Compulsory Organ Donations

More than a Nudge

Robert Thaler, the soon to be winner of this year's Nobel Memorial Prize in Economic Sciences, wrote about how organ donation rates can change significantly when the question is asked differently to potential donors. In a nutshell, he differentiates the opt-in and the opt-out method, where the opt-out method gets more people to become donors, because the default choice is to be a donor. But he goes on to mention that the presumed-content law may be upsetting to some people, and that the Illinois system, which "makes one's wishes to be a donor legally binding . . . is a winning combination."

Here, Thaler, in his strict adherence to libertarian paternalism, fails to consider a morally and economically superior policy: the policy of mandatory donations.

It is not hard to see that mandatory donations are economically superior. To see why mandatory donations are morally superior, one need only consider the trolley problem. Here is the thought experiment as summed up by Wikipedia:

The Trolley Problem, as presented by Wikipedia

There is a runaway trolley barreling down the railway tracks. Ahead, on the tracks, there are five people tied up and unable to move. The trolley is headed straight for them. You are standing some distance off in the train yard, next to a lever. If you pull this lever, the trolley will switch to a different set of tracks. However, you notice that there is one person tied up on the side track. You have two options:
1. Do nothing, and the trolley kills the five people on the main track.
2. Pull the lever, diverting the trolley onto the side track where it will kill one person.
Which is the most ethical choice?

There are a lot of variations to this problem, such as having the President on one of the tracks, or having infants on one track and terminally ill patients on the other. But the most relevant variation of this problem to the discussion above is the following: The trolley is headed straight for five people tied up on the tracks. If you pull the lever, the trolley will switch to a different set of tracks. However, you notice that there is a corpse tied up on the side track. What is the right thing to do?

Any sane person would agree that the ethical choice is to pull the lever and run over the corpse, even if the corpse was that of someone closely related. And yet, too many people believe that it is their right to do as they wish with the corpse of their deceased relative. Some people believe that is is their right to opt out of organ donation programs. But rights belong to humans. Corpses are not humans, and thus have no right. And because corpses are not human, the only ethical choice is to utilize the precious organs that are much needed by other humans.


Legalize-and-Regulate: The Seven Pounds Suicide

South Korea has the second highest suicide rate in the world. While this statistic by itself is unfortunate, it is even more unfortunate that the most common method suicide is by poisoning. People who wish to commit suicide should instead follow the example set by Ben Thomas from Seven Pounds, played by Will Smith. In the movie, Ben saves the lives of seven people by donating his organs. Ben's carefully planned suicide was committed by getting stung by his pet box jellyfish in an icy tub: a method that ensured that his organs would be undamaged and well preserved.

How much easier would altruistic suicides be if the state regulated suicides? Fully staffed and equipped suicide centers could provide a constant supply of fresh organs to meet the demands of the millions in need of organ transplants. As a beneficial side effect, the decrease in demand of organs would cause human organ trafficking to decline and eventually disappear.

Compulsory Blood Donations

Should the government own its citizens? This is a difficult question to answer. But when the normative question is rephrased into a positive one, namely, "Does the government own its citizens?" the answer is that in many ways, it does. And in some ways (albeit few ways), government power is an obvious, tremendous benefit to its citizens. In this light, states should extend their power to make blood donations compulsory.

The system would parallel military conscription. First, every citizen above a certain age would get their health examined to ensure that they are fit to provide blood. After that, everyone fit to give blood will do so every 6 months, though the exact time period can be determined according to the needs of each state. Everyone who fails to give blood during that time will face fines, just as reserved forces are to pay penalties if they fail to find time to train once a year. Finally, if there is a sharp increase in demand for blood due to some unforeseen disaster, the state should have the power to call all potential donors who have not given blood in the past two months (which is the current minimum time period that a donor must wait before giving blood again) to donate. This will be analogous to all reserved forces being called back into the military in times of war.

Mandatory blood donations could be questioned by societies, because it obstructs the personal freedom of every citizen. But there is simply no freedom in death, and no civilized society should call itself civilized if an injured person, who could have been saved by modern medicine, does not make it because of a shortage of blood.

Unfortunately, there are times when politely asking is not enough.