Gift of Life NC (Lay)
Sacred Heart
High School
“The only gift is a portion of thyself.”
It is because I agree with Ralph Waldo Emerson that I negate today’s resolution,
Resolved: A just society ought to presume consent for organ procurement from the
deceased.
The resolution asks what a just society ought to do, so the paramount value is justice.
To achieve the value of justice, the value criterion is honoring acts of altruism.
My thesis is that presuming consent for organ procurement from the deceased is a
disservice to the commendable and voluntary altruism of organ donors.
Organ donation is commendable because it is a voluntary act of altruism, a selfless gift
of life.
Keith Upchurch 14 writes1
DURHAM — Delores Benton Evans owes her life to her son. Without his donated kidney, Evans knows she would not be among the living. Evans’ kidneys were failing in 2008,
and her doctors said she needed a transplant soon. Tragically, her son was fatally shot that year. Before he died, he had volunteered to give his mother one of his kidneys, so the
transplant was done soon after his death. “I know it saved my life,” Evans, a 66-year-old Durham attorney, said. Evans is one of thousands of people in North Carolina and
In North Carolina,
3,343 people were waiting last week for an organ transplant, and 2,910 of those were for a kidney,
according to Sharon Hirsch, executive director of Donate Life North
Carolina, a coalition of organizations working to increase organ and tissue donations. Across the United States, 121,000 are on the waiting list. “That number is
across the nation whose lives were saved by an organ transplant, but the sad truth is that the need is far greater than the supply.
much higher than in past years,” Hirsch said. “It continues to increase every year.” Why? “A lot of it is how we’ve taken care of ourselves,” Hirsch said. “We’ve seen an increase
in diabetes and high blood pressure -- those are the diseases that tend to land people on the transplant waiting list.” Kidneys are by far the most needed organ. “Many people
don’t understand that you can be a living donor,” Hirsch said. In North Carolina, 4.5 million people are registered donors -- shown by a heart on their drivers’ licenses. The
main way to sign up as an organ and cornea donor is at the Department of Motor Vehicles, when getting your driver’s license or ID card. The law requires DMV examiners to ask
all applicants if they want to be a donor. A second way is to visit DonateLifeNC.org. That can be done at any time. Hirsch’s organization is pushing for more Durham residents
to sign up, because their participation rate is well below the state average of 50 percent. At Durham East DMV office, it’s 44.1 percent, and at the Durham South DMV, 48
percent. Hirsch also wants to dispel myths about organ donation that keep many from registering: -- Age doesn’t prevent you from being a donor. Everyone is a potential donor
regardless of age, race, ethnicity, gender or medical history. -- You can be a donor even with a history of cancer, if you take medication for high blood pressure or live with
diabetes and other chronic diseases. Your medical condition at death determines what organs and tissue can be donated. -- People registered as donors get the same medical
care in hospitals as non-registered donors. -- Organ and tissue donation won’t interfere with funeral arrangements. Open-casket funerals are still possible. - There are no costs
to you, your family or your estate to be a donor. You can register at a DMV office as an organ and cornea donor. To sign up as a tissue donor, visit DonateLifeNC.org Donating
tissue may not always be life-saving, but it can greatly improve a recipient’s life. Examples include ACL repair, back surgery that requires donor bone and hearts valves to extend
life. “There are no waiting lists for tissue and corneas today,” Hirsch said. “Through the miracle of eye and tissue banking, corneas and tissue are available for anyone who needs
them.” A major barrier to convincing people to be organ donors is fear, because it requires families to talk about death, Hirsch said. “These are tough conversations about what
you want when you pass away,” she said. “As a culture, we haven’t talked about that enough. We want you to have this conversation with your family and share your wishes, so
Hirsch said the most
gratifying thing about her job is meeting people who are alive because
someone gave an organ. “You hear about what their life was like while they were
waiting for an organ,” she said. “They didn’t have much of a life. And then to see how they are today
– living their lives and giving back, and doing extraordinary things. It’s miraculous. It motivates me every day.” For Delores Benton
Evans, having her son’s kidney let her return to a normal life. She’s resumed her law practice and
can work in her garden again. “I want people to know that the act of organ donation is one of the
that when something happens to you and your family is asked about donating organs, they’ll already know the answer.”
miracles that we see everyday ,” she said. “It’s a very unselfish gift , and an
opportunity for the recipient to get another chance at life. We want others to have the opportunity
that we had.”
