Deceased donor organ donation ought to be opt-out
Debate Rounds (3)
I will be Pro. Arguments from first round, unless Con deems further clarification of the issue necessary before starting. I will first state my position then my arguments.
Con is to argue that explicit consent should be required, on whatever grounds he/she wishes. I suppose it would be impossible to be Con if restricted to utilitarianism. But please try to choose arguments that lead to interesting debate.
The proposition is that organ donation from deceased person should not require explicit consent. Instead, those who do not wish their organs must provide explicit objection. The objections of next of kin should also be considered, just as today. More requirements on the authorities to inform the citizenry about these rules could reasonably be required for the system to be legitimate: everyone should be able to know the rules.
1: A dead body is not a person. The handling of it is not a question of its rights, but on the emotional comfort of the living related to respect for human decency/dignity. The dead body does not have any rights since death is by definition the end of personhood. Even if one would postulate an immortal soul, the soul loses its association with the body upon the moment of death. Thus, the proposal does not violate rights, and the possibility of opting out makes sure it does not harm anyones emotions or sense of dignity, whatever that may be defined as.
2: The benefits are simply to increase the supply of organs. This results in greater quantity and quality of life. As a utilitarian, this is obviously the main argument for me. (1) is there to show that rights-based moralities are not violated to achieve this good and aimed at nonutilitarians.
3: In at least some countries a broad majority state that they want their organs to be donated when asked in survey, but do not report their consent to national donator registries. In Sweden for example 80% say they want to donate, but only 20% sign up. Thus it is not really justified to regard "no" as the default answer. More persons would get thier will respected by making "yes" the default answer. Not that I myself consider consent to be important in the case of dead bodies, but to make the system broadly accepted it is necessary to consider the issue of consent.
Limitations on the debate:
I think the exact rules of which objections count is outside the scope of the debate. The deceased and his/her next of kin are allowed to object, we probably have no need for more clarification of that. One might argue to ignore certain objections but that would be another debate. Here we assume the right to objection.
We should only consider deceased donors, defined as brain death.
We also assume that organ trading stays illegal, and that artificial organs are not yet available despite seeming to become available in the foreseeable future. The current organ shortage is thus assumed.
I have chosen 3 rounds since I think this will be enough with arguments presented in all three rounds.
I will first attack the points which my opponent has laid out and then bring a few of my own.
The 'dead body is not a person' argument revolved around the theory that a dead body has no legal rights whatsoever. Despite the fact that a dead body has the power of a will to declare who gets what of their possessions and maybe even entitlement to run their business. From a legal standpoint a dead body actually has some power and, as blunt as this may sound, most people never get quite as much respect or attention as they do the moment after the news of their death has been revealed to those who knew them. There is something extremely significant about death and it is inherent form the times when we were fighting to survive in a world where the other species outnumbered us and our primate rivals were competing with much more muscle and stamina than we had alone. It is the unique ability of mammals (not just humans but other mammals also) to show extreme grievance and regret when one of their species, within a given community, passes away. To hold this being as sacred then acts as a drive to encourage each member of that community to fight harder and together when defending one another so as to avoid that unpleasant feeling of remorse on one's death (regardless of one's involvement of lack thereof in the death itself). A dead body is actually very much a person to those alive who knew of them and to ignore this beautiful aspect to human society would be to neglect one of the most essential tools of survival we have over other species; empathy.
