230). Voo, T., Campbell, A., & De Castro, L. (2009). The Ethics of Organ Transplantation: Shortages and Strategies. Annals of Academy of Medicine, 38 (4). Read More