3-27-2016 Bioethics Part 50

The speaker begins with a prayer, asking for wisdom and compassion in discussing bioethics. They explain that the topic of organ transplantation is important because it may be relevant to the listener's life at some point. They discuss the difficulties in determining death, specifically brain death and heart death. The speaker mentions the ethical issues surrounding the use of organs from individuals with dementia or mental disabilities. They explore the idea of considering lifestyle choices and character when determining organ eligibility. The speaker also discusses the current opt-in system for organ donation and the arguments for and against an opt-out system. Overall, the speaker emphasizes the complexity and importance of the topic. Let's pray. Give us wisdom and insight as we continue to think about and discuss a section of this study in bioethics. It's not exactly easy all the time to understand or to work out. And we do pray that you give us not only understanding but also compassion for those who are making these kinds of decisions each and every day. In Jesus' name, Amen. So last week we started to look at the first part of, we'll finish it today, the section on organ transplantation. And you go, why the heck are we doing that? Here's why. Because we're in a long series on bioethics and because you very well may be considering or have to consider one day either donating your own organs or the organs of somebody that you are responsible for. We looked at the reasons not to do it or at least the reasons to very much question the practice a couple weeks ago. And then last week we started to look at some of the public policy difficulties. Because while we could have done this at any point and we usually kind of shy away from public policy stuff, this is a very good point to just kind of sit back for a moment and go, let's look at the complications of this stuff in order to just be very grateful for people who work in the medical field in general or organ transplantation in particular, those who are having to face this kind of stuff, just to kind of look at the immensity of the topic. And we're just scratching the surface. So the first thing we looked at was very simply the question of what does it mean to be dead? That sounds like the most basic of all questions. However, we learned very quickly that it is not nearly as easy as we might think. Because what does it mean to be dead? Anybody? Whole brain death. Great. What does that mean? I mean, the brain, I guess, by the course of time, the criteria is dead. Yeah, right. So your brain is dead. But what is it, like, somebody who's brain dead, though, what's at least the difficulty, for those of us who might not be doctors, what's the difficulty when it comes to somebody who's brain dead? Yes. Because of medical technology, their heart could be beating. They could be breathing with some kind of aid. They could also have reflexes. Their nervous system could be functioning. So they are technically dead. These are not people who are going to come back. These are not people who are going to wake up out of the coma. They're dead. Now the question is, how much does somebody's brain have to be dead in order to be considered brain dead? Some people say 100%. Some people say, well, 50%. It depends on what part of the brain. Some parts of the brain you can come back from, some parts of the brain you can't come back from. So that's complicated. So you have brain death. Isn't that just what it means to be dead, then? Are there other things that might be considered to be dead? Are there other things that might be considered to be dead? Heart. Yeah, okay. What does that look like? Your heart stops. Okay? For an extended period of time. That's right. That's where the complication comes in. Because how long does the time have to be? Nobody really knows. You have people that argue for... It's got to be dead for like... You have to have a stopped heart for like 10 minutes. Then you're actually dead. Some people are like, no, you can't wait that long because organs are starting to kind of go downhill. You've got to get right in there. So maybe two minutes. So you have people that you either pull the plug, life support wise, and then you wait until their heart stops beating for a certain amount of time. Or, if somebody comes in and has a massive cardiac arrest, and their heart's just done beating, then the idea is, we talked about mobile care units, essentially, that are trying to be developed to keep people not alive, but viable in the organ sense, in order to get them to the place... They're dead, but in order to kind of keep the blood flowing, in order to then be able to harvest their organs for the use in others. That isn't around yet, but it's kind of like one of the burgeoning areas of research, because if we could do that, there'd be a lot more organs. And why are we concerned about organs? Okay, to keep people alive. Right. Why is it such a pressing issue in our society? The need is growing. That's right. So the need has always been pretty great, and the need is growing. The need will not go down, and the more advanced we get in medical technology, the more the need will arise. We saw that even the very first week that we talked about this, we thought, man, here are the transplantable organs. There was actually an organ added to the list that had never existed before in human history. Anybody remember what that organ was? Uterus. Ten years ago, nobody ever was like, we're going to transplant a uterus. Now we transplant uteruses. Right? Now, as we saw, it's super ethically weird, because you only get it for a limited amount of time. You essentially have a... I don't ever want to disparage anybody who ever gets one of these. However, it is very odd. You have to take anti-rejection medicine the whole time, so your body doesn't reject the thing. It essentially functions as a living sac in which to grow a human being. And you go, well, that's what, I don't know, all uteruses