‘Strip-mining’ the Dead

ELIMINATE suffering and expand the range of human choice. That sentence expresses the moral wisdom toward which our society is moving, and it is very minimal wisdom indeed. We can observe this minimalism at work especially well in the realm of bioethics, where we seem unable to find any guidance other than (1) relieve suffering and (2) promote self-determination. In accordance with such wisdom, we have forged ahead in the use of new technologies at the beginning of life and—with constantly increasing pressure for assisted suicide—at the end of it.

Less noticed—and perhaps not quite as significant—is the continuing pressure to increase the supply of organs for transplant. For the past quarter-century, transplantation technology has made rapid progress, though the “success rates” given for transplants may often conceal an enormous amount of suffering and frustration endured by those who accept a transplant as the price of possible survival. During this time, there has been continuing debate about what policies ought to govern the procurement of organs from the dead for transplant. Should we simply wait to see whether the dying person, or, after death, his family, decides to offer usable organs? Should we require, as some states now do, that medical caregivers request donation? Should we presume that organs for transplant may be salvaged from a corpse unless the deceased had explicitly rejected the possibility or the family rejects it later? Should we “buy” organs, using financial incentives to encourage people to sell what they had not thought or wanted to give? And, if we did use financial inducements, could one also sell organs such as kidneys even before death?

ELIMINATE suffering and expand the range of human choice. That sentence expresses the moral wisdom toward which our society is moving, and it is very minimal wisdom indeed. We can observe this minimalism at work especially well in the realm of bioethics, where we seem unable to find any guidance other than (1) relieve suffering and (2) promote self-determination. In accordance with such wisdom, we have forged ahead in the use of new technologies at the beginning of life and—with constantly increasing pressure for assisted suicide—at the end of it.

Less noticed—and perhaps not quite as significant—is the continuing pressure to increase the supply of organs for transplant. For the past quarter-century, transplantation technology has made rapid progress, though the “success rates” given for transplants may often conceal an enormous amount of suffering and frustration endured by those who accept a transplant as the price of possible survival. During this time, there has been continuing debate about what policies ought to govern the procurement of organs from the dead for transplant. Should we simply wait to see whether the dying person, or, after death, his family, decides to offer usable organs? Should we require, as some states now do, that medical caregivers request donation? Should we presume that organs for transplant may be salvaged from a corpse unless the deceased had explicitly rejected the possibility or the family rejects it later? Should we “buy” organs, using financial incentives to encourage people to sell what they had not thought or wanted to give? And, if we did use financial inducements, could one also sell organs such as kidneys even before death?