5
Planet Debate 2014
L-D Fall – Organs
Topic Wording 6
**DEFINITIONS** 7
Distinction Between Types of Consent 8
Presumed Consent =Opt-Out 9
Presumed Consent: Requires Proof that Deceased Would Have Consented 10
**ORGANS IMPACTS** 11
*Organ Shortage Now* 12
Organ Shortages Widespread and Increasing 13
AT: "New Technology Will Solve Organ Shortage" 15
AT: "New Policies Reducing Organ Shortage" 16
*Organ Shortage Now Answers* 17
US Supply Increasing: Breakthrough Collaborative 18
US Supply Increasing: 2006 UAGA Improvements 19
Current US Policy Increases Supply Without Compromising Principles 20
Family Veto Role Declining 21
*Organ Shortage Impact - General* 22
Consensus that Organ Transplantation is a Public Good 23
Organ Shortages Kill 24
*Organ Shortage Impact - Xenotransplantation Bad* 25
Organ Shortage Drives Xenotransplantation Research 26
Organ Supply Key - Banning Research Won't Solve 27
Xenotransplantation Impacts: Military Readiness 28
Xenotransplantation Impacts: Health Care Costs 29
Xenotransplantation Impacts: Disease Outbreaks/Extinction 32
Xenotransplantation Impacts: No Tech Solutions 37
*Organ Shortage Impact - Global Trafficking* 38
Link: Shortage Increases Trafficking 39
Organ Trafficking Exploits the Poor 40
Organ Trafficking Unjust 41
*Organ Shortage Impact Answers* 42
**AFFIRMATIVE** 43
*Presumed Consent Good* 44
Opt-In Systems Increase Organ Shortage 45
Generally Justified 46
Immoral Not to Adopt Presumed Consent 47
Justified Under Utilitarianism 48
Morally Justified : Better for the Family 49
Should Adopt Presumed Consent System 50
Presumed Consent Reduces Organ Trafficking 51
Presumed Consent Increases Organ Supply 52
Presumed Consent Causes More People to Choose Donation 55
Presumed Consent Decreases Family Opposition 56
Presumed Consent Effective: Empirical Evidence 57
Presumed Consent Effective: Spain Proves 58
Presumed Consent Effective: AT- "Family Veto Trumps" 59
Presumed Consent Effective: AT- "Undermines Trust in System" 60
Presumed Consent Solves Commodification 61
Many Countries Use Presumed Consent Systems 62
AT: "Presumed Consent Unethical" 63
AT: "Presumed Consent Violates Individual Autonomy" 64
AT: "Presumed Consent Coercive" 66
AT: "Presumed Consent Infringes on Religious Freedom" 67
*Mandated Choice Good* 68
Mandated Choice Best Option 69
Mandated Choice Solves Organ Supply While Avoiding Politics DAs 70
Mandated Choice Solves Organ Supply 71
Mandated Choice - Protects Autonomy 72
Illinois Proves Solvency 74
Education Solvency 75
Family Default Solvency 76
AT: "Prottas" 77
AT: Backlash 78
AT: Costly/Complicated 79
AT: Empirically Failed 80
AT: Registry Fails 82
Mandated Choice - What it Does 83
*Legal Organ Trade Bad* 84
Commodification K -- Shell 85
Commodification K -- Autonomy Link 88
Commodification K -- Bare Life Link 89
Commodification K -- Power Link 90
Commodification K -- Living Donors Link 92
Commodification K -- Organ Scarcity Link 93
Commodification K -- Impact 94
Commodification K -- Ethics Impact 95
Commodification K -- Imperialism Impact 96
Commodification K -- Turns the Case 97
Commodification K - Anthropology Alternative 99
Commodification K - Gift Alternative 100
Commodification K - Incentives Alternative 101
Commodification K - AT: "Commodification Good/Inevitable" 102
Commodification K - AT: "Capitalism Good" 103
Commodification K - AT: "Key to Autonomy" 104
Commodification K - AT: "Regulations Solve Abuse" 106
Commodification K - AT: "Incentives/Gifts Still Commodify" 108
*Alternatives Fail* 110
Incentives Fail- Turn: Undermines Trust in Organ System 111
Incentives Fail- Spain Prohibits Incentives 112
Incentives Bad: Fuels Trafficking/Coercive 113
Incentives Bad: Undermines Altruism 114
Incentives Bad: Priority Rule Allocation Problematic 115
Education Fails 117
Mandatory Consent Bad: Immoral 118
**NEGATIVE** 119
*Presumed Consent Bad* 120
Presumed Consent Unnecessary - Other Plans Available 121
Presumed Consent Fails: Turn- Undermines Public Support for Donations 122