are, if you want to just get really non-technical about it. But here's the thing. It's just kind of in there. You can't actually have the baby, although you can have the baby. Because they actually open you up, because you can't actually give birth to this thing. And then when you're done using it, they actually have to take it out. So it's super weird. It's like, here's the uterus for a while, and then we're going to take it out of you. But even ten years ago, nobody was even talking about that. They were thinking about that, but it wasn't like, here's something we're doing. Technology is going to improve. They are trying to do things, like the kind of golden pinnacle of all this would be brain transplants. But that is so far down the road, it's not even funny. Still, people are working on it. So, heart death, brain death. What's the most ethically ambiguous one? The most ethically ambiguous one is the loss of higher brain function. This is something that we ought to be incredibly morally opposed to, but this would be people with dementia, Alzheimer's, that are no longer who they once were. That's kind of the terms we use. They are somebody else. They're not like they used to be. And the idea is these people are suffering, and so we should greater utilize human resources by getting rid of them and using their organs for people who are much more viable. As we saw, that is very easily translated into people who are mentally retarded or something like that, should also be in this category. They are also suffering. These kinds of arguments exist. Those ethicists are not exactly beloved in the community. If they do, they are out there, and they are arguing kind of like, look, we've got a crisis, let's just, you know, we're two birds with one stone. We're ending their misery, which is presupposed, and we're giving life to all these other people, which is insanity, but it's something that is argued for. Determining what is death is difficult. We saw that this is such a pressing issue because the organs are so necessary, so we were talking about like the difference between blind justice and utility, right? Like when you think about utility, what were some of those kind of considerations that some people would kind of like to add to the mix? You might want to add these to the mix. They just kind of sound good in the beginning. What are the things that we might need to, or what should we take into consideration? This doesn't have to be your opinion, but just like somebody's opinion, a friend of yours' opinion or something, right? What would make it more fair? Lifestyle choices, great. Like what? Give me an example of a lifestyle choice. Yeah, so if you were a smoker and you did a lung transplant, you don't get one. Because we as a society don't think you should do that. Okay, good. Another one? Yeah, right. So if you're a criminal, you shouldn't get one. And if you're a philanthropist, right, you should. So the question is like, what if you got convicted for petty theft and what if you gave five dollars to the zoo one time at the koala fund because you like koalas? Does that count? Or the lifestyle thing. What if you smoked like for three years from the time you were 14 to 17 because it was cool and it was like one cigarette a month and then you stopped? How much do you have to smoke? You see this gets insanely complicated insanely quickly. All ways of determining these things are difficult, but necessary. So no system, even though our current system isn't perfectly blind, but it should be as just as humanly possible and making these kinds of considerations is hard. The last thing we talked about was opting in or opting out of the program. What is our current program? Opt in. That's right. So in our current state of Tennessee, in the United States of America, you have a driver's license, on the back of your driver's license, you have to sign the driver's license to say, yes, I do want to be a donor. Sign your name. Why do people want an opt-out system? They think we're lazy. That's right. Which is a true statement. We are lazy. Why should we, why would be a reason to not have an opt-out system? It's no longer a donation. Critical point. We are taking your organs and what you are doing voluntarily is removing yourself from this program. You're not voluntarily giving yourself to the program. As Paul Ramsey, ethicist from a generation ago, said the routine taking of organs would deprive individuals of the exercise of the virtue of generosity. We're just going to take them. You don't get to be generous. We're going to go in there. And that kind, making that kind of society is the worst kind of society, even if we got more organs out of it. Notice how pragmatic of a society we live in. We don't really care what kind of people this makes us. We just got to get some stinking organs because there's some people dying. And that's sad, which is true. It is sad that there's people dying of organ failure. However, you and I cannot be, as either citizens of this country or Christians or even just citizens of the world, down with the idea ever for any reason that just because there's a problem, we should do anything to fix it. You don't believe that about anything. You might believe that there's more things you should do depending on a circumstance, but we should definitely not just do anything to fix this, whatever this thing is. The kinds of people that we become and the kinds of people that we desire for other people to become is very important for a society in which any human being lives, which is why these things are so important. So, what other kinds of things should we take into consideration? I have two things that I want to talk about this morning. Here's one of the biggest ones. It's to sell or not to sell. This is the kind of golden frontier of organ donation. The idea is let's open up a very highly regulated and overseen market in which people can sell their organs. This includes both the selling of organs from living donors, give me an example of