What has Glenn Beck so fired up that he said on his radio show “If this doesn’t wake your a** up this morning, then nothing will?” How about this quote from prominent bioethicists comparing killing a human being to pulling weeds from a garden.
Two bioethicists — one from Duke University, the other from the National Institute of Health — bring up the question “What makes killing wrong?” in the latest issue of the Journal of Medical Ethics. Using their definition of killing, the authors conclude if the person is “universally and irreversibly disabled” and has “no abilities to lose” then killing them to take organs for donation in order to save the lives of others should not be considered morally wrong.
Walter Sinnott-Armstrong, a professor of practical ethics from Duke, and Franklin Miller, a senior faculty member in the NIH Department of Bioethics, state in their abstract ”What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities.” They argue that if no abilities remain then the “dead donor rule,” which is the ethical practice that a person must be declared dead before removing vital organs, should apply to patients whose hearts have stopped and are being removed from a respirator.
This discussion has been ongoing for several years and continues with this article. BioEdge, a publication discussing bioethical news, brings a few segments from the subscription-only journal in which Sinnott-Armstrong and Miller publish their opinion. BioEdge reports that the authors are seeking to make a case for organ donation after cardiac death when a person is taken off of a respirator. Once off the respirator, the person’s organs would be immediately harvested, but even at this point, BioEdge states, Sinnott-Armstrong and Miller believe the person is not yet dead because there is the possibility that his or her heart could start beating again.
Miller has written on this topic before for the New England Journal of Medicine. Here’s some of what was written in his co-authored piece from 2008 “The Dead Donor Rule and Organ Transplantation:”
Over the past few years, our reliance on the dead donor rule has again been challenged, this time by the emergence of donation after cardiac death as a pathway for organ donation. Under protocols for this type of donation, patients who are not brain-dead but who are undergoing an orchestrated withdrawal of life support are monitored for the onset of cardiac arrest. In typical protocols, patients are pronounced dead 2 to 5 minutes after the onset of asystole (on the basis of cardiac criteria), and their organs are expeditiously removed for transplantation. Although everyone agrees that many patients could be resuscitated after an interval of 2 to 5 minutes, advocates of this approach to donation say that these patients can be regarded as dead because a decision has been made not to attempt resuscitation.
In the more recent Sinnott-Armstrong and Miller article, BioEdge reports the authors as stating that “these patients are not known to be dead at the time of organ procurement.”
Sinnott-Armstrong and Miller argue that the dead donor rule is already being violated in many cases and that recognizing this violation and stopping organ donation in these conditions would drastically reduce an already limited number of donor organs for those in need. They suggest sidestepping this issue by rethinking the “norm of killing.” BioEdge has more from the authors:
“[T]he dead donor rule is routinely violated in the contemporary practice of vital organ donation. Consistency with traditional medical ethics would entail that this kind of vital organ donation must cease immediately. This outcome would, however, be extremely harmful and unreasonable from an ethical point of view [because patients who could be saved will die]. Luckily, it is easily obviated by abandoning the norm against killing.”
“[I]f killing were wrong just because it is causing death or the loss of life, then the same principle would apply with the same strength to pulling weeds out of a garden. If it is not immoral to weed a garden, then life as such cannot really be sacred, and killing as such cannot be morally wrong.”
BioEdge clarifies that the authors seeks to better define just what is considered killing. It adds that the authors suggest killing someone with “no autonomy left” cannot be considered “unfair” or disrespectful because it “if it does her no harm.”
While Sinnott-Armstrong and Miller make this argument, BioEdge reports in a separate article that several doctors have called for a moratorium on donated organs in the event of cardiac death until the issue is resolved from an ethical standpoint. The doctors state this opinion in the journal Philosophy, Ethics, and Humanities in Medicine.
In the abstract, these doctors calling for a moratorium write:
Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been “worked out” and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule.
Moreover, some arguments in favor of DCD, while likely true, are “straw-man arguments,” such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate.
The issue, however, isn’t an isolated incident. The Blaze has recently published articles about a disabled man in the U.K. who is seeking the “right” to die and a 3-year-old whose parents were told she couldn’t have kidney transplant because she was “mentally retarded.” And last year, we posted the disturbing video of a British advice columnist who said if a child were disabled a loving mother would “put a pillow over its face” to smother it. Watch that clip: