Thursday, November 4, 2010

It's not fair.

Good Morning God,
When did we stop being human and start being body parts? 3706 organ transplants were performed by the NHS this year, but apparently this is still not enough, people are still dying for lack of suitable organs. To borrow the phrase of the  TV campaign designed to shame us into signing the donor register - It's not fair!

No, it's not fair.
It's not fair on the whole human race that one gene pool, sick and diseased though it is, can come to dominate the species gene pool through the direct application of medical science simply because it can afford to do so..

Here in the West, our bodies have become the essential but uncomfortably fragile vehicles that we travel around in through this journey of life. It's not fair that our life-style and social evolution results in our bodies becoming diseased or broken, but we can generally find some way of patching them up - for a price. Life and health are commodities, the must have accessories to 'being' who we really are. They are a costly luxury for the sick and the poor, but the sick can harvest what they need from the poor - if they can pay.

Money is effectively halting the genetic and spiritual evolution of humanity - and we will all pay the cost later. Leave aside for one moment the sick irony of the growing market in organs which results in some of the poorest people world-wide selling their body parts to donor banks in order to survive. What is really happening here is the ultimate in the commodification of life. People get the life that they can pay for.

YES - of course, I would want to see those I love live longer lives - but only because I am selfish, not because I believe it is right for them - or for me - or for society. Grief is the bitter-sweet side of love that we do not want to taste. But we can't have everything we want - no matter how badly we want it, usually for good reasons!

So, even though I know that good people, even young people and new born babies, friends and family members might otherwise die, I still struggle with the idea of organ donation:

Firstly there is the inequality of it all - the cost of one liver transplant could pay for millions of newborn tetanus vaccines... whose life is more important - why is it the one who can pay? Where is the justice in this? Where in the gospel does it say that only those who can pay can have life?

Secondly there is the subtle but insidious signal that it sends to humanity that 'death' is the devil which must be defeated at all cost, that sickness and dying are not 'normal', and that it is imperative that we do everything we can to 'keep people alive' - as though dying is not a normal part of living. Dying is so normal that even you did it God, to show us it is not the end of us. We need have no fear of dying.

Thirdly there is the presumption that all that is necessary for us to live are bodies that work.  We start treating bodies as something separate and distinct, which fail us or let us down. We stop thinking of ourselves as whole human beings with a physicality and spirituality which are intended to combine to create a reality which transcends both.

Fourthly - and perhaps most importantly, we start behaving like gods - making decisions over who lives and who dies according to the organs that we have. We start convincing ourselves that we have life sussed, we don't need your help. We can now create life in a test-tube, clone it when we need to, educate it, milk it for its worth to society, mate it and when we deem it necessary or expedient to do so, heal it or fix it when it breaks and kill it humanely if we must. But what we create and manipulate is but a shadow of life in all its fullness.

Lastly, keeping people 'alive' in this way stops humanity evolving, growing, changing, developing. It keeps the diseased genes in the gene-pool, whilst we kid ourselves that it doesn't matter - we will find a medical fix for that too!

I am aware that what I have written is not confined to organ transplants, but transplants epitomize the problem underlying the demand for 'right to life' medical care. They are at the pointy end of a very sharp and pressing pair of questions which will in the end define us all...

What is the price of a human life?

And what is the real cost to humanity?

Personally, I think these questions were answered over 2000 years ago, by someone who paid the ultimate price so that we could learn how to obtain real healing, and gain life in all its fullness.


  1. True, death is not the ultimate evil, but we were put on this Earth to manage it, to use our skill and intelligence to assist and control the way nature works. I believe that includes medical science, part of which is organ transplants.

    It is wrong to seek death before God's time for us. God has stuff for us to do right up to the time He takes us. If God (through the skill of doctors and medical science) gives us an opportunity of living longer or reducing suffering, then we should not reject it.

  2. Afraid Angela I have to disagree and have popped some of my comments up on my blog as the comment here was growing and growing.

    With thanks for a thought provoking article - do feel free to comment on mine

    Regards Ever


  3. Thanks for the comment.
    I too agree with medical science, I believe that God has given us brains in order to work these things out and to do what we can to alleviate suffering and pain. I am not in favour of ANYONE dying before they need to - but that's my problem - who is now deciding whether people should die or not?

