Conscription of organs consists of removing all viable organs for tranplants from recently deceased. Spital & Erin (2002) argue that consent is neither required nor requested, with the exception of people with religious objections. Beliefs will be the primary grounds on which it can be argued that consent is necessary, and it will likely go beyond religious beliefs since certain groups will argue that their beliefs are on-par with religious affiliations.
The US currently uses as a system of expressed consent for organ donation, meaning organs are not collected unless an individual specifically indicated this (usually seen on driver’s license and state databases) or there is the consent of the family after death. This system is not very effective in meeting demand, so other countries sometimes use a system of presumed consent, where organ collection occurs unless an individual specifically chose to opt out. The main ethical issue is that consent as a principle only stands true if an individual is properly informed of the policy and is given the opportunity to opt out (Zink et al., 2005). If the consent is not required as happens in cases of presumed consent policy, then ethically how can it be known that the person was ever informed or given the opportunity. Not every person uses national healthcare systems or receives a driver license, not everyone is aware of national policies. Since it is impossible to interview every single resident of even a small country, by omission, there is always a possibility that consent was not fully understood or attained.
Furthermore, organ conscription violates one of the key elements of healthcare provision which is respect for individual autonomy. On the other hand, neither autonomy or consent should matter as the individual is dead. Unless their religious beliefs specifically interfere with organ removal, which would likely have been noted during their lifetime in some form, then consent should not matter.
Justice is often defined as offering each individual what they deserve, serving as a standard of rightness. Fairness is a term meaning of providing to everyone equally, distributed among a group of people without bias or reference to one’s feelings or interests. The concepts are often interchangeable in modern-day ethics and policy, although justice does offer the unique insight that “individuals should be treated the same, unless they differ in ways that are relevant to the situation in which they are involved” (Velasquez et al., 2014). Therefore, it can be argued that the system of organ conscription does establish a system of fairness, as everyone participates in the process of organ donation (if viable at death), and by so doing, they have an equally greater chance to receive an organ should the need arise. Those choosing to opt out for religious reasons, would also be opting out of their right for an organ transfer, this establishes fairness as those who participate and take the risks, reap the rewards.
Furthermore, conscription arguable creates more justice. Currently, organ transplants are highly expensive, and usually those with money, power, and influence find themselves at the top of the list due to the scarcity of organs. With conscription, participation would be more equalized as distribution would be more spread out due to availability and the limits placed upon requirements to participate, with money and influence being lesser determining factors in the decision of who receives the organs.
One of the alternative options that is presented by Munson (2014) is organ preservation. It is one of the lesser controversial means, and can potentially improve organ availability rates. By all accounts, it takes the principles of organ conscription and brings it down a level. The practice assumes that organs will be harvested and ensures steps to preserve them, but also provides the time to seek consent from families after the initial shock of death (during which healthcare professionals seek to avoid conversations). There are some concerns, about this method, but it is much less intrusive than other alternatives, and if professional conduct is followed there should be no harm to anyone living nor desecration of bodies. Arguably, this is not a long-term solution and would like see mediocre improvements in organ availability. However, if implemented nationwide, it can be a stepping stone in awareness of organ donation as a more standardized practice with most likely high consent rate. Therefore, at later times, stronger policies such as organ conscription can be implemented on this basis.
References
Munson, R. (2014). Intervention and reflection: Basic issues in bioethics (concise ed.). Wadsworth.
Spital, A., & Erin, C. (2002). Conscription of cadaveric organs for transplantation: Let’s at least talk about it. American Journal of Kidney Disease, 39(3), 611–615.
Velasquez, M., Andre, C., Shanks, T., Meyer, M. (2014). Justice and fairness.
Zink, S., Zeehandelaar, R., & Wertlieb, S. (2005). Presumed vs expressed consent in the US and internationally. Virtual Mentor, 7(9), 610-614.