Presumed Consent Fails: Turn- Increases Family Veto 124
Presumed Consent Fails: Respect for Individual Choice Key to Public Support 126
Presumed Consent Fails: Definitional Ambiguity 127
Presumed Consent Fails: No Empirical Support - Generally 128
Presumed Consent Fails: No Empirical Support - Spain 131
Presumed Consent Fails: No Empirical Support - Nordic Countries 132
Presumed Consent Fails: No Empirical Support - Chile 133
Presumed Consent Fails: No Empirical Support - Brazil 134
Presumed Consent Fails: Will Not Decrease Organ Shortage Even if it Increases Organ Donations 135
No Justification for Presumed Consent in Organ Donation 136
Presumed Consent Immoral 137
Presumed Consent Unethical 138
Presumed Consent Undermines Individual Choice 140
Presumed Consent Undermines Individual Choice: AT- "Individual Autonomy Bad/Communitarianism Good" 141
Presumed Consent Violates Religious Freedom 142
Presumed Consent Increases Biopower 143
Presumed Consent Coercive 145
Presumed Consent Commodifying 146
Presumed Consent Prone to Error 147
UK Has Rejected Presumed Consent 148
AT: "Presumed Consent Justified by Utilitarianism" 149
AT: "Presumed Consent Morally Justified" 150
*Solvency Arguments* 151
Healthy Lifestyle Turn 152
Family Veto Thwarts Solvency of All Proposals 153
Family Veto Not Justified 154
*Legal Organ Trade Good* 155
Gift Conception of Organ Transfer Bad 156
Legal Organ Trade Good Increasingly Accepted 157
Legal Organ Trade Justified on Autonomy Grounds 158
Legal Organ Trade Effective Way to Increase Supply 159
Legal Organ Trade Only Solution 162
Legal Organ Trade Solves Global Black Market 164
Ban on Sales Causes Shortages, Trafficking and Abuse 166
Regulated Market Solves Shortages And Avoids Abuses 168
Regulated Market Solves Abuses 170
Regulated Market Solves Exploitation of the Poor 172
Futures Market Avoids Solvency Arguments/DAs 173
Opposition to Legal Organ Sales Paternalistic 174
Market Inevitable -- Regulated Better than Unregulated 175
AT: "Legal Market Decreases Organ Supply" 177
AT: "Legal Market Destroys Altruism" 178
AT: "Legal Market Cheapens Individual Self-Worth" 179
AT: "Legal Market Unpopular" 180
*Commodification Answers* 181
Viewing Organ Market as Commodification Self Fulfilling 182
Legalization Doesn't Inevitably Link to Commodification 183
Organ Market Does Not Uniquely Lead to Commodification 184
Commodification Not Unique 185
Commodification of the Body Does Not Cause Commodification of the Person 188
No Morality Impact 189
No Slavery Impact 190
*Dehumanization Answers* 192
Not Unique 193
*Autonomy Answers* 194
No Link 195
Autonomy Does Not Survive Death 196
Respecting Autonomous Choice Has Immoral Consequences 197
Self Ownership Justifies Viewing People as Property -- Slavery 198
Self-Ownership Morally Unjust 199
Societal Interests Outweigh Autonomy Interests of the Dead 202
Self-Ownership Conception Traps People in Death Fear 204
Self-Ownership Conception Wrong 205
*Incentives Good* 207
Incentives Effective: Priority-Rule Allocation System Most Effective 208
Incentives Effective: Priority-Rule Allocation System Justified 209
Incentives Effective: Priority-Rule Allocation System Empirically Effective 210
Incentives Effective: Honor Roll 211
Incentives Effective: Opposition Declining 212
Incentives Promote Organ Donations From Deceased Donors 213
Incentives for Families Can Increase Donations 214
Institutional Incentives Important to Increase Donations 215
AT: "Incentives Unethical/Immoral" 216
AT: "Incentives Commodify Organs" 218
AT: "Family Incentives Violate Individual's Autonomy" 219
AT: "People Will Take the Incentive Without Giving the Organs" 220
*Education Effective* 221
Education Can Increase Supply 222
*UNOS Credibility* 223
Perception of Fairness Critical to Organ Donation 224
Perception of Commercialism Undermines Organ Donation 226
Perception of Racism Undermines Organ Donation 227
Executed Prisoner Organ Harvesting Doesn't Undermine Trust in Organ Donation 228
