The Uniform Anatomical Gift Act (UAGA) authorizes the indication, either in a will or on a driver’s license, of a desire to donate one’s organs or body post mortem to act as a legal document. It is crazy to think that any form of legal documentation not be honored and upheld in American society, but apparently it is not uncommon for doctors or even the Organ Procurement Organization (OPO) to allow the family to act against the expressed wishes of the deceased. According to the UAGA, if a person has indicated their preference to be an organ donor, legally, the family has no say in the matter. So, why is such a decision, one made autonomously and ethically accepted as to be respected, so easily overruled at times? D. W. Donovan, a chaplain and vice president for mission and spiritual care at Providence Regional Medical Center in Everett, WA, claims that it is common practice to grant families the ability override previous declarations made by the deceased and offers three reasons for this in his article Defending the Donor’s Decision.
Although a doctor or OPO official have no legal reason to honor or even consider a family’s request to override the wishes of the deceased in regards to donating their organs, Donovan points out that it “can often leave medical personnel caught in the middle of an emotionally charged event” and put them in an awkward position when confronted by an “angry family member who is strenuously opposed to donation” (1). A study conducted in 2001 indicated that only 8% of OPO’s were likely to procure the deceased’s organs if the next of kin objected (1). Respecting a family’s overriding wishes, spares the doctor and the family member’s emotional distress presented by the situation.
Refusing to appease a grieving family member’s desire to keep their deceased love one “whole” or in-tact can have negative repercussions on the health facilities and is another reason that Donovan offers as to why we give in to family member’s requests. Although supporting a person’s decision to be an organ donor is an act of respect for the patient’s autonomy, it can be perceived alternately by the public as an “invasion of privacy and bodily integrity” and can result in poor public perception of that medical facility which is something that doctor’s would obviously want to avoid.
The third reason Donovan offers is that many regard a person’s choice to be an organ donor to not be an authentic autonomous decision. Miller’s article (that we read the other day) listed 4 qualifications for a decision to be regarded as autonomous: free action, authenticity, effective deliberation, and moral reflection. The choice to become an organ donor or not is made by checking a box at the DMV that literally just asks you if you want to be an organ donor. There is no explanation of what that entails, how the process works, how the organs will be procured, etc. Surely Miller would say that this is not a truly autonomous decision. Without any information about risks, benefits or alternatives to consider, how can one actively participate in effective deliberation even if it is a choice free of coercion and true to one’s generous disposition?
Are these common arguments enough to grant a family paternalistic authority over the body of a deceased loved one? I think it’s important to realize that emotions over the loss of a loved one often cause family members to act/think irrationally which certainly should at least prompt discussion of its own to determine whether decisions made in such emotional states can even really be consented to as autonomous.
1. http://www.chausa.org/publications/health-progress/article/march-april-2008/defending-the-donor’s-decision
I think it would be interesting to ask those family members, “what if your loved one’s life could have been saved by a donated organ?” This should especially bring things into perspective under the cases where the donor had indicated their intentions to do so willingly. This post made me wonder as well under what circumstances specifically we lose autonomy. Such stories, which I was not aware were possible, indicate autonomy is lost at death. This also suggests that doctors have a say in the situation at hand, by deciding to give into pressure of the family or sticking to the legal document. This choice of their own removes autonomy. Such occurrences discredit the purpose of the system, and I agree that the process in making the decision should, as a result, be more extensive and perhaps require the agreement of immediate family members as well.
I, like the comment above, wonder where autonomy ends. Do we still had the obligation to respect autonomy after death when there are lives that can be saved by going against the dead person’s wishes? I’m not sure what the right answer is in this situation but it is definitely something worth debating.
I also agree with your point that checking the box to become an organ donator is not a fully autonomous decision. The decision is made in a split second with most likely no past research and therefore does not meet the criteria for effective deliberation at the very least. I think information on the pros and cons should be given or at least available at the time so that a more educated decision can be made. If a well thought out decision was made, it would be much easier for family members and doctors to respect the wishes of the deceased.
Doctors are choosing the easy way out when they go against the deceased’s wishes and comply with the family that is still living and mourning their recently lost loved one. Inevitably, when a family feels differently then the deceased about organ donation, the family is willing to put up a fight. As for the deceased, they won’t be putting up any sort of fight. So, even though the legal documents are there and the wishes of the deceased are clear, it becomes much easier for the doctors to avoid a scene and just take the easier route of going along with the family’s request.
I like how you mentioned avoiding distress for the family that is left. It is the responsibility of doctors to care for people; if their patient has died, is the patient still the priority? Or has the responsibility of the doctor shifted to the well being of the remaining family? If that is the case, then causing further distress to a family would be against a doctor’s better judgment, does that mean that the right decision is to appease the family, or should they continue to uphold the deceased’s autonomy?
I also think it’s interesting how you brought in the argument about Miller’s view of autonomy. However, I do not agree with him in the sense that choosing to be an organ donor is not an autonomous decision. The information about organ donation is available and can be inquired about. Just because information about it is not spoon fed to us as we fill out our driver’s license, does not mean that the decision lacks autonomy. At some point we must take responsibility for our own autonomy.
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