To: House Human Services Committee
From: Christopher T. Dodson, Executive Director
Subject: Senate Bill 2195
Date: March 17, 2009

The North Dakota Catholic Conference opposes Senate Bill 2195 in its current form, but believes the bill could be remedied with amendments that further the goal of encouraging anatomical gifts..

The Catholic Church strongly encourages organ donation. Organ donation after death is a noble and meritorious act and an expression of solidarity. The health care directive published by the North Dakota Catholic Conference has a section whereby people can state their request to make an anatomical gift. Last year, the conference sponsored a day-long workshop on organ donation and transplantation. So it is not from an attempt to discourage anatomical gifts that we raise concerns about SB 2195. Indeed, is it with the hope of not discouraging organ donation that we raise these issues.

In order for the public to accept and participate in organ donation -- as well as to be ethically acceptable -- donations must be made with informed consent and in a manner consistent with the donor’s wishes. This is the case with all health care procedures. For this reason North Dakota health care directive statute requires that decisions be made “in accordance with the agent's knowledge of the principal's wishes and religious or moral beliefs, as stated orally, or as contained in the principal's health care directive.”

This legislative body has determined that whenever a person with a health care directive cannot speak for himself or herself, the person’s health care directive prevails. Senate Bill 2195 would change this policy by placing potential anatomical gifts at the same level as a health care directive. The directive would no longer prevail. Instead, it forces the parties to resolve conflicts between the health care directive and the potential donation. In fact, lines 8 - 11 on page 2 of the bill go further, allowing procedures to be taken pending resolution of the conflict, even if they contradict the health care directive. This, in effect, gives priority to the potential anatomical gift.

This change has real consequences. Some measures used to enhance medical suitability of organs and tissue for transplantation raise serious ethical questions that have not been, and may not be, resolved. Like all health care procedures, these questions should be resolved in favor of the person’s health care directive.

Failure to respect and give priority to health care directives could ultimately undermine the Uniform Anatomical Gift Act’s purpose of fostering anatomical gift donation. Health care directives are the primary means by which a person indicates their health care wishes and the religious and moral beliefs that should guide and limit health care decisions. This principle guided us during years of work to improve and encourage the use of health care directives.

In the many workshops I have given on health care directives in North Dakota, one of the most commonly expressed reservations about executing a directive is concern that a physician’s wishes or interpretation of directive would prevail over the beliefs and principles set out in the directive. Similarly, a common concern about expressed about organ donation is that it will be done in a manner contrary to a person’s religious beliefs. In both cases, people want assurance that that under the law, the health care directive would prevail.

By elevating procedures to facilitate organ donation to the same level - or to a greater level - than health care directives, Senate Bill 2195 in its current form risks removing the sense of security people need before they will execute health care directives or make organ donations. Thus, in addition, to creating ethical problems, SB 2195, if not amended, threatens the work so many have done to encourage both organ donation and health care directives.

We think, however, that Senate Bill 2195 can be remedied by incorporating the standard that already applies to every other type of health care decision in North Dakota -- that decisions be made in accordance with the agent’s or person’s knowledge of the prospective donor’s wishes and religious or moral beliefs, as stated orally, or as contained in the health care directive.