Dr Lee Wei Ling has jumped back into the fray once again with respect to the kidney trade issue. Today's Straits Times carried carried half a page of her rants about this much debated issue.
I have great respect for Dr Lee. At other times she has given voice to segments of society that have been marginalized, and otherwise voiceless. But on this issue, I believe she is way off course. There is no doubting her passion in wanting to save the lives of patients who are dying of kidney failure. But her passion is misplaced, when she chooses to dismiss the exploitation problem. In doing so, she has chosen to take the side of the wealthy sick against the poor. Is the life of a wealthy Singaporean worth so much more than the welfare of the poor that she should so readily brush off any suggestion that they may be exploited in this transaction?
She makes the point that "If the seller makes an autonomous decision and, in return, receives a substantial payment that may improve his and his family's quality of life, why should that constitute exploitation?" I would find nothing objectionable in that statement, other than the fact that in a dependent and vulnerable position, the donor is not likely to be able to make a fully autonomous decision. Yes, he/she remains lucid, and rational. Yet we know that given a real choice in the matter he/she would rather not have to sell his/her kidney, whatever the price. She herself acknowledges: "Let's get real: Who would willingly donate his kidney to a stranger without profiting from that act?" She herself would not. She should therefore ask herself why a poor man/woman would go under a knife and 'donate' his kidney to a stranger unless the financial reasons were so compelling. This is the very nature of an 'inducement'. A fully autonomous decision needs to be free of inducements. It is true however, that in life, our decisions are always compounded by some element of inducement, but taken to the extreme, inducements compromise our autonomy. And in the situation of reimbursing kidney donors, the greater the payout, the greater the financial need of the donor, the greater the inducement will be, and the greater the likelihood that the decision was not made with full autonomy.
Much as we may be motivated to save the life of a dying patient, this must not be at the expense of another individual. Therein lies the dilemma in regulating organ trade. Our wealth must not be an instrument of exploitation of the poor.
But perhaps I am too idealistic. (See my other comments on this and related issues...)
I take further offense with respect to her comment : "Why the rigid insistence that the remuneration for the seller should not be so high as to be an inducement to part with a kidey? To be blunt, the main reason is because there is not enough independent thinking here."
Errmmm... 'not enough independent thinking'? Does she imagine that the only independent thinkers are those who agree with her? Legitimizing the organ trade is really a no brainer...and the far easier path to trod. Afterall, who doesn't want to save lives? Standing the moral high ground is a far more difficult choice to make. Wealth empowers. But it takes a stronger (and a more independent minded) person to exercise wisdom and forego that power in defense of the weak and poor.
C'mon Wei Ling....who is more deserving of your support?
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I quite agree that if I or my loved ones needed a transplant, I won't split hairs about what's legal, inducement, whatever.. in short, I wld very much be inclined to break the law, so long as I don't go so far as to kill or arrange for someone to be killed to obtain the kidney.
This said, decisions on taking a kidney from a live donor, with or without inducement, should best be made by those who aren't in such a desperate health situation, personally or because of a loved one. Otherwise emotions would cloud judgements and are made based on gut feelings, rather than in a calm, collected and as detached a manner as possible.
I think Dr Lee is becoming hysterical abt the issue and so doesn't make the best plausible advocate for the cause.
Yeah....it's funny how laws and ethics get messed up when our personal interests are at stake. I can't say myself if I can be so objective if my loved ones are involved...either with respect to this issue, or with euthanasia etc.
Which is why, I suppose, when we discuss these issues we need to especially detach ourselves, and try to be objective. Which is why we do need to have objective uninvolved third part opinions and inputs into the process. When we have a bunch of patients relatives inputing their views, you are really send a whole bunch of shopaholic housewives into the Great Singapore Sale, and expecting them to be rationally restrained.
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