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From Altruistic Donation to Conditional Societal Organ Appropriation After Death

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Abstract

Since we have learned that human organs can be used to treat severe health problems, only donation has been considered for organ procurement. Among the other possibilities that can be used after a person’s death, purchase or systematic removal have been a priori rejected. However, we will show that the appeal to individual altruism have resulted in some of the aporias of the present situation. Subsequently, we will consider how systematic organ removal from deceased persons can be made acceptable in liberal and democratic societies. Finally, we will suggest that individual choices with regard to systematic organ removal could well be registered in a way that allows proper implementation of present French legislation.

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Notes

  1. See S. Giordano: ‘Once informed, people can be asked to make a clear choice. By asking to make a choice the state would not frustrate, but, on the contrary, would encourage a responsible exercise of autonomy, and, at the same time, it would promote recruitment of organs and tissues’ (Giordano 2005).

  2. See for example the promotion of autonomy in the treatment and care of the elderly in public policies (see the Law of June 30th 2004 relative to the solidarity fund for the autonomy of elderly and disabled persons and the Law of March 31st 2003 on financing the elderly dependent and the Personal Autonomy Allowance). The public authorities currently place social concern for the elderly in the perspective of dependency costs that led to the creation of the Fifth Risk Plan to curb the ‘dependency risk’. See the public services web site:

    http://www.vie-publique.fr/actualite/alaune/protection-sociale-couvrir-risque-dependance.html.

  3. For figures concerning the number of organ transplants per region in France until 2009, see the Agence de la Biomédecine website: http://www.agence-biomedecine.fr/agence/regionaux.html and the 2006 and 2009 annual report, p. 166, fig. P 2 (http://www.agence-biomedecine.fr/uploads/document/RA_Biomed_2009-B.pdf).

  4. ‘Legislation ensures the primacy of the person, prohibits any infringement of the latter and safeguards the respect of the human being from the outset of life’ (Civil Code, chap. II, article 16; Law n° 75–596 of 9th July 1975). ‘The idea of liberty, equality in dignity and respect of human rights are the founding principles of French society. […] The necessity of safeguarding the inalienability of the human being is the only means of preserving his dignity’ (Rapport de Franck Sérusclat, t. I, fasc. 6, 1992, p. 17).

  5. ‘Everyone has the right to respect for his body. The human body is inviolable. The human body, its elements and its products may not form the subject of patrimonial right’ (French Civil Code, chap. II, article 16–1 inserted by Law n° 94–653 of 29th July 1994).

  6. It is at least certain, that as we have underlined that ‘when property is denied, it is because society does not wish to grants individuals a right to legally enforce this degree of bodily sovereignty’ (George 2001, p. 74).

  7. ‘There may be no invasion of the integrity of the human body except in case of medical necessity for the person or exceptionally in the therapeutic interest of others. The consent of the person concerned must be obtained previously except when his state necessitates a therapeutic intervention to which he is not able to assent’ (French Code Civil, chap. II, article 16–3, modified by Law n°2004-800 of 6th August 2004 - art. 9 JORF 7 August 2004).

  8. ‘Under conscription, all usable organs would be removed from recently deceased people and made available for transplantation; consent would be neither required nor requested’ (Spital 2002, p. 614).

  9. ‘Unlike organs obtained from living donors, organs obtained from cadaveric donors should be regarded as a societal resource’ (Truog 2005, p. 15).

  10. M.-A. Hermitte (1993 – unpublished) describes presumed consent as a ‘legal fiction’. The notion of presumed consent to organ donation was introduced following a misuse of language in reference to legislation regarding explicit consent; the absence of explicit refusal being interpreted as presumed consent.

  11. Jurists and practitioners equally underline this (see Thouvenin 2004, p. 135).

  12. Other authors have previously underlined the limits of current procedure in verifying that an individual has exercised his right to refuse that ‘in reality does not sufficiently guarantee the expression of that right’ (Thouvenin 2004, p. 109).

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Authors and Affiliations

  1. CNRS – Centre Maurice Halbwachs, 48 Bd Jourdan, Bât B, 1er étage, bur. 4, 75014, Paris, France

    Caroline Guibet Lafaye

  2. Université Paris Descartes, Hôpital Necker, Service de Transplantation, Paris, France

    Henri Kreis

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  1. Caroline Guibet Lafaye
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  2. Henri Kreis
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Correspondence to Caroline Guibet Lafaye.

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Guibet Lafaye, C., Kreis, H. From Altruistic Donation to Conditional Societal Organ Appropriation After Death. Ethic Theory Moral Prac 16, 355–368 (2013). https://doi.org/10.1007/s10677-012-9337-8

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