Jeremy Laurance: Clash of medicine and ethics

The Israeli government deserves congratulation for its courage and innovation in adopting a radical new approach to the problem of organ transplantation.The shortage of organs available for transplant is a global problem and is getting worse. But its move pushes medicine across a new ethical frontier.

In the UK more than 1,000 people a year die waiting for organs. The situation is so critical that some transplant specialists are prepared to contemplate extreme solutions, including opening up a legal market in organs.

So the world will watch closely the outcome of Israel's chosen solution. It will be controversial. Giving priority for transplants to patients who have signed donor cards violates a key principle of medical ethics – that medical care should be allocated on the grounds of medical need alone.

In passing the new law, the Israeli government has decreed that some patients – those who have signed donor cards – are more deserving than others. But there are other ways in which patients might be considered more, or less, deserving. Should smokers be treated equally with non-smokers? Do obese people deserve sympathy or blame?

Care must be non-judgmental if it is to be humane. Israel's move undermines this vital principle. On the other hand, if it successfully boosts the number of organs available for transplant, more lives will be saved. Israel may yet win the argument in the court of public opinion – but only if its experiment succeeds.

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