A Dutch broadcaster will air a show this week in which a terminally ill woman selects a recipient for her kidneys from three contestants, despite government calls for the programme to be scrapped…
She will make her choice based on the contestants’ history, profile and conversations with their families and friends. Viewers will be able to send text messages advising her during the 80-minute show.
“The chance for a kidney for the contestants is 33 percent. This is much higher than that for people on a waiting list. You would expect it to be better but it is worse,” the daily cited BNN Chairman Laurens Drillich as saying.
My first reaction: anger at the shows producers.
Then, my philosophical training kicked in. I wondered…
- Is the utilitarian reasoning of the network’s chairperson correct?
- What reasoning processes will the terminally ill donor make, and what factors will she consider? Does a single man with no children stand a chance against a married woman with children?
- The three candidates have doubtless been screened to make for ‘good television’. They might not be the people at the top of the waiting list. Is jumping the queue immoral? Is it unethical to select on the basis of something other than medical need? How do the screeners justify their choices?
- What decision-making processes will the audience make? Will they be emotionally swayed by sob stories? Will they focus on the relative beauty of the ‘contestants’? Their wealth, race, religion or home town? What allegiances will be relied upon, and be considered morally relevant?
- What kind of post-decision counseling will be given to those who lose?
- Will the terminally donor receive ethics counseling during the decision making, and psychological counseling afterwards when she realizes she has condemned two people to die – just like her?
- Would it be ethical for an ethics counselor to participate in this? Conversely, do people trained in ethics have an obligation to call in and offer advice?
- Is it ethical for the doctors and hospitals to be involved? Does the medical licensing authority have an obligation to step in and stop the spectacle? How did this survive an ethics review board?
- What does the donor get out of this, and does it matter?
- Would it make a difference if the donor was not terminally ill?
- The Dutch have a new system of public healthcare. Who is picking up the tab for the procedure – the network? Does it matter?
- How is the donor’s decision enforced? Is it a contractual arrangement? Could the doctors legally ignore the donor’s wishes? Ethically?
- Is all of this this excused if it raises awareness of the problem faced by people needing donor organs, and causes more people to donate?
- Why was I so filled with outrage, and why is that anger now muted by thinking about the ethical issues?
Chris and I have poked at the idea of the psychology involved in every-day moral decisions. This is most certainly not one of them.
My sympathies go to the families involved, to those with kidney disease awaiting a transplant, and to the production crews who have to document this tragedy.
Update: CBC News coverage of the story has a partial answer to my 12th question. The decision can’t be enforced.
“A spokeswoman for BNN said that could be no guarantees the donation would actually be made, “but the intention is” Lisa’s donation would be carried out before she died.
That’s because her wish to donate to a particular candidate “wouldn’t be valid anymore after her death” under Dutch donation rules, Marieke Saly said. If Lisa does donate one kidney while living, the other kidney may still be awarded to someone else on a national donation waiting list under the country’s organ allotment system.”
Update: This BBC story suggests the network chairperson anticipated the controversy, when he said,
we are acting in a shocking way to bring attention to this problem.
Update: Kelly Hills at Bioethics.net raises some of the concerns I’ve expressed above:
Are you pretty enough, sexy enough, compelling enough to be picked out of a flood of applicants to receive the chance of care? Will your story win the hearts, minds, and most importantly, votes of the viewing public?
Update: And finally, it is revealed this is just a hoax.