*Solvency Arguments* 229
Global Market Means Actions In One Country Not Key 230
*Organ Harvesting Not Immoral* 231
AT: "Organ Harvesting Violates Hippocratic Ethics" 232
AT: "Organ Harvesting from Executed Prisoners Proves Immorality" 236
AT: "Violation of Dead Donor Rule Immoral" 238
*Mandatory Consent Good* 239
Mandatory Consent Justified: Moral Responsibility to Donate Organs 240
Mandatory Consent Necessary to Solve Organ Shortage 241
Mandatory Consent Better than Presumed Consent 243
Mandatory Consent Solves Exploitation of the Poor 244
Mandatory Consent Popular 245
AT: "Mandatory Consent Violates Autonomy" 246
AT: "Mandatory Consent Violates Religious Beliefs" 247
*Mandated Choice Bad* 248
Mandated Choice Generally Bad 249
*Politics* 250
Uniqueness: Current US Policy Increases Supply Effective and Popular 251
*Federalism* 252
Topic Wording
2014 September/October Topic
Resolved: A just society ought to presume consent for organ procurement from the deceased.
**DEFINITIONS**
Distinction Between Types of Consent
DIFFERENCES BETWEEN PRESUMED CONSENT AND OPT-IN LAWS
Joseph L. Verheijde, Bioethics, Policy and Law Program-Arizona State University, 2009, "Enforcement of presumed-consent policy and willingness to donate organs identified in the EU survey", Health Policy, 90 (2009) 26-31, p. 26-7
To increase the supply of transplantable organs, several countries in the European Union (EU) have implemented and are enforcing presumed consent policies for organ donation[1,2]. In countries with informed consent or opt-in legislation, such as the United Kingdom, Germany, and Sweden, individuals or their family members must give explicit permission for organ removal. In countries with presumed consent, such, as Spain, Portugal, and Austria, universal consent without explicit registration is assumed. Enforced presumed consent means that individuals who have not opted out of organ donation will automatically donate their organs at the time of death if their organs are in a suitable clinical condition. Unenforced presumed consent allows people to refuse their relatives' organ donation even though the relative has not explicitly opted out of donation.
Presumed Consent =Opt-Out
PRESUMED CONSENT SYNONYMOUS WITH "OPT-OUT"
I. Kennedy, et al, School of Public Policy-University College London, 1998, "The case for 'presumed consent' in organ donation," The Lancet, V. 351, Issue 9116, May 30, pp. 1650-1652
Is there a moral case for changing the law regulating organ donation from a system of "contracting in" to "contracting out" or "presumed consent" in those countries that have not yet done so? Contracting in refers to a system in which the law requires that donors and/or relatives must positively indicate their willingness for organs to be removed for transplantation. In a contracting out system, organs may be removed after death unless individuals positively indicate during their lifetimes that they did not wish this to be done, a system also known as presumed consent.
Presumed Consent: Requires Proof that Deceased Would Have Consented
PRESUMED CONSENT: REQUIRES PROOF THAT THE DECEASED WOULD HAVE CONSENTED
T. Tottoczko, Medical Professor-Warsaw Medical University, 2003, "Presumed Consent: What Does it Mean?", Transplantation Proceedings, 35, 1195-1197, p. 1195-6
The notion of “presumption” refers to an attitude or belief based on reasonable evidence or grounds that have been already proven, but that have no value of explicit evidence. It refers to an idea that is taken to be true, although it is not known for certain. Accordingly, convincing, indirect evidence (proof by assumption) to confirm that consent has been given is a prerequisite for “presumed consent.” If, while alive, the deceased consented to donate organs, but did not register his or her will to do so, or if such will can be demonstrated to be in keeping with his or her views, then consent can be recognized as "presumed."