that kind of organ, kidney, great, or the sale of your organs upon your death, like a heart or something like that. So, please think for a moment, I know it's early, but please come up with one good reason why or for an open market on organs. What would be a benefit? This could be anything that comes to your brain. There's people waiting for kidney to motivate other people to basically fill up the list faster. Alright, get more people kidneys, that's right. We are appealing to people's financial interest which will motivate givers for needs. Great. Yes. That is probably the main argument for it. Anything else? If you don't back a plan to sell organs, then you hate poor people. That is a real argument. Why? Because the desperately poor own very little. But what they own inside of their own bodies could lift them out of the poverty in which they have lived perpetually and will continue on in society. And by allowing them to sell organs, they can lift themselves out of that place by giving of themselves blood and soul. That's a real argument, right? I mean, I don't preach. Oh yeah, that's a detriment. I don't care about that part. Yeah. We're going to get there in a second. What about the idea of oversight? What would be a benefit to that? Think about the argument for regulated abortions in the United States of America. What are some of the arguments, besides just people should have the freedom to do this or whatever, what's one of the arguments? You're going to prevent unnecessary deaths. And if you close clinics, what you are doing is you are telling women you should just go into an alley with a hanger and take care of this yourself and die. That's the kind of common way we're talking in our society today about people who want to close clinics. Which is ridiculous. It's not a false option, but it is, it might, at least it's hypothetically true that if we oversaw the giving of kidneys, just so you all know, there's a rampant black market trade in kidneys in the United States of America. People are already buying and putting them in other people's bodies. So, and the trend is growing, so the idea is let's regulate this thing. It's like marijuana, right? You could either tax the junk out of it, oversee it, have it be government regulated, and it'll lessen the tendency to do this illegally, like they're trying in states like Washington and Colorado, or you could just clamp down the process from the law standpoint and never get anything done. Those are kind of the benefits of a private free market system. There's so many problems about this, we could talk about it for weeks, but I will not do so. Let me just talk about a few things. Number one, it was banned in the United States of America in 1984. But since then, kind of since the day it was enacted, it's been a source of constant debate. History has not been a good indicator for this going well. Now you could say we are not China, and we are not India, which is true, but we are human, so that's a problem. For example, in China in particular, they have a sordid history, they've moved away from this, yet they did, were caught killing prisoners prematurely. There's a large number of state sponsored executions, and executions in such a way that people's organs were harvestable, they were then harvested, and then sold to the highest bidder. That of course, if you think you have problems with prisons today in the United States of America, imagine, just think about this, we dehumanize criminals already. We turn them into animals. We then foster a system which is privatized, which makes people, I'm not going to get to preaching, much, we then privatize the system and have people make tons of money off of prisons. Then what we do is we say we have this incredible public need. The public need is organs. These people over here who are a detriment to society and are a bane on our own existence, that are barely human, that are human maybe only in form, could give us what we need. This is not crazy talk, this is very much cost saving opportunity and a tax break for the middle class. That's what this is. We get rid of prisoners, we get organs, everybody wins. We rid society of vermin, and look, yay for us, we all have organs. And we also make a whole bunch of money off of estates for new roads and public education. That's not crazy talk, that's very much a very real possibility. There has been in the history of this going on, the sellers of organs, most of these people are selling kidneys, they are discriminated against when it comes to being hired for jobs because many people who give up their kidneys end up severely weakened as a result of the practice. Even people who heal well are not that full capacity as a laborer. And so you have to actually prove in some places that you do not have a kidney scar because if you have a scar, they're like, we will not hire you because we know that you will be a useless worker because other people we've hired have been useless workers. So in certain countries, people are just discriminated against, even if they have a kidney scar because they had some kind of operation as a kid or something. Also, in some countries, like Moldova, sellers are often unable to marry. That might not happen here. I'm not saying that if people had that, that's not a kind of social stigma we have in our own culture. However, what we do know is that social stigmas arise all the time for some of the weirdest reasons. It makes no sense why men in Moldova are unable to marry as a result of donating kidneys. It might be something different here, but it will almost assuredly be something. Also, history has shown that the health care is sketchy. Something that's likely to happen here, even if the markets are opened. Here's a good example of that. Abortion clinics are very highly regulated. However, are all abortion clinics equal? No, not even remotely close. Because they are not equal, care is not equal, and even if you had a highly regulated system, there is every motivation to cut corners. If you