This is a disturbing story in the Los Angeles Times: A doctor is under investigation for overdosing an organ donor with pain medication to hasten his death in order to procure organs. If so, it is a terrible breach of organ donation ethics and a profound act of wrongdoing.

We should not prejudge the case, of course, although the doctor’s lawyer whining that his client wasn’t the only one who did things wrong does not give great grounds for confidence. But let us instead look at the bigger picture.

There are many proposals out there to increase the number of transplantable organs. One is presumed consent. The idea is that society will presume that everyone wants to be an organ donor unless the person explicitly opts out in writing. In other words, rather than filling out an organ donation card, you would be a donor unless you filled out a form stating that you do not wish to be a donor.

Presumed consent might work in a medical milieu unequivocally devoted to the sanctity/equality of human life. But we don’t have that system. Health care, under the influence of the bioethics movement, is now sometimes practiced under the “quality of life” ethic, in which some patients are presumed to have greater value than others.

This being so, presumed consent would not succeed because patients and their families would reasonably worry that what the doctor in the Times story is suspected of doing would become standard procedure. At the very least, presumed consent could, over time, impact the way that very ill or injured patients–particularly those with head injuries–would be cared in a system in which medical personnel perceived that their patients are prospective organ donors.

We should all want there to be more organ donations, of course. But the only ethical way to get from here to there, in my view, is to increase medicine’s devotion to the sanctity/equality of life of all patients. Only then will more people have confidence that their organs will never be perceived as having greater value than their lives.

Post Script: As I published this post, this story was sent to me about a hospital scuffle over the removal of life support from a patient in Singapore, where presumed consent is the law.