"Presumed" consent must be based on the proof or well-founded assumption that the person had been properly informed about the consequences of his or her decision. As such it is "presumed informed" consent. Consent can be "presumed" only when people were properly informed and also given a genuine opportunity to opt out. When a prospective donor was not properly informed or there is no evidence of his or her will to donate, his or her hypothetical agreement cannot be recognized as presumed consent. The procurement practices must meet stringent, rigorous, widely known criteria of "presumed informed consent" accepted by the ethics committee, which is an independent body, not linked to the procurement and transplantation teams. When express consent is missing, these criteria should differentiate between "implicit consent," which indicates the will to donate organs for transplantation surgery in the event of a potential donor's death, and "implicit lack of consent' or even "implicit refusal." One should add that the criteria should be inflexible and must not be dictated by current needs and circumstance.
PRESUMED CONSENT DISTINCT FROM "GUESSED" CONSENT
T. Tottoczko, Medical Professor-Warsaw Medical University, 2003, "Presumed Consent: What Does it Mean?", Transplantation Proceedings, 35, 1195-1197, p. 1196
When there is no direct or indirect evidence, one may only guess whether the deceased would or would not have given his or her consent to use his or her organs for transplantation surgery. "To guess," however, is not the same as "to presume." A presumption is based on the validity of arguments and evidence, which support it, whereas guesswork is a "hit and miss" affair.
"Presumed consent" when not based on widely known and accepted criteria means free choice in interpretation and decision making. That is why, in the event of the death of an individual who has not been registered as a potential donor, the absence of "express consent" does not necessarily mean "implicit consent." The very fact of death does not automatically give us the right to harvest organs from the deceased because that would be based on "guessed consent."
**ORGANS IMPACTS**
*Organ Shortage Now*
Organ Shortages Widespread and Increasing
ORGAN SUPPLY AT CRISIS LEVEL GLOBALLY
Anne-Maree Farrell, David Price and Muireann Quigley, Ethics Professors, U. Manchester, De Montfort U., & U. Manchester, 2011, Organ Shortage: Ethics, Law and Pragmatism, ed. A. Farrell, D. Price, M. Quigley, p. 4
Numbers of heart-beating donors have reduced as a result of fewer younger people dying of severe head injury or catastrophic cerebrovascular events, such as road-traffic accidents. Changes in the diagnosis and management of severe brain injuries also now result in fewer critically ill patients fuflilling brain stem death testing criteria. The general decline in heart-beating donation represents a major problem with regard to addressing the problem of organ shortage. These trends are not just confined to the UK, but can be observed in most other countries with developed organ donation and transplantation systems. To a very significant extent, all such countries are in some form of crisis in terms of meeting the demand for organs, and those working in the field all largely share common concerns, anxieties and issues.
ORGAN SHORTAGE HIGH AND GROWING -- KILLS 18 PEOPLE A DAY
Alberto Abadie & Sebastien Gay, Harvard-Kennedy School & U. Chicago Economics Professor, 2006, "The impact of presumed consent legislation on cadaveric organ donation: A cross-country study," Journal of Health Economics, Vol 25, Issue 4, July, p. 599-620
In 2002, 6679 patients died on the U.S. organ waiting lists before an organ became available, roughly 18 per day (OPTN, 2003). In spite of media campaigns and other attempts to promote donation, the supply of organs cannot keep up with the demand, and the number of patients on waiting lists has been growing steadily during the last decade (see Fig. 1). One of the most frequently quoted explanations of the gap between the supply and demand of organs is that the number of families that refuse to grant consent to donation is still large. Approximately half of the families that are approached to request donation refuse it in the U.S. and Great Britain, compared to around 20% in Spain and around 30% in France.3 The U.S. and Great Britain are informed consent countries; Spain and France are presumed consent countries.