think, just think about this for a minute, if you think, regardless of the rightness or the wrongness of the actions of those who did the secret filming of all the clinics and the selling of the parts and all that kind of stuff, if you think that is a high motivation for both upping abortions and kind of cutting corners, imagine what happens when we're talking about billions of dollars being made on the selling of organs, legally. If that is not motivation to cut corners, I don't know what is. Let's get to something Caleb brought up. Go back to this idea of poor people being able to sell something and lift themselves up out of poverty. That seems like something. But as Caleb said, it's really just a one-way street. Poor people can give of themselves, but can poor people get anything? No. So we're stratifying society even more. Also there's this thing of if we start as a society, and we would do this very quickly, we hate poor people, poor people are despised as a general rule, and so if we started selling kidneys, I want you to just think about this, we'll just think about kidneys for a moment, if we started a program of selling kidneys, highly regulated, get five grand or something for a kidney, then what do you think would happen to me, let's say I'm a poor guy, mostly destitute, let's say, and I have both my kidneys. Exactly! That took like .3 seconds. Brian, you are heartless and cruel. Why should we help you as a society? You have two functioning kidneys, we will not help you until you have given a kidney. What is that called? Anybody know what that is called? Extortion, that could be one term for it, or coercion. We are now forcing people to give up organs. You go, Jeremy, this is a hypothetical world, it would never happen. I guarantee you it would happen. If not on a state level, definitely on a personal level, talking behind people's backs, that jerk is poor and getting welfare, and that idiot hasn't even sold one of his kidneys yet. You don't think that would happen? That would happen today. Some of you people might be the ones that at least think that for a second, right? Like, you know, he does have a kidney. People are already like, why doesn't that bum go get a job? Which is a true thing sometimes. Like, yeah, he should totally go get a job. And other times, there's some mitigating circumstances. We're very quick to judge other human beings, right? Just kind of what we do. It's what lazy people with lots of time on their hands have a very good time doing. Easy time doing. It will very quickly turn into something that is coercive for those who are poor. It also may lead, well, likely lead to a lack of care for the sick person. Imagine I am married with two children. Say that we are in this setup. We are desperately poor, and I am sick. I have a brain tumor, let's say. My other organs function just fine. However, let's say that my organs on the current market trend are worth $17,200. You take everything, right? The parts that I've got, the going rate, that's what I'm worth. There is at least a shred of a percentage, probably more, because I'm a jerk, in Marge's brain that is thinking, you know what? Let's just forego that treatment, Jeremy. Let's just go. Let's just have a little vacation. You can just go on out. The amount of care that dying people who had harvestable organs that could be used for sale of poor families would go down dramatically. Because we wouldn't actually care about you, we'd care about what's inside of you that could be used for the good of others to benefit from. And you go, those people are jerks. No, those people are humans. I'm sure that there would be middle class people who would think the same thing. I could go on a vacation. We could get a new car. And even the thought, again, we're not even talking about that actually working itself out in society, but do you want, should we want the kind of society that promotes that kind of thinking? Heck no, we shouldn't. I should not want to put you in that position. You should not want me to put me in that position. We should just avoid that kind of stuff. Lastly, on the history scale, in places like Turkey, there seems to be rising tension between Muslims and Jews. Jews are buying organs from Muslims. These donors are usually coming from further east and the Jews are going to Turkey because in Turkey there is a large organ transplantation kind of hub. So Jews are buying organs from Muslims. You go, great. It's like a unification party. You know, they can't get together in life, but they can get together in organs. False. Because some of these organs fail. And if an organ fails from a Muslim that comes into a Jew, what do you think all the Jews say? Anybody? Any guesses? A bunch of racist things. There you go, yeah. All the racist things. That's right. This isn't like hypothetical. This is what's really happening. There are people who are arguing that these, even these, like, so notice you have Israelis who are ticked off with the Turks for doing the procedure and for the Muslims donating it. There is a heightened amount of tension amongst groups. Now you might be able to get away with a practice that is like, okay, so we all know where it comes from and you know exactly where it comes from. That's probably not, I mean you don't have any clue who it comes from. That's probably likely the outcome. You wouldn't know exactly what it was. Let's say if you found out. There is already, I mean you can teach if you want to. There is already enough tension between groups. If you could buy an organ. Now notice, you are now purchasing an organ. Don't you want to know exactly where that organ comes from? Yeah, I need a warranty on this thing, right? I want it to be, notice, now we are going to foster some serious prejudice. I don't want it to be a poor person, because I know what poor people do. I don't want it to be, you know, I'd rather it come from a white person, right? I'd rather it come from an Asian person, or I'd rather it come from a whatever, tall person. If you