Let’s play a game of being the moral police

First of all I want to make clear that this is not an advertisement for becoming a organ donor, it is merely something that is on my mind for a while now.

Being in health care, you come to realise that it is a sector with a lot of stakeholders that all want to have their saying. It started way back when religion ruled every aspect of our lives up until now where our world is driven by science and money. There is not much difference between the church telling health care it can’t do “x” because of faith and holy documents, and the government telling the same because of money, morality or ethics. When you’re looking at health care in Sweden (which is build on using tax-money to pay for it) one could be easily startled by the complexity and difficulties of understanding it. It is truly frighting to see how deeply indulged the field is in trying to keep everybody happy; even up to the point that sometimes the quality of care is compromised because of decisions that have to be made in favour of some of the major stakeholders.

For numerous of times, I have been confronted with people that had someone in their surroundings being seriously ill, were terminally ill themselves or simply were hoping or praying for a donor so that they can survive a few more years. Sometimes medical facilities aren’t that enthusiastic when it comes to searching for available organs. I could never grasp why some individuals got very expensive donor procedures that were doomed to fail, while others were refused to receive a simple procedure that has shown its success over and over again simply because of (fill in whatever reason you can come up with.) Studying and working in health care myself I understand how difficult it is for the whole field to make decisions that can change a persons’ life in such a disruptive way.

When you’re looking at a specific field of health care, health economics, morality and ethics is something that is always taunting the decision making process of the field. As a doctor you always want to find the best treatment for your patient possible. You don’t want to be challenged to find a cheaper solution for a problem, just like a car-mechanic doesn’t want to be told to fix a driving axle with a stick and some rubber bands. Without the presence of health economics a lot of hospitals would be without any money within a month or so; and governments would see a significant raise in cost of care. But the profession has to undergo a lot of moral and ethical discussions.

While I was driving home I was thinking about money, valuing health care and the debates you can have about them. I finished reading a book called: “ Contemporary Debates in Bioethics” (link). It goes in deeper on the different ethical questions that arise in the field in money, health economics and the putting value on the human body. One of the questions they raised in the book was:

Is It Morally Acceptable to Buy and Sell Organs for Human Transplantation?

My immediate response, based on living in countries that offer health paying models based on the Beveridge model, was “morally unacceptable but emotionally understandable”. Depending on the payment model your country is using, putting a ‘price’ on organs might actually benefit the sector as a whole, I’ll leave it in the middle whether it is moral or not. In a single-payer health care system making sane decisions to alleviate the most suffering it is very important to put a ‘price’ on a human life (as awful as it might sound); otherwise we might fail to prioritise efficiently. That, specifically, was underlined a couple of years ago while I was doing courses in health economics. It was explained to me that the price of a human life depends greatly on a variety of different factors, bootstraps, stats, facts and opinions.

When looking at a life-changing procedures such as performing organ donation many concerns arise in the process. The great thing about it is that it can extend the lifespan of the receiver but it also might (if not already deceased) substantially shorten the lifespan of the individual donating, for instance, their kidney. The fact that we are raising the question whether or not it is “Morally acceptable to buy or sell organs for human transplantation” shows that there is something fundamentally wrong with the organ donation system as a whole. Transplantation lists at the moment are so long that half of the people on those lists die in the process of waiting.

What is even more mind boggling is that on one side governments and their politicians are playing the “moral blame-game”whether it is politically correct to change the donation system from an opt-in to an opt-out system, while on the other side people are dying and desperately buying organs of the illegal market to survive. The growing illegal market results in an increasing number of children and teenagers being kidnapped, taken to places with medical equipment and having their organs harvested for the illegal trade market after they have been murdered.

It is a sector that generates between €600 million and €1.2 billion per year. And in the meantime, politicians and governments can’t agree on finding a sustainable solution to prevent these cruelties from happening while on the other side patients pass away after a fatal (car) accident or a terminal illness not knowing that their organs could safe one or more people from dying.

Being an organ donor myself, I registered myself in all the countries I have been living in that I want them to use nearly all of my organs except my corneas and skin so that I can help people that need them more than I do (It’s not that I can take them with me to the afterlife anyway). Despite that I am probably biased in my decision making, I applaud countries that have made the difficult decision to change the organ donation system into an opt-out system (as for instance Austria, Belgium or Spain did).

Austria having a donor consent rate of 99.98% does not have to ask itself the question whether or not it is morally correct to ask money for organs for human transplantation. By law it is regulated that all it’s citizens are organ donors except if an individual explicitly refuses to be one. And so should it be for the rest of Europe and the world. I think we sometimes put ourselves in difficulties always trying to play the moral police. Whether it is because of faith, money, political or cultural believes, the question how we can make health care work more efficiently rises up because the way we are working now is not sustainable and it clearly needs improvement.

Are we willing to accept that these improvements might hurt a bit? Are we also willing to stop being the moral police and look at the bigger picture if it can significantly improve the situation in our hospitals and the cost of care. I wonder what your opinion is about this, please share!