The 'benefits' argument indicates that if there are more organs, more people will be able to survive when needing a transplant. Now, I do not mean to be heartless or rude but instead of seeing it as a benefit to a society to enable more people to overcome organ damage by transplant, shouldn't we be seeing it as a blindfold to the real problem? Binge drinkers and heavy smokers have got their problems by self-inflicted mistakes, often having complete knowledge of what they were doing to their bodies the entire time. If someone has been made aware that they have a cholesterol problem and then goes out and ignores it anyway, hoping the medication will compensate enough for their overdose on low-density lipoproteins and then it turns out they have a heart that has had all its arteries clogged up with a disgusting amount of cholesterol then why is it the duty of someone who merely wants to give their family and friends the emotional pleasure of seeing their body fully intact one last time before they either turn to ashes or slowly erode to skeletal form deep underground (or whatever death rituals apply to that specific community). You see, that dead person is merely dead because of an accident, usually, and since they have to be healthy (by default) in order to give their organs up for transplantation it's not likely that they died because of medical reasons. Why, then, should their family and friends be forced to see and empty case of what was once an intact body of their late father just so a binge drinker can get up off their hospital bed and drink some whisky to celebrate? The real problem to be dealt with is not having so many bodies on hospital beds in the first place, prevention is better than cure.
My opponent's third argument was just a statement that many people are too lazy to sign a consent form, this is irrelevant to the debate because I can easily argue that those people would still be too lazy to say they didn't want to in the reverse situation (we can't always assume that 80% of a nation will want to donate their organs upon death).
If my opponent wants to declare a limitation to debate that the next of kin are allowed to object then why not allow the very person themselves, who is obviously closer to themselves than their next of kin are, to have their own right over their body?
Why is it that one should feel it is their duty to donate an organ and have to sign off a document just to say "hey there, I own my body and don't want your filthy hands on my organs when I die because my next of kin would reject it anyway." I mean, what if the person had no family left but had friends who wanted to see their beautiful body in a coffin to make peace with their departure from this world. A friend doesn't count as a next of kin and so couldn't object it, according to you.
There is another problem with the system of automatic organ donation consent; the ability to give consent for organ donation requires one to be declared healthy enough to do so in the first place. Therefore the very fact that a person is licensed as an organ donor automatically makes it an efficient process for doctors to communicate across a nation that an organ is ready for donation. In a system where anyone above the age of eighteen who hadn't bother to sign a form at some point in their life to say they didn't want their organs donated was assumed to be a donor, it would require every organ to then have to be tested as healthy enough to be donated, this would then have wasted valuable organ life time outside of a body and if it's deemed unhealthy they it was probably an extreme waste of time and effort for the medics who did it. Thus, the con's version of consent is superior to the pro's for practical purposes.
The final issue to address is that if a person just turned eighteen and die don their birthday they wouldn't have had the time to sign off their anti-donation consent form, since eighteen is the age of consent in most countries. Thus, if their next of kin had never spent the time to discuss this and felt sorry for the heavy smoker needing a heart (or a lung) transplant and gave the organs away then the religious group of friends that that eighteen year old had (assuming they were a religion that the next of kin were not) would no be able to legally object to this and have their values and ethical code violated due to the next of kin having the final word. There is also the problem that in the system of assumed consent there is no way, whatsoever for a person to express the will to donate organs so as to override the will of their next of kin.
In conclusion, I find three main issues with the system of automatic donation consent. the first problem is that not everyone has a next of kin available to refuse it in case of them dying prior to signing the anti-donation form. The second is that since, in the system of reversed consent currently in place, to qualify as an organ donor already includes the declaration of being healthy enough to do so, it's far more efficient than a system where most dead body's organs end up being tested and rejected anyway since not everyone being considered a valid organ donor by consent is a valid organ donor by health standards. The final issue is that not everyone's religious views will match those of their next of kin and if they just reached the age where one qualifies as a consenting organ donor (commonly eighteen) then their next of kin might allow it despite their religious friends' denial of it. Additionally it's fundamentally impossible for a person, in Pro's system of consent, to express the will to donate their organs so as to override the wishes of their next of kin (which is currently possible in some nations where Con's system of consent is in place).
