organ harvesting

[lazygood4nothinbum]

while reading meadbh's post to another thread i got to thinking about organ harvesting and searched but found little mention on this board. i wondered if the canadian citizen mentioned would get in trouble in his own country for harvesting the organ when such a purchase of body parts from living persons seems similar to, say, traveling out of country to engage in child porn. though i suppose people can travel to where doing drugs is legal and come back home without being prosecuted so why would this be any different.

anyway, i did a quick google of "canada paying for organ" and came upon
The Epoch Times | Are Canadian Taxes Paying for Stolen Organs? .

Taxpayers could be footing the bill for patients who receive organ transplants from persecuted groups in China, says a recent report.
A revised report on organ harvesting in China entitled "Bloody Harvest" concludes that a major portion of the organs being used in China's booming transplant trade come from unwilling donors, most notably Falun Gong practitioners....

Just as pedophiles can be charged in Canada for having sex with children in other countries, the report says Canada should enact similar extra-territorial legislation that would penalize Canadians who participate in organ harvesting without the consent of the donor.

i wouldn't even attend the bodies exhibit in florida because no record was ever produced to document permission of the families to use them.

for reference purposes:

I saw a documentary recently about a Canadian who went to India for a renal transplant and purchased the kidney from a man who needed the money for his family. The two met, which must have been a strange experience. The quality of medical care was excellent but the facility was old and decrepit and the transplant recipient developed septicemia and dehydration and almost died. His family had to go and rescue him. He is now well, but says that if he rejects the kidney, he will not repeat the experience.

so i'm left to wonder, is it that he won't harvest another organ from a poor person or he'll have the transplant brought to a better facility?

 

[Meadbh]

I think he said "that was it", he would rather go back on dialysis, or die, than go through that again.

If he tried to bring a purchased organ into this country, he would face all sorts of ethical and regulatory barriers. Most probably no institution would agree to host the procedure, and any healthcare professional who participated would be risking discipline by his or her professional licencing body for an ethical breach of conduct. I think this man actually investigated that avenue before going to India.

 

[Meadbh]

I think there's a difference between buying an organ from an adult who consents and profits, buying an organ removed involuntarily from a prisoner, and pedophilia. The latter two are clearly very, very wrong in all cases and I agree, the arm of the law should be far reaching. However, if an adult makes an economic decision that involves some risk to him or her, is that transaction a crime? Certainly there is a power gradient between the customer recipient and the provider donor.

It would be interesting to hear from our lawyers on this one.

 

[lazygood4nothinbum]

as women & gays well know, society often attempts to place its laws on your body.

according to The Straight Dope: Is suicide against the law? (i can't decide if the internet is just too convenient or if i'm getting really lazy):

as of 1963, six states still considered attempted suicide a crime--North and South Dakota, Washington, New Jersey, Nevada, and Oklahoma. Of course they didn't take matters as seriously as the Roman emperor Hadrian, who in 117 AD declared attempted suicide by soldiers a form of desertion and made it--no joke this time--a capital offense.

even easier to research would be how many laws i can find declaring sex among consenting gay adults to be illegal. if just interaction can be a crime, it seems transaction can as well.

 

[Martha]

I think there's a difference between buying an organ from an adult who consents and profits, buying an organ removed involuntarily from a prisoner, and pedophilia. The latter two are clearly very, very wrong in all cases and I agree, the arm of the law should be far reaching. However, if an adult makes an economic decision that involves some risk to him or her, is that transaction a crime? Certainly there is a power gradient between the customer recipient and the provider donor.

It would be interesting to hear from our lawyers on this one.

I agree with you Meadh.

It has nothing to do with law, but ethics. The law should follow the ethical decision we make as a society.

 

[bssc]

as women & gays well know, society often attempts to place its laws on your body.

according to The Straight Dope: Is suicide against the law? (i can't decide if the internet is just too convenient or if i'm getting really lazy):

Quote:
as of 1963, six states still considered attempted suicide a crime--North and South Dakota, Washington, New Jersey, Nevada, and Oklahoma. Of course they didn't take matters as seriously as the Roman emperor Hadrian, who in 117 AD declared attempted suicide by soldiers a form of desertion and made it--no joke this time--a capital offense.

The Washington Post had an article today about how the Army is prosecuting an officer for attempted suicide even through the officer is undergoing psychiatric care.

 

[bbbamI]

I saw a documentary regarding organ sales in Iran a couple of weeks ago. The citizens could only sell to another Iranian citizen. The organ they discussed was the kidney. The price for a kidney was in the $2500 to $3500 (American dollar) range. This amount was about six months of a lower salaried individual.

 

[lazygood4nothinbum]

The Washington Post had an article today about how the Army is prosecuting an officer for attempted suicide even through the officer is undergoing psychiatric care.

good story. thanx for posting.

