Biomedical technology is one of the fastest growing areas of research in modern society. Whether it is reproductive technologies, cloning, genetic engineering or any other topic, people generally approach these with an attitude of both awe and hesitation. Most of us recognize the seemingly limitless potential of new technologies when it comes to curing diseases, elongating lifespans or increasing quality of life. At the same time, we also recognize that these new technologies bring difficult (and seemingly unanswerable) ethical questions. It seems that the reason many people find these questions so hard to answer is that they don’t have a well-established ethical framework from which to answer them. Once we establish an ethical framework, we can explore the answers to the difficult questions. In this paper, I am going to take a virtue ethics perspective on the topic of post-mortem organ donation. I don’t plan on defending virtue ethics as a theory, but I will clarify some of the important issues as they relate to the donation of organs after death.
A brief look at the medical statistics reveals a significant problem; there is ahuge disparity between those who are waiting for organs and the number of organs available. “According to the United Network for Organ Sharing (UNOS) 83,472 people were waiting for an organ transplant in the United States as of January 2004. From January to October of 2003, 19,101 transplants were performed” (Glannon, 2005). As of today (December 3, 2013), there are 120,845 people waiting for organs in the United States (www.unos.org). The number has increased by approximately 37,000 people in only 9 years, and doesn’t show any signs of decreasing. It is obvious that the human body is a valuable resource, and until medical technology researchers develop fully functional artificial organs, the human body is the primary source for the ‘spare parts’ used in organ transplants. It is also clear that “… we are being prodigally wasteful in our funerary practices and stupidly selfish in our use of vital organs while we live and even more so when we die”. (Fletcher, 1979) So what should we do? Should we donate our organs after we die? When approached from a virtue ethics perspective, we may have a moral obligation to donate our organs after our death. Donating our organs may be how we could continue behaving virtuously even after our life is over.
The arguments presented here assume a lot about the philosophy and science behind adequately defining death. If death is not properly defined or understood, that may prevent these conclusions from being as obvious as presented. The current understanding of death as defined by brain death is not without its difficulties, but it is a reasonable way to determine actual death without requiring the heart to stop. In many cases, the patient is in a ‘vegetative state’ without brain function. The body is kept alive with machines while the organs are removed. In slightly more rare cases, a patient voluntarily undergoes anesthesia and the organs are removed and the patient is pronounced dead after the procedure. This is obviously a form of physician-assisted suicide and the ethics of that are far outside of the scope of this paper. However, the arguments presented in this paper are not affected in any significant way by either situation. They may come with more baggage depending on one’s view of physician-assisted suicide, but the logical flow of thought remains largely unaffected.
The behaviors of the physicians are also assumed to be noble and virtuous. Under no circumstances do I advocate for physicians to treat patients as merely a bag of useful organs. Physicians ought to perform their duties in accordance with ethical standards. In the event that someone was to pass away or volunteer to undergo organ removal surgery, my arguments would apply.
Lastly, these arguments did not consider prior commitments to religious or philosophical positions that would preclude someone from having their dead body “mutilated” or “disfigured”. Individual religious or philosophical hesitations should always be considered as a way to maintain personal autonomy.
In many states, people have the option to sign up for organ donationwhen they receive their license. In the state of New York, if you check the organ donation box (or complete the organ donor form), you are “giving legal consent to the donation of [your] organs, tissues and eyes in the event of [your] death” which is maintained by the State Department of Health (NYS Organ Donation Form). In essence, you are promising New York State that they can have your organs when you die. As Thomas Scanlon points out, a promise conveys “complex conditions of mutual knowledge and intent… it also conveys specific terms and conditions”. The promise given to the state shows that we understand the implications of signing up to be an organ donor. Scanlon explores the idea of promises and whether or not they bind us to the thing that we promised, but because the person is dead when the promise is going to be fulfilled, it is impossible to recant your promise to donate your organs. For this reason, we have to make a choice before we die; abstaining from making a choice is making the choice to not donate. This is an important aspect of organ donation; we must choose what to do with our own organs so that the decision does not fall on our grieving relatives. Often times, physicians are seen as heartless or inconsiderate when asking about obtaining organs from recently deceased family members. Many of them are trying to balance emotional care for the family and the reality of rapid organ deterioration, and if they do not procure the organs quickly, they will be unusable. But no family wants to think about having their loved one’s organs removed, especially not so soon after death. For this reason, it is important that we decide for ourselves, without feeling pressured by doctors or family to decide. As Scanlon points out, “the binding force [of a promise]… depends on the conditions under which the promise is made”. When considering organ donation, we should avoid making the decision when pressured in one way or another. But why should we sign up to be an organ donor anyway?
Applying Virtue Ethics to post-mortem organ donation
Moral theories are ways to approach ethical issues in a systematic and consistent manner. In essence, a moral theory will generally give us the framework by which we can determine the right action. Virtue ethics is the moral framework that puts great emphasis on the individual’s character. A virtuous person will behave rightly when presented with a situation that requires ethical deliberation. And for that reason, it is somewhat counter-intuitive to apply a character-based ethical theory to a situation where the person in question is dead. A virtue ethicist approaches a topic like this by analyzing the reasons a virtuous person would behave in a certain way, given a certain situation. As Julia Annas explains, we want a theory of right action that tells us what to do, but not in a way that is just giving us rules to obey. We want a moral theory that “reveals something about [us] such that [we] can be praised or blamed” for our decisions. A virtue ethics approach “does not literally tell [us] what to do”, but “it still gives the criteria for coming to the right decision”. (Annas 2004) “Learning to be moral is like acquiring a practical skill” and is “a useful model for the intellectual structure of a virtue in several ways”, according to Annas. One of the prerequisites for behaving virtuously in a given context is a “proper understanding of the relevant field”. In this case, the relevant field is post-mortem organ donation and the complexities inherent within. Gaining a proper understanding requires that a person is reflective regarding the important issues, and this entails that we are “taking ourselves seriously” and “getting it right”, as Harry Frankfurt explains in his papers.
