Medicine and Morality 2

It looks like the ministry of health is willing to study the option of "legalising organ trading in Singapore" after all.

However, it seems that morality is still a consideration for the health minister when he said:

"If you allow trading, currently those who volunteer for the family members or under HOTA, they may then object and say, 'since you can now buy organs, then why should I volunteer to save my family members?'

Why should they indeed? After all, the aim of the transplant is to improve the patient's health, and not to give his relatives a chance to demonstrate their selflessness.

While the chances of finding a matching donor amongst relatives are higher, with the proper selection process and follow-up, transplants from living unrelated donor (whether a spouse or a 'seller') have good long-term results. Patients whose relatives are unable or unwilling to donate their kidneys must look to unrelated donors, living or dead.

More resistant to the idea, however, is the Singapore Medical Association:


SMA against legalising human organ trade
By Valarie Tan, Channel NewsAsia

SINGAPORE: Doctors in Singapore are split over whether human organ trading should be legalised in the country.

A medical ethics debate over the issue has been re-ignited in recent weeks after five persons were prosecuted over illegal kidney-for-sale deals.

For the Singapore Medical Association (SMA), after much internal discussion, it has come to a collective stand that it does not support legalised organ trading.

In response to queries by Channel NewsAsia, the SMA said that besides the medical risks to the organ seller, there is too much potential for abuse of disadvantaged individuals. It is also difficult to make the process transparent and equitable.

The SMA represents two-thirds of doctors and specialists from the private and public hospitals in Singapore. It said emails and discussions were exchanged over the past two weeks, and its 16-member council held an emergency meeting on Saturday to deliberate.

Dr Tan Sze Wee, a spokesperson for the SMA, said: "Within the council itself, we had a debate and the views were split down the middle as well, between those who felt that there could be a possibility of legalising it because of the good it can bring to the recipients - the quality of life, saving a life.

"However, the other point that we still felt was very important is - how are you able to administer it? The devil is in the details."

But with the number of kidney patients growing in Singapore, the SMA said the call to legalise organ trade may grow stronger in the future.

Dr Tan said: "It may, but the voice for legalising organ trade is not something that's a current topic. It has been around since the beginning of time. But we recognise the fact that the human body itself cannot be treated like a commercial property that it can be traded with a value.

"There are medical complications, short-term and long-term. The short-term risks are... the operation itself, anaesthesia for both the recipient and the donor in the surgery.

"Long-term risks are: if you have two kidneys and you donated one... what do you do when something happens to you? Some accident or some illness, then you've got no back-up plan. And, it's well documented that organ donors do suffer from, what we call, donor remorse."

The SMA was not able to comment on the implications on the growing number of patients getting transplants from non-related donors in Singapore. In 2007, 33 patients received kidneys from non-related living donors compared to 19 in 2006 and six in 2005.

However, the SMA does support the suggestion to have transplant patients screened at the Health Ministry level, instead of just leaving it to a hospital ethics committee.

Dr Tan said: "I think that's definitely better. I think that is something for the ministry to work out to ensure that such cases do not repeat again.

"There are so many things that can possibly happen that even if you want to think about ways to put safeguards in to prevent illegal activities from happening, there are a lot of details that have to be worked out."

(snip)


angry doc wonders how the SMA, with it's membership "split down the middle", could choose to make a stand on the issue; essentially, SMA is making the stand of one-third of doctors in Singapore its official stand.

What is worse are the reasons SMA had given for opposing the legalisation of organ trading.

Had the SMA stuck to the moral argument of "the human body itself cannot be treated like a commercial property that it can be traded with a value", angry doc would have respected that, even if he did not agree with it.

However, Dr Tan showed that the SMA's position may stem more from a lack of moral courage than moral conviction when he argued:"There are so many things that can possibly happen that even if you want to think about ways to put safeguards in to prevent illegal activities from happening, there are a lot of details that have to be worked out," and when he asked "how are you able to administer it? The devil is in the details.".

In other word, faced with the complexity of the task of regulating organ trading, SMA has chosen to object to it than to participate in looking at whether we can create a system that will minimise unfairness to parties concerned. How noble.

Dr Tan also could not help throwing in some flawed arguments against organ trading:

"There are medical complications... The short-term risks are... the operation itself, anaesthesia for both the recipient and the donor in the surgery."

This is not a valid argument because all surgeries which are performed under anaesthesia carry anaesthetic risks. More importantly, risks to donor and recipient are similar whether they are related or unrelated. If the SMA's position is (as angry doc's is) that it is unethical to subject a person (the donor) to anaesthetic risks for a surgery that does not benefit him physically, then should it not similarly object to living-related transplant?

"...if you have two kidneys and you donated one... what do you do when something happens to you? Some accident or some illness, then you've got no back-up plan."

Here Dr Tan chose to appeal to fear, instead of providing the public with actual risks to donors in the form of statistics to allow them to make their own decisions on whether or not donation constitutes an unacceptable risk.

How many donors actually require renal replacement therapy due to trauma to their single remianing kidneys? How many donors go into chronic renal failure due to diseases which would not have affected both kidneys equally had he not donated one anyway?

If Dr Tan is concerned with the lack of a "back-up plan" for donors, will it not be better to provide for their interests by having a regulated system that covers their medical follow-up and costs, and which makes more organs available?

angry doc feels that Dr Tan had not represented the position of the half of its membership which do not oppose legalisation of organ trading adequately or fairly; by making a moral stand on the issue and backing it up with flawed arguments, Dr Tan gives the impression that the SMA is willing to impose the morality of some doctors over the public, and that its members either think that the public are too dumb to see through the flawed arguments, or that its members themselves are, when in reality it may be more a case of SMA being unwilling to tackle the issues of organ trading head-on.

The fast pace of progress in medical science means that we are now often faced with treatment options which are not available a generation ago - options which morality we, as a society, have yet to come to an agreement on. angry doc feels that while doctors are individually entitled to their own moral viewpoints, and as a profession our ethics allow us to choose whether to participate or refrain from participation in a certain type of treatment, as advocates for our patients our role when it comes to a medical issue should be one of active participation through education and provision of information. We must not try to abdicate our responsibilty while using the morality of a portion of doctors as an excuse.