    The issue for me isn't whether or not individual transplants are good - of course they are if they are life enhancing. It is the wider issue of what we are doing as a species that worries me and the increasing disregard for the unity of body, mind and soul.

    If organ transplants were available for all or even most people, instead of a very small select few, (taken globally) I doubt that I would have as much of a problem with what is currently happening.
    But as it is - the question needs to be asked - Is it fair that only the wealthy have access to this sort of life-saving care? And what are the consequences long term of this? Is this another form of elitism? It certainly is a form of eugenics.

    IS it fair that so much money is spent in the West saving a very few select lives, when that same amount of money could fund the WHO projects to eradicate some of the more pressing health concerns in poorer countries?

    What should our priorities as a species be?

    What bothers me about all this is the use of the expression - it's not fair.

    HOW on earth can we use this expression when we know how unfair it is that a significant proportion of people do not have access to the basic medical treatment for diarrhea leave alone heart disease.

    I dont say transplants are wrong - but I do think the inequality is UNFAIR - and that there are some serious theological questions we need to explore too as the market for transplants grows.

  4. I'm intrigued by the question about genetics/eugenics. I wonder several things:

    What proportion of organ transplants are given to people who then go on to have children? (I have no idea, but if it's not high then any eugenic question is a minor one)
    How many organ transplants would have to happen to make a noticeable impact on the human gene pool overall?
    Why are organ transplants any more of an issue when it comes to eugenics than any other treatment which is available to the rich but not the poor? (I'm not sure you're saying they are)

    Which is all a bit of a tangent. And the inequalities are certainly huge issues, but when there are people complaining that the overseas aid budget was protected in the spending review because 'why should we help other people while cutting benefits/services to our own' I suspect we're a long way from even coming close to addressing them. Sadly.

  5. Hi Helen,

    I dont know the answers to your questions re-numbers, but given that we are talking about the Western world - America, Canada and Western Europe, I suspect the figures might be quite high.

    I am repeatedly puzzled that we will raise funds to keep people alive following a 'natural disaster' such as the tsunami or the floods in Pakistan, only to let them then die from illnesses which we treat routinely.

    I believe that access to modern medicine is as much a social justice and theological issue as it is an ethical one - it speaks volumes about who and what we value (as they have been discovering in America where they are debating health care reforms!)

    As I say - transplants are just the tip of a very nasty problem which has no easy solutions because we all want to live - even those who have no access to asprin or the clean water to take it with.

  6. This is particularly interesting given that I'm the Chaplain on a heart and lung transplant unit. There are lots of issues about transplants, anti rejection drugs, and donors. I really don't know that there are any easy answers. I can tell you that living post-transplant is very difficult and not at all straight forward.

  7. For professional reasons I have to remain anonymous, but I am a Methodist Local Preacher.

    I am currently working on several projects which promote the donation of organs. I have seen a transplant operation and met transplant recipients. Seeing a young cystic fibrosis patient regain their lives is something that no one can begrudge. Seeing a transplanted kidney, bled white and being filled with the recipients blood and seeing the joy of someone able to pee without dialysis is very moving.

    The time, skill and technology required is awesome and you are right that only very rich countries (or rich individuals) can afford to undertake such a programme.

    But we need to remember that these technologies take time to develop. The first recipients of transplanted organs survived for just a few weeks, now they can survive much longer.

    The first transplants were dramatic breakthroughs, now they are not quite common place, but they happen everyday. (Where I work the motorcycle delivery men arrive with organs from all over the region throughout the day).

    Gradually this technology and skill will be found in every corner of the world. Hopefully political action will ensure that it is open to everyone and anyone. Its a political issue, not a medical issue.

    The reason why we understand the importance of clean water is because the biggest city in the world at the time had repeated cholera epidemics. It was 19th Century London. Fortunately medical science, expensive public works and a political will eradicated the disease entirely. This could only have happened because the rich economy was able to create a critical mass of expertise. That expertise is today available the world over, what is now needed is the political will.

    Likewise with cancer. The first chemo patients lasted just a few weeks longer. Treatment was expensive. Now we understand the importance of catching the condition in time and can regulate the treatment. The British NHS and other western health economies now have a transferable wealth of skill that can be used elsewhere in the world.

