Monday, May 01, 2006



I don't understand

Doctors are objecting to Jackie Blue's Human Tissue (Organ Donation) Amendment Bill. The bill would create an opt-in register specifying exactly what a person wants to donate, and what purpose it may be used for (or, alternatively, saying that they do not wish to be donors under any circumstances). It is fundamentally about personal autonomy and informed consent. And I thought that would be something doctors would be in favour of, rather than opposing.

The bill does not and can not force doctors to harvest organs where they do not want to (it is very careful to state "may" rather than "must" in the appropriate sections, and imposes no penalty for refusal; after all, medical professionals deserve autonomy too). What it does is move the locus of first choice from the deceased's relatives to the deceased - which is where it belongs. And I really don't understand why doctors would object institutionally to that, through their professional bodies.

11 comments:

Perhaps we should consider some sort of opt-out process. Make a law that, by default, your organs will be taken if needed and, if you don't want that, then the onus is on you to make sure the records show that.

Posted by Anonymous : 5/02/2006 10:04:00 AM

Because they would never perform a transplant against relatives wishes, making the bill pointless.

My impression is that what is required is for people to agree with the relatives that they will donate their organs, rather than just checking the box on a driving license.

Posted by Rich : 5/02/2006 10:07:00 AM

"The bill would create an opt-in register specifying exactly what a person wants to donate, and what purpose it may be used for (or, alternatively, saying that they do not wish to be donors under any circumstances)."

I believe the problem with this, as far as bio-ethics is concerned, is what if someone were to say "I will only give my organs to white people"

Sure, there are more organs in the system, but it risks creating a whole underclass of people for whom there are no organs available, and it might undermine the entire system.

Although, actually reading through some of that bill, I don't see a provision for that, so ignore that part.
Probably as someone else said, who wants to be in a fight with a family because their son or daughter requested their organs be donated and the family disagrees?

Posted by Anonymous : 5/02/2006 02:59:00 PM

I suspect that part of the problem is that you don't remove organs from really, _really_ dead people. Often it happens in people who are pretty mostly dead other than what life support can offer. So it's entangled up with other issues, such as deciding to allow your loved one to die.

These doctors are the people who use the system, if they have issues then I would suspect they have good reasons behind them.

Posted by Muerk : 5/02/2006 07:50:00 PM

Rich wrote:
My impression is that what is required is for people to agree with the relatives that they will donate their organs, rather than just checking the box on a driving license.

I reply:
And in the best of all possible worlds, that would be enough. But I've seen too many occasions where the relatives who never even visited in life, are suddenly on the scene at the hospital. And, goddamnit, it's funny how what the corpse wants conforms suspiciously to the crack-brained attitudes that estranged them in the first place.

Sorry if that sounds harsh, but I've seen gay friends die only to have their estranged families sweep in and take over - making sure the partner, and the people who were actually part of his life were cut dead. Fuck that.

Hamish wrote:
Perhaps we should consider some sort of opt-out process. Make a law that, by default, your organs will be taken if needed and, if you don't want that, then the onus is on you to make sure the records show that.

I reply:
And that's going to the other extreme and still takes the real choice away from the patient. As NRT has pointed out, the bill also gives people the option of saying they DON'T want to be organ donors under any circumstances. The central issue for me is where the choice lies - and it should be with me, not my partner (who is not only my next of kin but holds a durable power of attorney), not relations I have next to no contact with, and certainly not the medical establishment.

William wrote:
I believe the problem with this, as far as bio-ethics is concerned, is what if someone were to say "I will only give my organs to white people"

I reply:
Um, you tell people that transplant organs are apportioned on clinical criteria, not on the basis of eugenics - and if that is unacceptable to you, then becoming an organ donor is not the best option? Just a thought...

And more:
Probably as someone else said, who wants to be in a fight with a family because their son or daughter requested their organs be donated and the family disagrees?

I reply:
Again, "the family" can do whatever the fuck they want with their own bodies. Otherwise, the will of the patient should be paramount unless there are very good clinical or ethical reasons not to do so. Sorry if this sounds harsh, but I've a good friend who had a double masectomy and her husband (to put it mildly) had a tough time dealing. Should her doctors have refused to perform the surgery that saved her life for the sake of a quiet life, and to avoid discomforting a third party?

I've also sat down and drawn up a 'living will'. Now, I've discussed it with my partner, and I'm sure it would be hard for him to just let me die, but I expect my wishes to be respected. Now, I'm truly sorry if my family (most of who I have cordial but relations with) and friends have religious, ethical or emotional issues with my decision. But it's not theirs to make.

Posted by Craig Ranapia : 5/03/2006 09:01:00 AM

Really, this shouldn't be a big issue. Organ-donor status is simply a contract between an individual and a health service provider (private or, shudder, public).

The fact that family members can contest a legal will is simply unjust.

That said, if I were running an organ bank of my own, I'd have a simple rule: organs would only be available to those who had already signed up as a donor.

Posted by Duncan Bayne : 5/03/2006 12:51:00 PM

I am the co-author with Dr. Jackie Blue on the organ donor bill. It's taken me 4 years to get to this point.

As for organs only being available to those who sign up on the register, I agree. I wrote an article in the NZ Herald on this here is the link to it.

http://givelife.org.nz/home__organ_donor/latest_news_and_press_cuttings/andy_tookey_give_donors_first_priority.cfm

Also I have an online petition that I will be presenting to Parliament when I make my appearance soon. The petition is to uphold your right to autonomy.
If you wish to sign the petition the link to it is on our website www.givelife.org.nz

Posted by Anonymous : 5/06/2006 06:34:00 PM

that link didn't show right, will try again...

http://givelife.org.nz/home__
organ_donor/latest_news_
and_press_cuttings/andy_tookey
_give_donors_first_
priority.cfm

Posted by Anonymous : 5/06/2006 06:38:00 PM

> I'd have a simple rule: organs would only be available to those who had already signed up as a donor.

That would cause people to die for no good reason. (ie you have one critical organ and one person desperatly needing it - but he isnt a donor - so he dies)
How about "those who are signed up as donors get preferential treatment".

Posted by Genius : 5/06/2006 09:27:00 PM

That's what's in the article I wrote...

(see link above to read it)

Posted by Anonymous : 5/07/2006 10:34:00 AM

OK sounds reasonable - at least in as far as a waiting list forms and the organ can be considered reasonably similar in its usefulness to each paitient. So I support it.

Although I expect doctors might be a little uncomfortable applying the preference concept.

Posted by Genius : 5/07/2006 02:39:00 PM