First of all, I think my post might not have been clear enough on the deceased vs next-of-kin consent. I did not say that the deceased person will should be ignored. It is perfectly reasonable to let the deceased persons will override that of the next of kin. The reason to include next of kin in the rigt to objection is that they might with great probability be aware of the preferences of the deceased if he/she did not report nonconsent. In the case where the deceased had no preference whatsoever then it would be good for the emotional wellbeing of the next of kin to be allowed to decide in place of the deceased. Also, as for overriding the next of kin in the case the deceased wants to donate, assumed consent does not necessarily mean that explicit consent cannot be registered for the purpose of overriding the wishes of the next of kin. Actually, not only those who have a disagreement in the family have reason to do this, anyone can have reason to make sure that his/her will is made explicit to spare the family any uncertainty in the matter.
"The 'dead body is not a person' argument revolved around the theory that a dead body has no legal rights whatsoever. [...]"
It might have legal rights, but not moral rights. Moral rights are either approximations to utilitarianism, or derived from the nature of the moral agent. But the corpse is not a moral agent. I think the stronger case for respecting the dead is actually given by utilitarianism, namely that we do it for the sake of the well being of the living.
Anyhow, the legal rights must be motivated by the well-being or rights of the living. The living can most likely gain or lose wellbeing simply by knowing that their death will be handled in a disrespectful way. Thus we prohibit disrespectful handling of bodies even when there are no relatives or close friends to take offense. The case for giving legal rights to a corpse is however weaker than that for giving rights to a person, so any rights given to a corpse must be significantly less extensive.
I cannot agree that the dignity of a corpse implies equally strong rights as the living have. As i have said, the corpse is neither a moral agent nor capable of pleasure, pain, preference satisfaction or anything similar. The emotions of the living grant some form of right to dignity to the deceased, that is in human and mammalian nature. But this is not the same case as for the moral worth of actual moral agents, it is just derived from the moral agents having a connection to the corpse (to some extent including the previously existing person). The moral status of a corpse must therefore be weaker than that of a living person.
"The 'benefits' argument indicates that if there are more organs, more people will be able to survive when needing a transplant. Now, I do not mean to be heartless or rude but instead of seeing it as a benefit to a society to enable more people to overcome organ damage by transplant, shouldn't we be seeing it as a blindfold to the real problem? [...]"
Now I do not know the proportion of transplants directed at self-inflicted behaviour, but I doubt it is so great that organ shortage would be eliminated by excluding them. There is a multitude of inherited or communicable deceases causing organ failure as well as more or less random diseases such as cancer. It varies greatly with the type of cancer what possibiliy there is to avoid it. Also physical trauma from accidents can lead to a lot of different conditions that might damage internal organs. But more importantly it is not possible to draw a line between self-inflicted and externally inflicted conditions. Even if it were, the fact that it was self-inflicted does not in itself decrease the moral value of prolonged or improved life, and that value must obviously be greater than the moral value of the dignity of a corpse. The worst violations of corpse dignity are avoided by providing an option to not donate. Giving a liver to an alcoholic has the problem that its effectiveness is decreased if the behaviour continues after treatment, but that is quite a different issue. It is relevant in prioritizing of course.
"Why, then, should their family and friends be forced to see and empty case of what was once an intact body of their late father just so a binge drinker can get up off their hospital bed and drink some whisky to celebrate? The real problem to be dealt with is not having so many bodies on hospital beds in the first place, prevention is better than cure."
This is not really relevant since the possibility exists to opt-out if one is opposed to helping others even when there is none at all cost to oneself.
"My opponent's third argument was just a statement that many people are too lazy to sign a consent form, this is irrelevant to the debate because I can easily argue that those people would still be too lazy to say they didn't want to in the reverse situation (we can't always assume that 80% of a nation will want to donate their organs upon death)."
Actually, this IS probably the most relevant argument from a rights perspective. If the majority wants to donate, then the natural assumption is to assume consent. I see no compelling reason to consider the assumption of objection more "natural" than the assumption of consent. To assume nonconsent even when the majority do not oppose the extraction of their organs could only be justified by arguing that nonconsent in some sense is more "natural". I actually think there is reason to regard consent as the natural state in this issue, since the most natural thing is not to care very much what happens after death, except for possibly gross violations of dignity. It is also more natural to help others than not to help if there is no cost to oneself of doing so.
