Organ transplant procedures are one of the most challenging and complex areas of modern medicine. If successful, organ transplants could improve and save many lives worldwide. This new technology poses the risk of organ rejection, and comes with barriers of time sensitivity, financial cost and inadequate availability of healthy donor organs. Suppose however, for the principle of this paper that organ transplant procedures have been perfected; there exists little to no risk in ensuing the procedure and the only obstacle standing in the way of organ transplant which remains is that of moral ambiguity. This paper will address both sides of ethical debate surrounding transplants and make a case for one solution to the organ shortage.
I. Y and Z's proposal of a survival lottery
Two patients, Y and Z, are the victims of organ failure. Without new organs they have no chance of survival. Given the success of organ transplant procedures, Y and Z know that if they could receive new, healthy organs save both of their lives could be saved. Y and Z share the logic that if their doctor does not provide them with healthy organs, even though he has access to them, then he is responsible for their death. The doctor becomes the murderer of Y and Z.
On these grounds, Y and Z offer a proposal: The Survival Lottery. The objective of The Survival Lottery is to save more lives. The idea is to harvest organs from one healthy individual and endow them onto more than one sick, dying patient, thus reducing the number of lives lost. The lottery would include healthy and unhealthy, but otherwise equal members of society. Despite initial doubts because of moral intuition, the process of The Survival Lottery is a fair process. The “Thought Experiment”, which can help us determine how just the given situation is by randomly assigning whether an individual sick, or healthy, further demonstrates that the survival lottery is fair.
Y and Z believe that they have just as much reason to live, as does the healthy individual A. They do not deserve to die just because nature made them the victim of organ failure, and allowed A to stay fit with functioning organsl. Given that Y and Z have just as much reason to live, and that The Survival Lottery is fair; Y and Z's proposal for the survival lottery is acceptable.
II. In defense of Y and Z's proposal of a survival lottery.
Many OBJECT to the idea of a survival lottery. Because most people are not faced with a life-threatening medical problem, they could not imagine signing up to sacrifice their happy, healthy lives to be harvested for a stranger in need. It is worth considering, however, how these people would feel is they were suddenly afflicted by organ failure, and thrown into Y and Z's situation. Still, there are various arguments to contend the morality of The Survival Lottery.
One objection to Y and Z's proposal deals with humans “playing God”. Some feel strongly that to alter one's natural course of life- the one “God” planned for them is wrong. These people believe that Y and Z's deaths have been determined by nature and are thus expected. To intervene with their deaths would be unnatural and hence immoral. This argument, however, is ludicrous, because it would contradict the morality of organ transplants in any situation. For the most part, our society already embraces organ donation, and has been practicing it for decades. It is irrational to argue The Survival Lottery's selection would be any more like “playing god” than modern medicine is already doing.
Another objection critics make is that the survival lottery is a great threat to our security. Everyone, even those who may contribute a great deal to society, share an equal chance of being drawn in the lottery and having their lives immediately ended. This reduced sense of security could create a serious amount of distress among our world citizens and have a profound impact on our ability to function. Proponents of The Survival Lottery however, emphasize the rarity of being selected, and address the “fear factor” for its minimal impact on our world's quality of life. In addition, supporters of The Survival Lottery lobby for the fairness of the survival lottery process. The artificial lottery would allow five-hundred people each year to die by organ donation, and have zero die of organ failure. The natural lottery- one completed left untouched by medicine- would permit one thousand people to die each year by organ failure, and no one from donation, showing that the odds of survival are better in a society which embraces the artificial lottery. If by killing one, a doctor can save two, there should be no argument to Y and Z's proposal of a survival lottery.
The feeling that no man should be required to lay down his life for others makes many shy away from the lottery scheme, but we must assess both viewpoints. Opponents argue selecting to live in a society that abides by The Survival Lottery would be to adopt a society where saintliness is mandatory. Each member of society would be obligated to give up their life, and recognize the obligation of their child to give up his or her life, if randomly chosen. Any individual who rejected this duty would be considered a murderer, but is that fair? To re-address the “ thought experiment”, the lottery process is fair across society- there is equal risk to every member of the community to be healthy or not. If we were in Y and Z's shoes, we would recognize our innocence in the matter, and in our self-defense argue that no other man deserves to live more than both Y and Z.
Lastly, some would contend that Y and Z support the survival lottery because they have nothing to lose; they have been given a death sentence by the failure of their organs. By putting their names in to the lottery, they do not increase their chances of dying. A on the other hand has everything to lose, a healthy life, family, friends, responsibilities and a future. Individual A would never choose to be in the lottery given what he has. However, this argument goes against everything Y and Z have been reasoning. If their lottery proposal is adopted, they do not have a death sentence, rather they have a chance at survival. And with a chance at survival, they are again found equal to every other member of society. So, to leave Y and Z to die would discriminate against Y and Z, treating them as members of a class less deserving of life than the rest of society.
III. Objecting and Response to Y and Z's Proposal of a survival lottery.
The strongest argument against Y and Z's proposal of the survival lottery addresses the issue of innocence. It is wrong to kill the innocent, this fact is hardly debatable. The matter at hand however, is not whether killing the innocent is wrong, but determining who is innocent. Individual A is innocent, just a regular healthy person. Subject A has done nothing to deserve being put in to the lottery, or being killed for use of his organs. Y and Z are equally innocent, just unlucky victims of organ failure, simply recipients of weaker genes passed down by nature. Given the shared innocence of Y and Z with A, no one individual deserves to die more than another. Because there is no moral distinction between killing, and letting die, Y, Z and A all have the same right to live. Killing A to save both Y and Z, should be viewed as the more reasonable course of action, because this would save two lives instead of one. Objecting to this argument however, one could contend that Y and Z were chosen by natural selection to die. Nature found them unfit to survive on earth, and by ending their lives, would stop their genetic plague of sick organs. It may not be fair, but it is how natural, and taking into consideration the future generations, it does not make sense to save those with weak organs. Individual A on the other hand, is healthy, and fit to survive. He should not have to die, he is healthy and thriving, with the potential to procreate and enhance the vitality of future generations. Given A's conditions, he is in fact more worthy of living.
Considering all arguments in support of Y and Z's proposal, as well as all objections to the survival lottery, it can be concluded that Y and Z's proposal is permissible. The initial hunch from moral intuition dissuades many from agreeing with the survival lottery. It is difficult to see how one could agree to random death by lottery; but consider the risks we take everyday- getting hit by a car, crushed by an earthquake, shot in a drive-by- any of these freak accidents are equally likely to occur and end our life. Every person is uniformly susceptible to being the victim of a freak accident, organ failure, or being chosen from the lottery. And to reiterate, there is no ethical discrepancy between killing and letting die- hence it is no more fair to allow Y and Z- innocent victims- to die, than to kill A, especially when doing so could save more people. Y and Z's proposal of a survival lottery is thus morally understandable and acceptable.