Paul A. Byrne, M.D.
Bioethics experts challenge the 'Revised Uniform Anatomical Gift Act (2006)'
By Paul A. Byrne, M.D.
The following letter to the editor by three bioethics experts was recently submitted to Critical Care Medicine.
We agree with Iltis et al. [1] that the enactment of the 2006 Revised Uniform Anatomical Gift Act and its subsequent 2007 amendment represents a serious transgression on civil liberties in the United States. If organs are removed from donors without fulfilling the legal definition of death [2], then enforcement of the Revised Uniform Anatomical Gift Act can also be a direct violation of the Fourteenth Amendment of the United States Constitution (1868):
"No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
The revisions to the federal policies and state legislations were made on the recommendations of several concurring reports from governmental committees, health regulatory agencies, and prestigious private professional organizations [3]. These entities represented a select group of shareholders (e.g., transplant professionals and advocates) but were also without a proportionate representation of the principal stakeholder (i.e., the general public) [4]. The disproportionate representation served the objective of maximizing opportunities for procuring human organs for transplantation.
Although organ transplantation can save human lives, organ procurement and transplantation activities take place within financially prosperous, domestic, and globally competitive markets [5]. We had previously outlined at least two steps to resolve the societal challenges created by the Revised Uniform Anatomical Gift Act [6].
First, doctors and hospitals must fulfill their legal obligations to patients or surrogate decision makers by disclosing organ donation legislations particularly the sections 14 (c) and 21 (b). They must also disclose that patients have the right to document preferences about the use of life support systems for preserving organs at the end of life.
Second, a broad-based societal discussion must be initiated to resolve the infringement of the Revised Uniform Anatomical Gift Act on an individual's autonomy. We think that the US Congress is the proper authority to initiate such a discussion and to ensure the respect of diverse personal values, cultures, and religious practices in a pluralistic society.
The authors have not disclosed any potential conflicts of interest.
Joseph L. Verheijde, PhD, MBA, PT, Department of Biomedical Ethics, Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Phoenix, AZ, Bioethics, Policy, and Law Program, Arizona State University, Tempe, AZ; Mohamed Y. Rady, MD, PhD, FCCM, Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ, Bioethics, Policy, and Law Program, Arizona State University, Tempe, AZ; Joan L. McGregor, PhD, Department of Philosophy, Arizona State University, Tempe, AZ
NOTES:
© Paul A. Byrne, M.D.
April 14, 2009
The following letter to the editor by three bioethics experts was recently submitted to Critical Care Medicine.
We agree with Iltis et al. [1] that the enactment of the 2006 Revised Uniform Anatomical Gift Act and its subsequent 2007 amendment represents a serious transgression on civil liberties in the United States. If organs are removed from donors without fulfilling the legal definition of death [2], then enforcement of the Revised Uniform Anatomical Gift Act can also be a direct violation of the Fourteenth Amendment of the United States Constitution (1868):
"No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
The revisions to the federal policies and state legislations were made on the recommendations of several concurring reports from governmental committees, health regulatory agencies, and prestigious private professional organizations [3]. These entities represented a select group of shareholders (e.g., transplant professionals and advocates) but were also without a proportionate representation of the principal stakeholder (i.e., the general public) [4]. The disproportionate representation served the objective of maximizing opportunities for procuring human organs for transplantation.
Although organ transplantation can save human lives, organ procurement and transplantation activities take place within financially prosperous, domestic, and globally competitive markets [5]. We had previously outlined at least two steps to resolve the societal challenges created by the Revised Uniform Anatomical Gift Act [6].
First, doctors and hospitals must fulfill their legal obligations to patients or surrogate decision makers by disclosing organ donation legislations particularly the sections 14 (c) and 21 (b). They must also disclose that patients have the right to document preferences about the use of life support systems for preserving organs at the end of life.
Second, a broad-based societal discussion must be initiated to resolve the infringement of the Revised Uniform Anatomical Gift Act on an individual's autonomy. We think that the US Congress is the proper authority to initiate such a discussion and to ensure the respect of diverse personal values, cultures, and religious practices in a pluralistic society.
The authors have not disclosed any potential conflicts of interest.
Joseph L. Verheijde, PhD, MBA, PT, Department of Biomedical Ethics, Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Phoenix, AZ, Bioethics, Policy, and Law Program, Arizona State University, Tempe, AZ; Mohamed Y. Rady, MD, PhD, FCCM, Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ, Bioethics, Policy, and Law Program, Arizona State University, Tempe, AZ; Joan L. McGregor, PhD, Department of Philosophy, Arizona State University, Tempe, AZ
NOTES:
[1] Iltis A, Rie M, Wall A: Organ donation, patients' rights, and medical responsibilities at the end of life. Crit Care Med 2009; 37:1–6
[2] Miller FG, Truog RD: Rethinking the ethics of vital organ donations. Hastings Cent Rep 2008; 38:38–46
[3] DuBois JM, DeVita M: Donation after cardiac death in the United States: How to move forward. Crit Care Med 2006; 34:3045–3047
[4] Mongoven AM: Duties to stakeholders amidst pressures from shareholders: Lessons from an advisory panel on transplant policy. Bioethics 2003; 17:319–340
[5] Hauboldt RH, Hanson SG, Bernstein GR: 2008 U.S. organ and tissue transplant cost estimates and discussion. Available at: http://www.milliman.com/expertise/healthcare/publications/rr/. Accessed December 10, 2008
[6] Verheijde JL, Rady MY, McGregor JL: The United States Revised Uniform Anatomical Gift Act (2006): New challenges to balancing patient rights and physician responsibilities. Philos Ethics Humanit Med 2007; 2:19. Available at: http://www.peh-med.com/content/2/1/19
© Paul A. Byrne, M.D.
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