"Why is it that one should feel it is their duty to donate an organ and have to sign off a document just to say "hey there, I own my body and don't want your filthy hands on my organs when I die because my next of kin would reject it anyway." I mean, what if the person had no family left but had friends who wanted to see their beautiful body in a coffin to make peace with their departure from this world. A friend doesn't count as a next of kin and so couldn't object it, according to you."
It is quite hard to know who qualifies as friend, unless the dceased left some explicit instructions regarding that. But then it would probably be clear what the deceased wanted and no other opinions needed.
"The final issue to address is that if a person just turned eighteen and die don their birthday"
We could let kids fill out the forms in school if this is such an important issue, or send the form by mail to everyone before the age of consent. Including both YES and NO as explicit options. I can't however agree that incidental violations of dignity are enough to justify a system that causes grave harm to more persons. The benefit of the system would be very much greater than the "harm" of occasional violations of the will of donors. This is an extremely unlikely situation. People are wrongfully killed by law enforcement, and would oasionaly be even with perfect regulation. But that does not lead us to totally reject law enforcement, only to minimize the risks.
"to qualify as an organ donor already includes the declaration of being healthy enough to do so, it's far more efficient than a system where most dead body's organs end up being tested and rejected anyway since not everyone being considered a valid organ donor by consent is a valid organ donor by health standards. "
The cost of the testing is negligible compared to the medical benefits. This applies to the current system also, everyone who signs up is not tested repeatedly over their lifespan. The price of quality adjusted lifeyears is generally quite high, WHO suggests 3xGDP/c to be the limit.
 Murray CJ, Evans DB, Acharya A, Baltussen RM. Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ 2000; 9:235–51.
Well, I have clearly lost the spelling and grammar vote for this debate (I apologise if it caused any hassle in understanding what I meant) I even spell checked it but, alas, there were mistakes nonetheless.
Now I shall reinforce my argument by defending against the attacks my opponent raised in round two.
Defense Against Rebuttal One: The Introduction
My opponent begins by telling me that he will of the deceased person will override that of the next of kin. Firstly, this contradicts his entire round one argument that a dead body shouldn't be seen as capable of having will or being, in any way, 'a person'. Secondly, this is fundamentally impossible because there is no way in a system of assumed consent to express consent so as to override the wishes of the next of kin. My opponent assumes that the next of kin would know the wishes of the deceased person but my point is that some family members will still object to it regardless of the deceased person's wishes (but if my opponent holds the view that a deceased person shouldn't be considered worthy of having will then this would be fine according to them... Except that contradicts his entire rebuttal that the deceased should have the power to override the next of kin's wishes).
Essentially, the first problem with the rebuttal my opponent put forth was that the deceased person, if wishing to not have his/her organs removed, would have the power to override the wishes of the next of kin. This contradicts my opponent's philosophy of a dead person not being worthy of such privilege as declaring rights over his/her organs. The second is that in my opponent's proposed system, it is fundamentally impossible for a dead person to express an overriding will to donate organs in a way that would override the objection of the next of kin. Thus, in my opponent's system the will of the dead person isn't appreciated anyway thus destroying his entire rebuttal altogether.
Defense Against Rebuttal Two: Legal Right Vs. Moral Value
My opponent explains that while he realises that, by the fact a will exists for possession sharing, a dead body has some legal rights, he thinks, regardless of this, that the person has no moral value. The reasoning behind this is that since the dead body has no capacity for emotion, they are therefore not a moral agent.
The first, rather ironic, defense against this rebuttal is that most Gods of any religion are seen as completely non-physical entities of raw power. How can an entity with no hormones to initiate emotions, no physical stimuli to stimulate the initiation of any emotion in the first place then be considered to feel emotion? (http://www.mkprojects.com...)
