Tuesday 24 April 2012

Ethical elasticity

If Otago medical ethicists think it's abhorrent that organ donors might be compensated, why is it ethical for the University of Otago Medical School to pay for the cremation of cadavers donated for research?

From the Department of Anatomy's guidelines:

Funeral service         

Because the donor's body has to be specially embalmed very soon after death, it is not possible to hold the usual funeral service with the body present.  However, a memorial service can be held without the body being present, if the donor or the relatives wish.  This is to be arranged at the estate's expense. 

Costs paid by the Department of Anatomy

The Department pays the expenses of our special methods of embalming, and for transporting the body from the place of death to the Department in Dunedin.  The Department also pays the cost of cremating the remains.  The donor's estate will be required to register the death in the usual way.
So, what's cremation worth? SimplyCremations charges $1,495 for body removal, cremation, and return of the ashes without memorial service. Otago can return the ashes to the family, but prefers to scatter them without service at the local cemetery; the service is roughly what the budget cremation service above provides.

Recall what the University of Otago's Professor John McCall said about ethics, cash, and organs:
Where commerce has had things to do with organ donation, terrible things happen. If you make it legal it’s still open to exploitation, and I think trading organs for money is fundamentally ethically untenable. The people who are most exploited by that tend to be the poor.
There are ethical considerations in the anatomy department as well:
The most resounding of such ethical concerns, according to Professor Jones, was the appropriateness of using “unclaimed” bodies as medical cadavers. As he says, “Those [unclaimed] bodies tended to be from the poor, the disadvantaged, the outcast, and generally the most vulnerable people of society. Altruistically bequeathed bodies seemed to me to be far superior, ethically.”

Although the University of Otago now relies solely on bequeathed bodies, Professor Jones aims to get the anatomical profession worldwide to think seriously about the repercussions of using unclaimed bodies. “[Use of unclaimed bodies] opens the door to very dubious, ethically slippery circumstances. 


Indeed, the interests of the body’s family are granted high regard in matters concerning body bequests – as I’ve already mentioned, they have the power to veto the whole donation process. Is it really fair to give the wishes of the living such weight over the wishes of the dead? Professor Jones thinks that, “…ethically, this is an area that’s full of tension. And it’s exactly the same when it comes to donation of organs… If the family says ‘no’, then they override [the intention of the donor]. The families’ wishes and feelings are placed above those of the donor, and that’s a highly debatable issue.”

Professor Jones insists though, that it’s important to realise that the gift of a body is not just a gift from the deceased, but also a gift from the deceased’s loved ones. Once again, this brings us back to the central motivation of altruism – an attitude which Professor Jones stresses is important throughout all aspects of medicine: “The issues that we encounter here are very similar to the issues that we encounter in clinical medicine. And that the basic ethical value of altruism really was, and should be, the main driving force.”
It's fortunate for Otago's anatomy department that they are able to get enough bodies for their purposes through altruistic donation, and that their ethicists don't view a $1,495 cremation subsidy as interfering with the altruistic decision by the deceased or the deceased's family.

Would that similar consideration to organ donors be deemed ethically acceptable.

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