The importance of practical reason in ethical decision-making
Virtue ethics, according to Annas, “picks out a cluster of theories”, so that no single option is driving the behavior of a virtuous person alone. She explains, “becoming more fully virtuous requires each of us to think for ourselves, hard and critically, about the moral concepts… that we have picked up from our surroundings.” Due to the fact that becoming a moral person is similar to acquiring a specific skill, we should treat it as such. In order to be proficient in any skill, we are to analyze the situation critically, using our “practical reason”. Frankfurt emphasizes the role of practical reason, coupled with love, in making ethical decisions. Practical reason is reflective and is grounded in what we care about. If we care about something, then practical reason will inform our decision making process
regarding what actions we ought to take in response. This approach fits well with the virtue ethics approach to moral reasoning; it takes into account our desires, but not without analyzing our decisions properly. According to Frankfurt, it is possible that “we can fail what we love, through ignorance or ineptitude” and points out that “these problems have to do with competence and character”. We should work on improving our understanding of the issues and improving our character so that we can act rightly upon what we care about. ‘Taking ourselves seriously’ is the way to improve our character, with the ultimate goal of ‘getting it right’.
What would a virtuous person do with his organs?
Following Frankfurt’s line of reasoning, the ground of our ethical decision-making is our desires: what we love. If we love a certain thing, we should use our practical reason in order to gain an understanding of the situation. Critically analyzing the situation will entail that we internalize certain standards, ultimately shaping our character. When talking about the issue of organ donation, what is it that we care about? After we’re dead, it doesn’t seem reasonable to think that we will care about our organs; we’re dead. We won’t be using our organs. However, we do care about the well being of other people. We do not like when other people are suffering, so if we are able, we should do something to alleviate the suffering of others. Organ donation certainly alleviates the suffering of others by providing them with a functional organ that they did not have before it was donated. Therefore, any thoughtful person should donate their organs to suffering people if they are able. This does not only entail after death; this may also include organ/tissue/blood donation before death. If someone is able to donate something in order to alleviate the suffering of others, I see no reason why that person should refrain from donating.
If a person will not be using X, and X will alleviate the suffering of others, that person should certainly donate X. We do this kind of thing all the time; people donate their time to homeless shelters, donate money to charities and donate blood to hospitals. Consider a dead body – it will never be using those organs again. If they are not donated, the organs will remain unused until they are no longer functional. Therefore, it seems only reasonable that dead people should donate their organs. However, dead people cannot make decisions, so that decision must be made prior to death (ideally) or by the family of the recently deceased. The importance of the individual making that decision before death was addressed earlier. There doesn’t seem to be any obvious reason why the recently deceased should keep their organs. As Jonathan Baron explains in his book, “Against Bioethics”, the “failure to donate organs” is “an example of selfishness by omission”. The obvious need for more organs should compel a virtuous person to desire to donate their organs, especially if they are never going to use them. Imagine, for a moment, a man who has 5 million dollars. He is very strict with his money, and never donates any of it. He knows of many people who could benefit from his money, but instead of donating it to charity or giving it to his family before he dies, he buys 5 million dollars worth of diamonds and decides to be buried with the diamonds. How would we view such a man? Obviously we would see him as foolish and absurdly selfish; who would choose to be buried with 5 million dollars worth of diamonds? He should have given the money to someone who could have used it. Our organs are not that much different from the man’s money. Currently, selling organs is illegal in the United States, and for this reason, it is not possible to determine how much an organ is worth on the free market. However, a kidney can be sold (illegally) on the black market for approximately $160,000. (Martinez, 2009) If a kidney can be sold for that much money, one can only imagine how much an entire body of functioning organs may be worth. Our bodies may, in fact, be worth more than the old man’s 5 million dollar diamonds. It is not the monetary value of the organs that should be considered, but the practical value. By not donating, we are senselessly taking valuable organs to the grave with us. This does not seem justified.
There are many reasons why choosing to donate your post-mortem organs is considered to be ethically virtuous. When approaching this topic from a virtue-ethics perspective, we are able to take a more robust look at what a virtuous person would do with organs that will never be used again. Additionally, if someone decides to sign up for organ donation, there are several good reasons to follow through with it (assuming it was a promise made without coercion). Put simply, if we are able to relieve suffering by giving another person something that we will never use, there are no good reasons to selfishly keep that which will relieve suffering. If a man decided to be buried with his money, he would certainly not be considered virtuous. The same line of reasoning applies to organ donation. We are all carrying valuable, life-saving organs with us, and when we die, we can’t take them with us.
- Annas, Julia. 2004. Being Virtuous and Doing the Right Thing. Proceedings and Addresses of the American Philosophical Association.
- Baron, Jonathan. 2006. Against Bioethics. Massachusetts Institute of Technology
- Fletcher, Joseph. 1979. Humanhood: Essays in Biomedical Ethics. Prometheus Books.
- Frankfurt, Harry. 2004. I. Taking Ourselves Seriously & II. Getting It Right. The Tanner Lectures on Human Values. Stanford University.
- Glannon, Walter. 2005. Biomedical Ethics. Fundamentals of Philosophy Series. Oxford University Press.
- Martinez, Edecio. 2009. Black Market Kidneys, $160,000 a Pop. CBS News
- New York State Department of Health. NYS Donate Life Organ and Tissue Donor Registry Specification Form.
- United Network for Organ Sharing. 2013. www.unos.org
- Scanlon, Thomas. Promises.
This paper was originally one of the handful of papers I did for my contemporary ethics course at Buffalo State