Keith Upchurch (public safety reporter). “Organ donations: The gift of life.” The Herald Sun. April 13th, 2014.
http://www.heraldsun.com/news/localnews/x27232919/Organ-donations-The-gift-of-life
1
Gift of Life NC (Lay)
Sacred Heart
High School
Contention 1: Presumed consent turns the gift of life into a duty of life.
Dialysis patient Peter Laird 8, MD, writes2
In keeping with Bill’s tradition of political issues, there is an important battle brewing in the UK and other countries regarding
a transplant donation procedure called presumed consent. The operative ethical paradigm for
transplant donation has been informed consent and an “opt in” procedure
that was further agreed to at the time of death by the donors family who had the final authority to approve or disapprove of donation. In England, Europe and Australia, there
are proposals on changing to a presumed consent system of organ donation where those that do not wish to donate for personal or religious reasons would be required to “opt
out” with a written refusal of organ donation while still competent. Otherwise, all medical suitable “specimens” will be automatically considered as organ donors and families
will have limited ability to appeal this decision. Surprisingly, America has also moved with the Revised Uniform Anatomical Gift Act which also incorporates the same
On a personal appeal,
I would not feel comfortable
accepting a renal transplant graft from anyone that has not explicitly
“Presumed consent” here in the US as well, yet quietly and without the fanfare of discussion as seen in Europe and Australia.
although there are benefits of renal transplant that are quite attractive, in my own opinion,
consented to serving as an organ donor and likewise having the blessing of their
family. Do those of us with ESRD have the “right” to a renal graft or is it
still a supreme gift of love from one person to another? Thus, are we moving
from a “gift of life” to the “duty of life” here in America and around the world. Are the rights of the individual even over our
“own” organs and body tissues now fallen to the state’s utilitarian ethos of duty and obligation above autonomy and personal considerations? In fact, by Talcott Parsons treatise
on the “sick role,” will it next be considered by the state that all ESRD patients should likewise undergo renal transplant in the “best interest” and “duty” of a citizen of their
respective countries since the “obligation” of those that are sick is to help to get better and to comply with treatment? Will we thus have “presumed consent” for donation
coupled later with enforced renal transplant? Would those that refuse renal transplantation be subjected to loss of funding?
Contention 2: Presumed consent causes backlash.
Bramhall 11 writes3
presumed consent might damage the
trust between clinicians caring for patients at the end of life and their families (survey of Intensive Care Society
members, 2008). There is a possibility that some clinicians could opt out of donation programmes at a
time when their support is required to improve rates of organ donation. In addition,
evidence from recipients of organs suggests that many need to know that organs
had been donated without coercion by the organ donor and his or her
family. The families of organ donors usually find great comfort in being an active part of the decision to donate. The introduction of a system of presumed consent
There is a belief among some members of the medical profession that the introduction of
relationship of
would be highly complex and costly if it were to command the trust of the involved professions and the general public. Every member of the UK public at the time of introduction
and moving forward would need to be contacted and offered the choice of opting out. This would require a significant and sustained communication programme and any ‘optout’ register would need a robust IT system to support the process. There are real concerns among the general public about centrally controlled IT registers containing personal
information and the introduction of such a personal database at this time is probably ill conceived.4 Despite support among the UK population for organ donation an attempt to
presumed consent might provoke anti-donation feelings and even
active anti-donation campaigning among some vocal groups. This view has been supported
introduce a system of
by some faith leaders who under the current system support organ
donation.5
Thus, because organs must be given, not taken, I negate.
Peter Laird, MD (dialysis patient). “Presumed Consent: a right to life or the gift of life.” May 11th, 2008.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/05/presumed-consen.html
3 Simon Bramhall (Consultant Surgeon at the Liver Unit, Queen Elizabeth Hospital in the UK since 2002). “Presumed consent for
organ donation: A case against.” Ann R Coll Surg Engl. May 2011; 93(4): 270–272.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363073/
2
Gift of Life NC (Lay)
Sacred Heart
High School
AT Framework
Human psychology justifies an act/omission distinction. Human willpower is finite and
time-consuming, so we can’t expect humans to consider every possible action.
