Pros and Cons - Debbie Newman, Ben Woolgar 2014

Organ donation: priority for healthy lifestyle
Section H. Health, science and technology

Debates about organ donation fall into two categories: those about how to increase the overall size of the donor pool, to reduce scarcity of organs; and those about how to allocate scarce organs. While the former are more common, the latter are also vitally important. Given that organ scarcity is not going away any time soon, we also need to think about the questions of principle and policy about how we give them out. Most states adopt a broadly similar system of allocating organs based on need, without regard to other factors, which means that patients typically have to wait until they are very ill for transplant organs. The policy proposed here is already often enforced in a minimal form; for instance, by denying liver transplants to alcoholics who have failed to stop drinking. The policy is not mutually exclusive of other systems of allocation, such as the sale of organs or prioritising those who are registered donors themselves, but gives substantially greater weight to people’s prior choices. There is also a related debate about prioritising a healthy lifestyle in other medical treatment such as changing the order on waiting lists for surgery in favour of those who follow a healthy lifestyle, or (in national health services) denying costly treatment to smokers or the obese.

Pros

[1] Given that organs are scarce, we should make them do as much good as possible. Those who have lived healthy lifestyles are more likely to recover from their illnesses, and more likely to live longer after their transplant; for instance, a smoker who requires a kidney transplant is more likely to die from other illnesses than a nonsmoker. This system of allocation thus maximises the number of healthy years of life that it is possible to create by allocating organs, and is thus the best we can do in the bad situation of organ scarcity.

[2] It is a fundamental principle of a liberal society that people are held responsible for their choices, and judged accordingly. In this situation, we are in effect faced with a straight choice as to whose life we should save; the person who has led the healthy lifestyle, or the person who has not. As the latter will often be to blame for their illnesses (for instance, by drinking to excess and so damaging their livers), it is more appropriate to save the former, because their illnesses are mere chance, and not self-induced.

[3] This policy does not have a differential impact on the poor. That is to mischaracterise how poor people actually live. It is simply not that difficult to live a healthy lifestyle; it requires moderation in alcohol consumption, avoiding illegal substances, and sensible calorie intake. None of these things require enormous incomes; indeed, it is important to send the message that poor people are equally expected to live healthily and sensibly, and should not be stigmatised as unable to do so.

[4] This policy acts as an incentive for people to live more healthily. While it is obviously not plausible that teenagers will radically change their behaviour, many people who persistently engage in unhealthy practices, like drinking to excess or smoking, are aware that they will probably make themselves ill by doing so, but persist in this anyway. It is important for the government to send a signal that this type of behaviour is unacceptable; individuals must be encouraged to clean up their lives and behave in a way that is conducive to public health generally.

[5] This policy also encourages the donation of organs. It is important to signify that governments take organ donation seriously, and value it; in that way, being an organ donor becomes a ’badge of honour’, which makes people more likely to want to do it. At the moment, the fact that many organs are ’wasted’ on those who do not take adequate precautions with their lives and lifestyles sends a message that organs are not important. This policy creates a link between the individual virtues of those who are donating with those of the recipients, establishing both as social role models.

Cons

[1] It is true that organs should do as much good as possible, but this policy does not achieve that. The existing system of allocation by need, however, does exactly that; when patients most need organs, they are available. Denying those who most need the organs is obviously counterproductive, and will prevent doctors from saving many lives. In particular, it is just not correct to claim that people who have led unhealthy lifestyles are less likely to recover; in fact, they may have a very high chance of recovery, which this policy ignores.

[2] We do hold people responsible for their choices, but we also acknowledge that sometimes it is important to protect people from them. We do not, in general, deny medical care to anyone who has caused their own illness; rather, the state recognises the importance of providing a safety net against people’s irrational or short-term choices. A death sentence does not give someone a chance to learn from their choices, which is also a very important part of living in a free society.

[3] The main consequences of this policy fall overwhelmingly on the poor. Obesity, alcoholism and drugs are all, for various tragic social reasons, problems which occur predominantly in poor areas. For instance, ready meals tend to be cheaper than fresh food, and so eating healthily is much harder on a lower income. This policy thus disproportionately punishes those who, through no fault of their own, have less money, which also sends the message that the state considers the poor less worthy of life.

[4] It is just unrealistic to suppose that anyone will in fact live more healthily because of this policy, because no one expects that they will need an organ transplant; after all, if they did, getting so ill would presumably be a sufficient deterrent, without much attention to the added worry of an organ transplant. Moreover, many of the lifestyle choices that are under discussion (drinking, smoking, drug taking, etc.) are addictive; those who engage in them do not rationally calculate costs and benefits, especially about the distant future.

[5] This policy will not increase the overall number of organs donated; if anything, it will reduce it. That is because it is harder to understand why people who have lived healthily for their entire lives would need organ transplants, so the PR effect of this policy is actually to reduce the perceived demand for organs, thus discouraging donation. Moreover, this policy seems like an acceptance that there will never be enough organs; that undermines the strongest arguments for new policies on donation (such as opt-out systems).

Possible motions

This House would prioritise those who have lived healthy lives when allocating organs for transplants.

This House would deny liver transplants to alcoholics.

This House believes that if the state is going to take care of you, you should have taken care of yourself.

Related topics

Organs, legal sale of