God(s) is/are the moral guide(s) of almost every religion, par Buddhism, known to mankind today. (https://en.wikipedia.org...) Thus, if the moral guide of the majority of the world is an entity that has no hormones or physical stimuli for emotion than wouldn't it be foolish for my opponent to take the Nihilistic view of morality so as to attach it to subjective emotion? (http://atheistempire.com...)
The second rebuttal is that my opponent has not proved morality to be subjective as opposed to objective and thus needs to assert Moral Nihilism (which, unlike Utilitarianism, appreciates that morality is only possible from a subjective standpoint). My opponent claims to be Utilitarian in their view but Utilitarianism is an objective moral philosophy and thus attaches no subjectivity, or emotion, to one's validity in moral agency.
Defense Against Rebuttal Three: I'm Not Sure What This Was About
My opponent seemed to be rambling about how a self-inflicted individual, according to Utilitarianism is still more valuable than a dead person regardless of their self-inflicted harm. Not only is this purely base don my opponent's system of morality alone but it is also irrelevant to the point which he was rebutting.
I was explaining that the real issue should be prevention of organ damage as opposed to assuming consent of people to give up their organs just for the sake of saving individuals who are very often self-inflicting this harm (I also could not find any statistics and am in a similar situation to my opponent in ignorance of this fact but it is very likely to be above 50% since the cause for transplant not usually cancer).
Defense Against Rebuttal Four: Irrelevance
My point was an entertaining display of the prevention versus cure argument. It wasn't irrelevant to the debate and should be considered as a valid part of line that argumentation.
Defense Against Rebuttal Five: Ignorance of Legal Age of Consent
A person under eighteen can't deny having their organs taken because no one under the age of eighteen will ever be demanded to do so (this isn't 'My Sister's Keeper'). Also, no one under the legal age of consent can go, via school, to express their lack of consent past the age of consent because they are not yet at the age of consent to begin with. That is like asking a child under eighteen to sign a form to allow a pedophile to have sex with them, it entirely ignores what the age of consent is in the first place.
In summary, my birthday dilemma is actually extremely valid in a system of presumed consent.
Defense Against Rebuttal Six: Money, Money, Money
The cost of time and effort for hospital workers to waste on testing unhealthy organs for transplantation is HUGE! Let's face it; most people too lazy to sign a form are too lazy to keep healthy. Rarely is a person too lazy to go for a walk a day and to stop stuffing hot dogs and burgers down their throat going to suddenly find the willpower to sign a non-consent form so as to save hospital testing time. the system of informed consent is far superior to the system of presumed consent because every single person who has informed of consent has also been tested and declared healthy enough to donate in the first place. Therefore, the 80% of people who wanted to consent couldn't have consented anyway and frankly the lazy 60% were probably unhealthy considering that laziness as well. Just because it costs less money doesn't mean that the time and effort wasted are negligible at all, in fact they are so huge that it probably would stop people being saved in the end anyway, cancelling out what the system was meant to achieve in the first place.
On my rebuttal one:
Actually, I have not specified that the corpse has a moral right/value. I have said in round one that the corpse lacks moral value. It can still gain some legal protection due to indirect effects of its disposal on the living. Including the fact that the living might feel some discomfort at what happens after death. This can justify some legal protection of corpses even in the absense of moral value, but since there is no inherent moral value associated with the corpse the protection must be weaker than which a person receives.
Regarding a willing donor overriding the will of his next of kin, there is nothing that actually makes it impossible to keep a registry of explicit consent even if consent is assumed. It would be perfect for handling the situation Con describes.
On my rebuttal two:
The existence of God(s) is a statement for which the burden of proof rests on those who state it. And usually God is defined in ways that are both contradictory and unprovable. The same could be said of objective morality. There is no moral law that can be discovered floating around in space or discovered by colliding particles in accelerators or any other experimental methods. We have only preferences that may conflict and thus we need a consistent system of conflict resolution. We can put some formal demands on the system but we cannot prove what moral values to use. Utilitarianism depends on choosing a common goal in the form of some utility function composed of actual consequences, but it need not be objectively true. It legitimacy is based on using moral values that are as universal as possible, then taking every actors interests into equal consideration. Morality arises out of practical needs. No otherworldly moral authority can be proven to exist, and neither there is any need for it to exist for us to specify moral codes, thus parsimony suggests we reject it.