Richard Chappell 08 writes4
Humans have limited executive cognitive control or 'willpower' (cf. the psychological literature on egodepletion). Decision-making and conscious action is draining. It's hard work. The immediate concerns
of everyday life can be burdensome enough without adding all the world's
ills to one's plate. Again, so long as one is leading a basically decent life, it just doesn't seem reasonable to condemn them or demand that they attend to
more pressing concerns elsewhere. Most people have more than enough to attend to already! So perhaps we should say that one would be 'doing'/bringing about X (or 'allowing'
This could make sense of
why bringing about harms is more blameworthy than merely allowing
them.
not-X) iff the X option requires more effortful decision-making (i.e. is more ego-depleting) than the not-X option.
Util fails because not all values are reducible to good consequences.
Nagel 02 writes5
The central claim is that the motivational source of morality is something quite different from the impartial universal benevolence most naturally expressed by a utilitarian
system—a system whose ultimate standard is the maximization of overall, aggregate well-being. In fact he sets himself against the natural but simplistic idea that well-being is
Value takes many
forms other than that of something to be promoted or maximized. One would not, he
observes, show an appreciation for the value of friendship by betraying one
friend in order to make several new ones. Morality, too, is not identified with
promoting the good—human happiness, for example.
the domin ant value or that any other measure of the good, conceived as an end to be promoted by everyone, is the basic form of value.
Sunstein relies on flawed logic. Haque 07 writes6
Eric Blumenson was the first to observe that the authors’ [Sunstein and Vermeule’s] argument involves a
non sequitur. Blumenson agreed that governments have both negative duties of forbearance and
positive duties of assistance toward their citizens; but he recognized that it does not follow that
governments may violate the former in order to satisfy the latter. 40 Similarly, we may agree with
the authors that the state has a duty to prevent foreseeable harms to its citizens; but this does not entail that the state may intentionally harm some to prevent foreseeable harms
to others. The authors write that those who accept the moral relevance of the act/omission distinction believe that there are negative duties but no positive duties. 41 They
similarly indicate that those who accept the intention/foresight distinction believe that there is no moral requirement to prevent foreseen but unintended harms. 42 However,
Killing
may be a more serious wrong than letting die; purposeful wrongdoing may be more blameworthy and deserving of
there are several ways in which a moral distinction can make a moral difference between two requirements, both of which are accepted as real and important.
greater punishment than non-purposeful wrongdoing; 43 greater force may be used against someone who is killing another person than against someone who is allowing
another person to die. Most importantly, it may be justifiable to let some die to save many others but not justifiable to kill some to save many others; similarly, one may be
justified in causing foreseen deaths as a side effect of one’s action but not be justified in intentionally killing as a means to one’s end. Defenders of the act/omission and
intention/foresight distinctions generally do not deny the existence of the requirements the authors defend; they primarily argue that violations of moral requirements marked
by the relevant distinctions admit of different justifying circumstances.
Richard Chappell (grad student @ Princeton). 22 May 2008 “Doing/Allowing and Effortful Willing.”
http://www.philosophyetc.net/2008/05/doingallowing-and-effortful-willing.html
5Nagel, Thomas [University Professor of Philosophy and Law at New York University]. “Scanlon’s Moral Theory” in Concealment
and Exposure & Other Essays. Oxford University Press, 2002. Print. pp. 148-9.
6 Adil Ahmad Haque (Assistant Professor of Law at Rutgers, JD from Yale). “Torture,
4
Terror, and the Inversion of Moral Principle.” New Criminal Law Review: An
International and Interdisciplinary Journal, Vol. 10, No. 4 (Fall 2007), pp. 613-657
Published by: University of California Press.
http://www.jstor.org/stable/10.1525/nclr.2007.10.4.613
Gift of Life NC (Lay)
Sacred Heart
High School
AT Solvency
The conclusion of Sowden et al actually negates—his evidence is misrepresented
A meta-analysis of 13 studies concludes presumed consent does not increase donation
rates.
