By Vivian Tork

Criticized widely as coercive and extreme, a bill introduced in January in the Massachusetts House of Representatives proposed to reduce prisoners’ sentences by between two and twelve months in exchange for their bone marrow or organ donations. Its cosponsor Rep. Judith Garcia (D) offers that the objective of the bill is to allow prisoners to participate in the potentially life-saving work of providing those in need with new organs. Garcia appeals especially to prisoners with family members on the organ transplant list. With more than four thousand patients in Garcia’s state awaiting an organ, there certainly is a need for encouraging organ donation. To put that number in perspective, according to statistics available from the Organ Procurement and Transplantation Network, Massachusetts has the sixth greatest number of patients in the nation awaiting an organ.

Garcia’s bill expresses concern for those on the bone marrow transplant list as well. Her office adds that African American patients have difficulty finding a donor. Transplant success statistics indicate that higher acceptance rates after organ transplants have been correlated to donations from blood relatives. However, only 30 percent of the time do patients match with a family member. Making matters more difficult, only one in four African Americans in need of a marrow transplant is matched with a donor who is not related to him or her. Eighty percent of the time, that individual is the only match on the national donor registry.

A disproportionate number of prisoners are African American, and Garcia claims they are a perfect group to appeal to in an effort to support the needs of the larger African American community in Massachusetts. To accomplish this end, the bill would establish a Bone Marrow and Organ Donation Committee comprising Department of Corrections staff, transplant experts, and advocates for both the prisoners and transplant team that would oversee the selection of candidates eligible for the program. Once selected, the committee would determine how much marrow or organ material must be donated for the individual to earn a sentence reduction. The Department of Corrections would not benefit monetarily. The only exchange to take place would be organs for time in prison.

By design the committee includes two advocates for the rights of the prisoner and only one for marrow and organ donations in order to protect the interests of the prisoner. However, legislators have raised concern that the balance of demands and rewards presented to prisoners is inevitably coercive. Despite their advocates, the numerous pressures of a prison environment make it difficult to distinguish just how willing prisoners’ spirit of volunteerism really is.

An environment like the one created by the Bone Marrow and Organ Donation Committee could be categorized as one of “undue influence” as defined by the Belmont Report, which warns that this can happen all too easily in prisons. Prisoners’ reduced self-determination, therefore, renders them a vulnerable population. Evaluating the consent of those whose agency is most handicapped merits a higher level of scrutiny.

Especially in these circumstances, special measures must be taken to uphold the Hippocratic maxim: Do no harm. Skeptics of the bill, like the policy director of the Prisoner’s Legal Services in Massachusetts, Jesse White, weigh the harm that prisoners may incur from donating their organs or marrow against the advantages they stand to gain. White worries that poor-quality health care within prisons does not offer much promise that prisoners who agree to donate will be given adequate care. This concern does not belong to White alone. Adequate and timely medical care is not just a legislative concern but is widely considered to be a requirement of Catholic ethical teaching on human life and dignity.

Further, the bill runs the risk of compromising the individual rights of prisoners for the good of the community. The US Conference of Catholic Bishops is particularly sensitive to this concern and warns against prisoners and other vulnerable populations being used to serve the political interests of those in power. The State has a duty to confer benefits and burdens upon its citizens according to ethical requirements that are designed to protect the rights and dignity of each individual. Both benefits and burdens must be equally distributed according to the needs, merits, and contributions of each individual in the community.

The Belmont Report recommends that less-burdened classes of citizens be called on to sacrifice for the cause of medicine before those who are vulnerable—like prisoners. Massachusetts Speaker of the House Ronald Mariano says that pitching a marrow and organ donation program to prisoners resorts to “extreme” measures in its attempt to ease the burdens suffered by residents on the transplant list. Many legislators concur.

Others, like George Annas, the director of the Center for Health Law, Ethics and Human Rights at Boston University, raise concerns that the bill calls for the sale of bone marrow and organs. He says that even though money does not change hands, a sentence reduction still is “compensation for services,” which is equivalent to paying prisoners for their organs. Federal law prohibits such transactions. Voluntary donation, within very particular circumstances, is the only legal means of giving or acquiring human organs in the United States. In response to criticism like Annas’s, the bill’s cosponsor Rep. Carlos Gonzales (D) agreed to rework the legislation and expressed that he welcomes suggestions for a bone marrow and organ donation program that does not involve a commuted sentence, understanding that these laws are in place to ensure that any and all organ transplantation is ethical and consensual.

When considering how ethical a bill like this is, Catholic moral teaching proves insightful and encouraging. According to the Ethical and Religious Directives for Catholic Health Care Services, the mission of Catholic health care is to participate in the healing and life-giving mission of Christ and “to see Christian love as the animating principle of health care, to see suffering as a participation in the redemptive power of Christ’s passion.” While it could very well be true that Christian love motivates Garcia and Gonzalez to implement a program that could potentially save many lives, one cannot force such a motive onto another. Just as Christ’s love is freely given, so must man’s be. In the case of incentivizing prisoners to participate in a merciful work by legally and ethically questionable means, the prisoner is placed within conditions that make it unlikely that his motive would be pure.

Rather than encouraging prisoners to partake in the corporal works of mercy for mercy’s sake, the bill encourages them to act mercifully in their own interest, which is contrary to the Gospel. Perhaps a more Christian and ethical means of alleviating the burdens of those on the transplant list would be to educate prisoners about the need for organ donation and the great good it can do for others and to create a pathway for those who feel called to participate in this good, free of any sort of coercive pressure.

Vivian Tork is studying history and biology at Hillsdale College and is an undergraduate publications fellow at The National Catholic Bioethics Center.