Under military law, soldiers who attempt suicide can be prosecuted under the theory that it affects the order and discipline of a unit and brings discredit to the armed forces.

before reading the story, but just based your post, my first thought was that maybe the court-martial was justified on contractural grounds.

though i often question myself, i generally find individuals sovereign and i would extend that concept as widely as i could until its logic shreds, extending not just to the society we see but to spirits if such exist. i would extend that from refusing another life to come through me even if i have to stop it, to harvesting my own organs, to ending my own life.

and so i thought, based on your post, that maybe there are times when you forfeit sovereignty which i suppose those who are against abortion could argue (to which i would answer in immature fashion: finders keepers--i was here first) and i supposed it might be the case of someone who contracts a set amount of time of their life over to an organization like the military.

i never would have considered losing face as justification for a life sentence; but, while i am not military trained, i still would find more shame in punishing human weakness which was merely self-directed in a desperate call for help (real suicides succeed) which put no one else at harm. is it the duty of the military to protect the weak or to prosecute the weak?

 

[RetireeRobert]

If he tried to bring a purchased organ into this country, he would face all sorts of ethical and regulatory barriers. Most probably no institution would agree to host the procedure, and any healthcare professional who participated would be risking discipline by his or her professional licencing body for an ethical breach of conduct.

Leading to this line of thought---the man goes to India and gets the organ transplant. He THEN returns to this country with the transplanted organ inside himself! And then he needs some kind of care relating to this transplanted purchased organ----maybe even after a decent interval has passed like several months or a year.

The organ is still a purchased organ---what are the ethics for health professional and facilities now?

 

[lazygood4nothinbum]

The organ is still a purchased organ---what are the ethics for health professional and facilities now?

good point & very much in line with one in the article i posted, only the writer questioned government funding of after transplant care rather than your point of the ethics of aftercare...

He said BC does not reimburse patients that receive transplants in other countries but they can receive aftercare once they return

 

[Rich_by_the_Bay]

The organ is still a purchased organ---what are the ethics for health professional and facilities now?

Most ethicists I know feel that the physician has two broad constituencies: the patient sitting in front you right now, and the larger communities which the patient represents. Usually the patient in front of you takes precedence, but not always. If the individual patient's needs and requests bring greater harm to the community than they bring benefit to the patient, the community's needs might prevail.

For example, a patient who is a school bus driver is diagnosed with a serious contagious disease. You advise home- or hospital care until the disease is no longer infectious. The patient says that would bankrupt him, and he will try to be careful but refused confinement. Mandatory reporting requirements aside, I would probably report that patient to the public health authority. Note that the risk to the patient loses; society wins in my view.

For organs, if a patient came to me for care after the fact I would give that care. The ethical decision is over - right or wrong - and the patient needs care. I would not be able to turn the patient away.

Just offering another way the dilemma might be framed.

 

[Nords]

before reading the story, but just based your post, my first thought was that maybe the court-martial was justified on contractural grounds.
i never would have considered losing face as justification for a life sentence; but, while i am not military trained, i still would find more shame in punishing human weakness which was merely self-directed in a desperate call for help (real suicides succeed) which put no one else at harm. is it the duty of the military to protect the weak or to prosecute the weak?

She must've scared a bunch of people around her unit and pissed off one or two at HQ. This strikes me as bureaucratic ass-covering for the sake of satisfying "military honor & discipline" and discouraging copycats. They'll probably dismiss everything and let her resign with an honorable discharge. She's doing the right thing by fighting through the process (and in the press), although I'm not sure it's going to get her anything she wouldn't already be eligible to receive.

The military puts a great deal of importance on discharges, but hardly anyone in America gives a crap about the characterization of military service anymore. In the Navy, the decision by an administrative board to hand out a general discharge (instead of honorable) gets a lot of "Are you really sure about this?" second-guessing and is frequently [-]backstabbed[/-] overridden by the chain of command for fear of adverse publicity. Handing out an OTHD would require backup from The Great Santini, CAPT Queeg, and Darth Vader. Even Scott Waddle, who killed nine Japanese with his submarine and precipitated the worst international military crisis & Navy accident since Vietnam, was allowed to retire with a reprimand.

10 years ago an NCIS officer told of a case she'd testified in for felony theft. The sailor was awarded a BCD. Six months later she saw him at the Navy Exchange as a security guard. The NEX didn't care about her feedback until the NCIS offered to conduct a physical-security inspection.

For organs, if a patient came to me for care after the fact I would give that care. The ethical decision is over - right or wrong - and the patient needs care. I would not be able to turn the patient away.

So who pays for the treatment? The patient's health insurance (which may not be aware that their insured had a transplant, oops) or Medicaid?

 

[Rich_by_the_Bay]

So who pays for the treatment? The patient's health insurance (which may not be aware that their insured had a transplant, oops) or Medicaid?

Probably no one, i.e. me and the hospital.

If we are all in luck, insurance will cover after-care. BTW, antirejection drugs can cost thousands per month.

 

[RetireeRobert]

For organs, if a patient came to me for care after the fact I would give that care.

The ethical decision is over - right or wrong -


and the patient needs care. I would not be able to turn the patient away.

Why is the ethical decision now over? Maybe it is a "different" ethical decision now requiring confrontation, but I am not even sure it is totally different.