On my rebuttal three:
Prevention is not mutually exusive with cure. I'm also not sure why the assertion that the cause of illness is relevant to the moral worth of its treatment would be more natural than my assertion. Seems like it is just there to punish those who made bad choices.
On my rebuttal four:
Indeed it is mostly the same, you are right. But to equate assumed consent with duty is simply not correct.
On my rebuttal five:
Age of consent is a legal construction we can modify at will to eliminate the issue you raise, if it would be considered a grave problem. We could create a period efore the age of consent is reached where consent applying after the 18th birthday is to be filed for certain important issues.
Anyway, my statistical argument still applies. We do not reject law enforcement because it might kill innocents, at least not if proper precautions have been taken to avoid it. This is because of the utility of law enforcement, or because it is needed to uphold rights. But in upholding rights, it will sometimes infringe rights. Of course transplantation is not required to uphold negative rights, that is a difference. But rejecting a system drastically increasing the availability of organs for a very uncommon violation of the rights of a corpse is to put an unreasonably high pricetag on rights of corpses as compared to utility or positive rights to life.
On my rebuttal six:
Testing is not required for filing the consent form in all countries, it surprises me that it is so in any country. Testing would have to be done repeadly over the donors life in order for such a system to work and seems a lot more expensive than only testing potential donors while in intensive treatment who seem to match with some recipient in the national or transnational database used. Being a suitable donor is not all that unusual, perfect health is not required, just absence of disease and a proper functioning of the organ in question.
Sorry to say but I think your spelling and grammar in round three was just as bad as mine in round one so I think we should be tied on that vote as of now.
I shall make a list of problems I found in the reasoning of your overall argument and then highlight why I feel you insufficiently defended them.
In the system of presumed consent it's impossible for the person to express an overriding consent to get their organs donate so as to cancel out the objections of their next of kin whereas this is possible in the system of informed consent (Con's system).
My opponent offered an escape route of 'explicit consent' forms but explicit consent forms already exist in informed consent systems anyway.
It is hypocritical to base the system on the basis that a dead person has no moral value if you then allow them to deny their organ transplants so as to override the next of kin. If explicit consent forms and denial are allowed to override the wishes of the next of kin then it goes against the entire basis of Utilitarianism and thus contradicts my opponent's reasoning for presumed consent being an acceptable system in the first place.
I did not find any sufficient contradiction to this issue and he never denied being a hypocrite.
My opponent was never able to deny that God shows all the characteristics of a dead person including having no emotions (for which physical hormones are required). Therefore, the moral guide of many people is actually a similar entity to a dead corpse and thus it is going against many belief system to regard such an entity, that feels no emotion and can not physically do anything, as incapable of being a moral agent.
The argument about the burden of proof on God had nothing to do with the fact that God, whether he actually exists or not, is a moral guide of many people in a nation where presumed consent would be implemented.
The argument that it saves people doesn't address the fact that most people who are in such a situation have self-inflicted it and will just go out and get it again.
My opponent want to completely tear down the entire concept of an age of consent and never justified doing so. My 18 year-old birthday dilemma still stands.
Testing is required to become an organ donor in almost every nation that has it, including the UK. Testing on top of requiring consent makes informed consent far more efficient ant ensuring the person who has informed consent is already certified to be healthy for transplant (leaving the only testing necessary to be blood types, etc et era) (http://www.nhs.uk...)
In conclusion, Pro had many flaws in the case proposed for a system of presumed consent to take lace and thus I believe that a system of informed consent reigns superior to the proposed system of presumed consent.
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