    This is all the to good. Hopefully with stem cell organ creation even today's transplants will be seen as old hat, but to get to one stage we have to explore and understand. Every doctor stands on the shoulder of a predecessor.

    Let's continue the transplant programme. Let us show what can be achieved when medical science, resources and public understanding are pooled together.

    We managed it with blood transfusion (See Titmusses wonderful book The Gift Relationship) we can do it with transplant technology. One day the techniques being pioneered where I presently work will be available to all. Surely that is not a bad thing or one that we should dismiss.

  8. Hello anonymous,
    Thank you for your very helpful comments.
    Allow me to reassure you that I have no desire to see the transplant program end, but the question we are challenged with is -
    is it fair?

    I guess I would want to ask what is the ultimate goal of western medicine and how do we square that with a belief in what it means to be human from a Christian perspective?

    At what point do we say that a life has a legitimate end - when we can't fix it anymore?

    Isn't is fascinating that we have 'right to death' issues being debated at the same time that we are investing so heavily in 'right to live' medicine.

    Is this simply human desire for control over life and death - Are we trying to engineer our own immortality? And is that ok?

    I have no answers, and the above questions should not be read as negatives or rebuttals of what we are currently doing. As I mention earlier - this is not an either/or situation - but I'm not quite reconciled to the both/and either. Both Western privileged medicine and death in the thousands from diarrhea - how do I square that with my faith?

    The questions hinge around 'fairness'.

    They are my way of trying to work through and discover a way to reconcile what it means to be human and not just Western and privileged with what it means to be Christian in the light of modern medicine.

  9. Once again having to remain anonymous for professional reasons.

    I work across the health service and hear all sorts of stories. I am not a medic but I see a lot of what goes on.

    One lesson I've learnt is that many people aspire to immortality. In many ways this is not a bad thing. A good Nanna can give a lot of love to grandchildren and provide those children with a sense of continuity and identity.

    However keeping that Nana alive costs a lot of money: the average over 80 will be taking at least 10 or 12 medications to manage various conditions. They may also make surgical demands such as cataract removal or hip replacement. Many of these medications and treatments have only become available in recent years.

    I remember once being confronted (I was responsible for managing a complaints department) by a family who demanded to know why the medical staff had not resuscitated a 97 year old woman. They just couldn't understand that her body had simply had enough and that resuscitation can be a violent and intrusive procedure.

    However when we think of medical advances our minds go high tech. Many hospitals are little more than factories to repair our bodies. I believe there now needs to be a greater emphasis on the "healing hospital". I fear chaplains are too often marginalised (and with budget cuts may be let go altogether), nurses often complain that they are not given the time to work with recovering patients who often need a lot of reassurance. And that's at what is called the acute end.

    I have also worked for several mental health organisations. The truth is that we devote far less resources to supporting mentally ill people. It was very telling that in a recent NHS consultation across London, the provision of mental health services was hardly touched upon.

    The last government introduced national service frameworks. It was noticeable that references to mental health services were very patchy and the overriding concern seemed to be that they should remain solvent. There is excellent work in the mental health field but it is seriously under resourced. I mention mental health because many of the service users actually want to end their lives: they don't want immortality and preventing suicide is the everyday job of mental health staff.

    In recent years there has been a greater understanding that self care can pay big dividends - avoiding excessive alcohol, taking exercise, having a balanced diet etc - but far less attention has been paid to our mental self care. For some time I have been badgering those mental health trusts for whom I have worked to think about the public health issues but we rarely get beyond alcohol and drugs, and there's a fear of confronting them for being seen as "judgmental" or even "fuddy duddy".

    I mention that for two reasons. Firstly I think it will help us understand that we are not physically immortal. If we are at peace with ourselves - and hopefully with G-d - we will understand that death is part of the natural rhythm of life. Death has lost its sting if we lead happy and satisfying lives.

    Secondly a breakdown of mental health can be a social, economic, physical and family disaster.

    I can see that mental health self care could be something that the churches could actually lead on. We do have expertise is helping people develop their spiritual and social resources. Sadly I feel that we have lost the self confidence to make that contribution to society.

    Sorry, a bit long, I don't often get a chance to write about health issues anonymously, so I've got quite a bit off my chest.