are buying it, then all of a sudden you have this, we feel, especially in consumeristic society, there is some kind of obligation. I have a right to buy what I want to buy. You are not just going to sell me anything. And then it is going to function the way I want it to function. Because I bought the thing, so do I get a warranty on it? This is why people who are talking about organ markets are saying, yeah, younger people should get a lot more money for their organs. Older people should get a lot less money. So you can actually, there is a concept of a futures market, where you put your organs on the market and as time goes by, at any point you die, then those organs get donated, as long as they are viable and healthy and everything, then you get a certain amount of money. You live longer than the price of those organs would drop, which is insanity. It makes all this sense economically, but it is not exactly the kind of world you and I would like to live in. Also, this idea of selling our organs gets back to this market idea or the Paul Ramsey idea of opting in or opting out. The last thing we want to do is commodify the body. This needs to be a donation, not just this is what we do as a society. Think about also just the way that healthcare is run in general. And this is, by the way, I am not talking about Obamacare, right? That changed just kind of like the pathway to healthcare. But just think about healthcare. If healthcare in the United States, if you thought it from a financial perspective of those paying, not those receiving, is it a beloved sector of our society? No. Why? Why is it not beloved? Very expensive, yes? Yes. There is some, there are some economists who actually make an argument that if we started selling organs, organ donations would go down and they would go down dramatically because people would not want to get wrapped up in the system that is so corrupt and backwards and just messed up, which our medical system is. Now, this is not like some rant against the medical system. We have some medical professionals and future medical professionals here. Thank you very much for your services. However, anybody who is in the medical industry knows this is kind of a crazy place to be. There is all kinds of sketchy stuff that happens. All you have to do is kind of think for about three seconds about drug companies that show up to hospitals and buy lunch for the staff every time they show up. They go, hey, here are some free samples and you should talk about this with your clients. It is just a tip of a gigantic crazy iceberg. And so if we open this up to market so you can sell it now and we are putting this into the health care system, people will be like, I don't even want to get into that. If I am just giving it, this is all donation stuff, great. But if I am actually going to get wrapped up in sales, then I don't want to do this. This system is bound to be corrupt because it is run by human beings. The last thing, and again, I could talk about this for a long time. I already have, way longer than I should have. This would easily favor the rich. I don't know if you hate poor people or love poor people or hate rich people or love rich people. It doesn't really matter to me. But the system of a free market would easily favor the rich. This would probably lead, most people are positing if this happens, it would lead to a two tiered market. There would be the free market, which is for the rich people, and then to address Caleb's concerns, which are valid and are real concerns that people have raised in society, there would be a public market. Now, what do you think the quality of the organs are going to be in the regulated market, the public market? Exactly. You want to buy an alcoholic drink? It would be garbage, right? And there would definitely be this well, we're giving it to you, you pathetic jerk. You should just be grateful. Oh, all the good organs? All the class A and B organs? Yeah, those all get sent up the chain. You could buy it. Would you like to buy one? $20,000. Oh, no, I don't have that kind of money. Great, get the free organ. Oh, by the way, get it in line. You're probably going to die before you get it. Because remember, like, the good organs get shipped up to the top, and people sketch that about this because they don't know if, like, those are all the good organs or if some of the bad organs get shipped up there. Who knows? It's a terrible way to go. This would further divide people all day long, which is something you and I should seek to avoid. So, should we have an open market? Absolutely not. That's just my opinion, of course. I think those are reasonable arguments against it. We would get more organs, possibly. It's not a society worth living in. If the organ market does open up to being a sales thing, it would be a point at which we might have to reconsider whether Christians should participate. It's not the system we have now. But the selling of your body is rather complicated. Second thing, and this is dramatically shorter, is this, the difficulties with being a living donor. Lethal living donations are always and will always, they're currently illegal, they always should be illegal. The kind of classic case scenario, the first one that came up with this, but other people worked off of it, is this. You are the head of a hospital and you learn of a case right before it happens. The nurse comes in and goes, I can't not say anything. This is what's happening. Up on the seventh floor, there's a father that is being prepped. On the sixth floor, there is a son. The son has been in the hospital off and on for the last six months. He has a heart failure. What's happened is they've figured out that there is a match. There is a great match. There is a genetic match. And the father is going to give his heart to his son. So the case comes to you and the question is, the nurse is bothered. She goes, should we go through with this or not? What's the answer? Huh? 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