What should be the role of the state in the development of transplantation?

Abstract

IN THIS paper the state is defined as “the power or authority represented by a body of people politically organized under one government, especially an independent government, within a territory or territories having definite boundaries.” The term government is used as a synonym and is the preferred term. The involved medical profession is defined as all those professionals having experience with transplantation as well as professional organizations and societies dealing with transplantation. It is taken for granted that the state as well as the medical profession have a working knowledge of medical ethics, that both are “ethically aware.” The general public has a vested interest in transplantation; it is impossible for the individual to know in advance whether one will be a potential donor or whether one will need a transplant. Organizations of patients as in patient unions are important provided they have the necessary experience and knowledge. The state or government signifies any state not a specific state or government. The state in a centralized society may be in almost total control of health care while without much control in a decentralized society. One would not be surprised if there were as many different views as there are persons being asked on the role of the state or the government in the development of transplantation. Most probably the answers would be expected to range from one extreme to the other; from the primary role of the government, crucial for the development of transplantation to the other extreme that the government should leave it to the medical profession to develop and run all transplantation activities. Regardless of the view, the primary objective would be to give as many patients as possible the benefit of a transplant; striking a balance between medical utility and justice and appropriate involvement of the government. The view of any one person will be based on his or her background and education. One might expect an individual with a medical background to be most critical of any government involvement in the development of transplantation and the individual with a legal, political, or administrative background to favor such involvement. In any case, one would like to see a confidence-building collaboration between the general public, the government representing the general public, and the medical profession. Such collaboration could minimize the role of the government. If a medical practice such as transplantation is managed in an ethically and legally acceptable way there is little need for government involvement. Too often there is a distrust; the general public and possibly also the bureaucrats being aware and alerted by the news media about real or alleged professional malpractice and misconduct. Consequently participation of the government may be called for. The state or government, the profession, and the general public would agree as well as disagree on the role of the state when it comes to legislation pertinent to transplantation; there should be full agreement on legislation and possibly disagreement on what is pertinent. I suggest there are both areas where there is need for legislation and thus for direct state involvement because it is only the governments that legislate; and also areas where legislation is not necessary but where the state can and should supervise or oversee transplant practice.