 

[Meadbh]

Probably no one, i.e. me and the hospital.

If we are all in luck, insurance will cover after-care. BTW, antirejection drugs can cost thousands per month.

In Canada he is covered just as he had been prior to the transplant, by Altared, Kumquat, Accountingsucks and Meadbh's taxes, and his own (I think he's FI). Since he doesn't need dialysis anymore, another patient has his slot, impacting slightly on the societal cost. So the net result may be cost neutral.

Ethically, I would have no problem treating him after the fact. My patients, or their parents, do a lot of things I might not agree with, but that's not a reason to deny them treatment.

 

[Rich_by_the_Bay]

Why is the ethical decision now over? Maybe it is a "different" ethical decision now requiring confrontation, but I am not even sure it is totally different.

Over? Confrontation?

I'm saying that given the choice of treating the human being who came to me seeking help, versus turning him away to reject his transplant and die, my opinion of the proper ethical response is to treat him.

Some might choose otherwise, I guess. Maybe I'm missing your point?

 

[kumquat]

In Canada he is covered just as he had been prior to the transplant, by Altared, Kumquat, Accountingsucks and Meadbh's taxes, and his own (I think he's FI). Since he doesn't need dialysis anymore, another patient has his slot, impacting slightly on the societal cost. So the net result may be cost neutral.

Ethically, I would have no problem treating him after the fact. My patients, or their parents, do a lot of things I might not agree with, but that's not a reason to deny them treatment.

Organ sales by poor 3rd world people or, in the case of China, by governments executing people, are an interesting dillema. A poor worker in a 3rd world country could, at least in theory, sell a kidney and still live a long and prosperous (maybe wishfull thing re post surgical care) life. His family might be better off because of it. The opposite could also be true. Hearts, of course are another story. I'm glad it's not my problem.

As to after-care? OK, I'll pay my share. What do you other guy's think?

 

[RetireeRobert]

For organs, if a patient came to me for care after the fact I would give that care. The ethical decision is over - right or wrong - and the patient needs care. I would not be able to turn the patient away..............

You posit above then, that if some other medical professional makes the choice to do an organ transplant in a foreign country (where the recipient "bought" his new organ from an impoverished donor), then the "ethical decision is over-right or wrong."

I guess what still bothers me is, *assume* (for argument sake) that ethical choice was *wrong* in one's ethical construct. IF that is the case, then does not one have an ongoing ethical decision--to decide whether to "reward" that *wrong* act, and thus encourage more high bidders to purchase needed organs from impoverished donors?

You have said *after* the done deal of a transplant, your situation is simply that you are faced with a patient needing care, the transplant recipient--your choice is to give it to that patient. That seems straightforward.

But I guess it just doesn't seem quite so simple to me---perhaps I am thinking their may be a "societal good" involved greater than the good of treating this immediate patient.

To put it another way, if I were a medical professional, and would not have done the organ transplant for this patient under those circumstances in the first place, why do I now forget whatever societal good led me to this first ethical decision, and *reward* what I ethically concluded was *wrong* behavior?

It troubles me.

 

[Rich_by_the_Bay]

You have said *after* the done deal of a transplant, your situation is simply that you are faced with a patient needing care, the transplant recipient--your choice is to give it to that patient. That seems straightforward.

But I guess it just doesn't seem quite so simple to me---perhaps I am thinking their may be a "societal good" involved greater than the good of treating this immediate patient.

To put it another way, if I were a medical professional, and would not have done the organ transplant for this patient under those circumstances in the first place, why do I now forget whatever societal good led me to this first ethical decision, and *reward* what I ethically concluded was *wrong* behavior?

It troubles me.

The ethical imperative is sometimes less about the consequences of what you do, than it is the consequences of what you don't do.

I realize that you are not literally proposing this, Robert, and that this discussion is somewhat intellectual and even theoretical, but consider that refusal to treat this patient (who may have "sinned" in your value system or mine) would directly cause his death. That troubles me (as it would anyone), and I would not do it.

It feels like refusing to treat smokers with lung cancer, alcoholics with cirrhosis, AIDs patients with high risk behaviors. At that point in time, I don't feel it is my place to judge, to exact retribution, to punish. Indeed, just the opposite.

I've found that many armchair discussions of ethics don't hold up well under real-world situations, but admit it's complicated and difficult to know what to do sometimes. BTW. I do NOT support for-profit organ donation.

 

[RetireeRobert]

......., but consider that refusal to treat this patient (who may have "sinned" in your value system or mine) would directly cause his death. That troubles me (as it would anyone), and I would not do it...................

It feels like refusing to treat smokers with lung cancer, alcoholics with cirrhosis, AIDs patients with high risk behaviors...........

Yes, I was just thinking along those lines.

Never having been in the medical field, I've never had to face the real life decisions. I think maybe I am glad about that. I have had a CPR card though, I wonder what ethical situations could have come my way from holding that card?

 

[Meadbh]

Never having been in the medical field, I've never had to face the real life decisions.

Ethics issues are some of the toughest that I face in my clinical work (ICU).