Coercion, informed consent and organ donation

Last week, Mississippi Gov. Haley Barbour announced he would grant two sisters an early release from prison. Gladys and Jamie Scott had both served 16 years of their life sentences for armed robbery. Because life sentences are unusually long for armed robbery, their cause had been advocated by civil rights groups. There's very little disagreement about whether they should have been paroled early. But the story was also noteworthy because their release was conditioned on one sister donating her kidney to her other. The sisters had earlier proposed the donation, for what it's worth.

The Washington Post reported the story with a particular emphasis on the ethics debate surrounding this early release. In fact, the headline for the piece was "'Conditioned on' kidney donation, sisters' prison release prompts ethics debate." Here's the basic gist of that ethics debate as presented by the Washington Post:

While Barbour's decision in the Scotts' case was lauded by the NAACP, some medical ethicists say they are concerned about the role of the organ donation in the release. Barbour's spokesman Dan Turner said the contingency was Gladys Scott's idea.

"It was something that she offered," he said. "It was not something that the governor's office or Department of Corrections or the parole board said, 'If you do this, we would do this.' It was not held as a quid pro quo. She offered."

The medical ethicists say they're still concerned, even if the donation is voluntary.

"If the sister belongs in prison, then she should be allowed to donate and return to prison, and if she doesn't belong in prison, then she should have her sentence commuted whether or not she is a donor," said Michael Shapiro, chief of organ transplantation at Hackensack University Medical Center in New Jersey and chair of the United Network for Organ Sharing's ethics committee.

The thing that was lacking in the story was much beyond assertions. I wanted to know specifically why Shapiro or other ethicists think there is something wrong with Barbour's release order. Asserting that it's wrong isn't enough.

There were other reasons cited -- although they dealt with the unintended consequences of this release order. For instance, if organ donation could result in early release, would that coerce prisoners into donating body parts?

We get close to an explanation later in the piece, after we're told that medical ethicists and physicians around the country have been debating the issue on list-servs and in conversations. Here's Arthur Caplan, chair of the department of medical ethics at the University of Pennsylvania:

He said Barbour's decision potentially interferes with sound medical judgment. Inmates are often not in the best physical shape because of communicable diseases, poor diet and other issues related to health, Caplan said. All of those factors contribute to a person's readiness for organ donation.

"In our system of getting kidneys from living people we would never coerce them by saying we hope you do this or else," Caplan said. "You're in a weird situation where the governor is meddling a little bit into what is basically a medical decision first."

I just don't think the full ethical debate was given enough say, nevermind that overtly religious voices are completely absent from the conversation. Via First Things, I found this Center for Bioethics and Human Dignity essay on the ethics of organ donation from 2002. In it Christian bioethicist Dr. Gregory Rutecki writes:

The hallmark ethic of organ donation has always been informed consent. Informed consent must be free of any hint of coercion.

Why is "informed consent" the hallmark ethic of organ donation? Why is consent, informed or otherwise, not even mentioned in the article? What does this case have to do with compensation for organ donation? Why are there no voices from people, such as kidney donor Virginia Postrel, who advocate payment for organ donation?

Were there any other stories that did a better job of answering some of these questions?

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