Gil the Armless

A few decades ago, US author Larry Niven wrote a series of stories concerning "Gil the Arm", a detective in a near-future society. This society had so well-perfected transplant techniques that there was a severe shortage of donor organs. The government responded by introducing the death penalty for a broad range of offences, so that the convicted could be harvested for organs. Such heinous crimes included exceeding the speed limit or running a red light.

This science fictional future has now become reality. The Australian government's Organ and Tissue Authority has introduced a system where Australia hospitals can receive up to $A11,400 for each patient they can turn into an organ donor (Sunday Telegraph, February 21, 2010).

All the hospitals have to do is convince patients' families to authorise organ donation consent for critical patients that the hospital claim should not be revived if they should technically die. The patients are then kept alive on life support until their organs can be harvested. Not revived and kept on life support in the hope they can recover (as many do), but kept alive as a source of organ donations for profit.

Doctors seem to have expressed criticism of the scheme, not because it removed the requirement to keep a patient alive at all costs, but because it encourages hospitals to pressure families to allow patients to become organ donors before they are dead. Already, hospitals have the right to deny commencing life support to critical patients (but not turning it off once commenced, since there is a risk that the next-of-kin will sue unless they give permission for cessation of life support).

All that a hospital need to do is convince the next-of-kin that the patient should be allowed to die. Currently, hospitals prefer to keep patients in an ICU because they are paid $10,000 per day for little extra expenditure. If there is no room in the ICU, this is a good way to make extra money (the hospital can be paid $A7,218 for transferring a patient from emergency to the ICU with the intention of harvesting organs, even if such harvesting never occurs; meaning no bed space is required).

This is off interest to me. I decided decades past that I would not consent to organ donation, out of fear that this system would be implemented. In January/February 2007, my fears were partly justified. While I was in a long and serious coma, the hospital told my next-of-kin that my critical condition might deteriorate into death. When I prolonged my agony by refusing to die (and in fact tried to escape from the hospital bed while in a coma), my next-of-kin was told that by keeping me on life support, he was only prolonging my agony in a hopeless case. What would have happened if the hospital could make extra money by declaring me irredeemable?