Sowden et al 9 writes7
A systematic review was conducted. Eight electronic databases (MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, PsycINFO, HMIC, PAIS
International and OpenSIGLE ) were searched from inception to January 2008 to locate published and unpublished studies on
organ donation and presumed consent. Supplementary internet searches were also performed. To
be included studies had to compare donation rates in a single country before and after the introduction of a presumed consent law (before-and-after studies) or compare
donation rates in countries with and without presumed consent systems (between-country comparisons). The methodological quality of these studies was assessed and a
The methodological quality
of the surveys was assessed and considered within a summary of the results of the surveys. Go to: Results Over 2000 potentially relevant
narrative synthesis of results was undertaken. In addition, surveys of attitudes towards presumed consent legislation were included.
citations were identified, of which 68 were retrieved as full papers (44 for the primary objective and 24 for the secondary objective). After screening, a total of 13 studies
13 studies met the inclusion criteria
(reported in 15 publications) met the inclusion criteria for the primary objective and
for the
secondary objective. Of the 13 studies addressing the primary objective, eight were between-country comparisons and five were before-and-after studies. Four of the eight
These studies all used regression models to
compare data from different countries. In all four studies presumed consent law or practice was associated with increased
between-country comparisons were of sufficient methodological quality to provide reliable results.
rates of organ donation, ranging from an increase of 2.7 donors pmp in one study to 6.14 donors pmp in another. In the third study there was an increase in the rate of organ
The studies all
assessed the impact of factors other than presumed consent on organ donation
donation of between 25% and 30% in presumed consent countries and in the fourth study the increase was between 21% and 26%.
rates. Factors found to be important in at least one study were mortality from road traffic accidents and cerebrovascular accident, the transplant capacity of a country, gross
domestic product (GDP) per capita and health expenditure per capita, religion (Catholicism), education, public access to information and a common law legal system. The five
before-and-after studies represented three countries, all of which reported an increase in donation rates following the introduction of a presumed consent system. For example,
in Austria the donation rates rose from 4.6 donors pmp to 27.2 pmp over a 5-year period; in Belgium kidney donation rose from 10.9 pmp to 41.3 pmp during a 3-year period;
and in Singapore kidney procurement rose from an average of 4.7 per year to 31.3 per year in the 3 years after the change in legislation. Importantly, however, there was very
limited investigation of any other changes taking place concurrently with the changes in legislation across this set of studies. Of the 13 studies addressing the secondary
objective, eight were surveys of the UK public and four were from other countries, along with one international survey of health professionals. There was variation among the UK
surveys in the level of support for presumed consent, with surveys conducted before 2000 reporting the lowest levels of support (28–57%). The most recent survey by YouGov in
2007 reported that 64% of respondents supported a change to presumed consent. Among the surveys from other countries, only in Belgium, a presumed consent country, was
there overall approval of presumed consent. Go to: Conclusions Presumed consent alone is unlikely to
explain the variation in organ donation rates between different countries. A combination of
legislation, availability of donors, transplantation system organisation and infrastructure, wealth and
investment in health care, as well as underlying public attitudes to and awareness of organ donation and transplantation, may
all play a role, although the relative importance of each is unclear. The between-country comparison studies overall point to presumed consent law being
associated with increased organ donation rates (even when other factors are accounted for) although it cannot be inferred from this that the
introduction of presumed consent legislation per se leads to an increase in donation rates. The before-and-after
studies suggest an increase in donation rates following the introduction of presumed consent legislation; however, it is not possible to rule
out the influence of other factors on donation rates. It is important to note that the survey evidence is incomplete and the variation in attitudes between
surveys may reflect differences in methods and the phrasing of questions. Some surveys suggest a lack of public support for presumed consent, both in the UK and in other
countries; however, more recent UK surveys provide evidence of support for presumed consent.
A Sowden, A Rithalia, C McDaid, S Suekarran, G Norman, and L Meyers ( Centre for Reviews and Dissemination (CRD), University
of York, York) “A Systematic Review of presumed consent systems for deceased organ donation” BMJ. 2009; 338
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628300/
7