July 2019 Pulse
One of the most important breakthroughs in modern medicine in the treatment of patients with certain forms of organ failure is organ transplantation. In the case of patients with kidney failure, for example, renal transplantation is preferred to dialysis in most cases because it usually results in better quality of life.
With more and more patients suffering from organ failure due to chronic illnesses like diabetes, the problem of the shortage of transplantable organs is a serious one, to which there are no easy solutions. One way in which some countries have tried to address this problem is to encourage living donations. This of course applies only to certain organs like the kidney or the liver, and not to others like the heart.
In countries where euthanasia or physician-assisted suicide are legal, patients suffering from terminal illnesses and who wish to end their lives are encouraged to allow physicians to procure viable organs for transplant after their lives have been terminated. Needless to say, the Christian ethicist who opposes euthanasia and physician-assisted suicide would find this approach morally unacceptable.
There is a recent development in the practice of organ procurement and transplantation that is slowly gaining traction among physicians in some circles. Some commentators have described this appalling practice as ‘death by organ donation.’
In a recent article in USA Today, E. Wesley Ely describes this procedure as ‘ending people’s lives with their informed consent by taking them to the operating room and, under general anaesthesia, opening their chest and abdomen surgically while they are still alive to remove vital organs for transplantation into other people.’ In other words, organs viable for transplantation are removed from a patient while he is still alive, with his informed consent, killing him in the process.
Supporters of this practice argue that this is the best way to ensure that the organs procured will be optimal for transplantation. This approach, they maintain, trumps even procuring organs from patients that are euthanised by the administration of a lethal drug.
This is because the dying process takes 5 to 10 minutes, during which the organs may be damaged because of insufficient blood flow. This problem will be circumvented if the patients are still alive when their organs are removed.
One of the obstacles for this new procedure is the current ‘dead donor rule’. This is a traditional ethical principle which states that vital organs may not be removed when the patient is still alive and that the procurement of organs may not cause the patient’s death.
In their article published in The New England Journal of Medicine, Ian M. Ball et al. noted that some patients ‘may not want only a rapid, peaceful death, but also the option of donating as many organs as possible in the best condition possible.’ In such cases, ‘following the dead donor rule could interfere with the ability of these patients to achieve their goals.’
In light of this, Ball et al. suggest that ‘it may be ethically preferable to procure the patient’s organ in the same way that organs are procured from brain-dead patients …’
But supporters of this approach to organ procurement see yet another obstacle that would prevent it from becoming a wide-spread practice, even in countries where euthanasia and assisted-physician suicide are legal. In these countries, the legal method of assisting the death of a patient is by the administration of a ‘substance’ by a qualified provider or physician. Organ retrieval is not an accepted means of euthanising a patient.
Thus, those who wish to promote this practice of organ procurement are arguing for the amendment of the criminal codes of countries that have legalised euthanasia to include organ retrieval as a legal means of causing death.
No Christian could accept, much less endorse, this barbaric way of procuring organs for transplantation. This method not only violates the dignity of the patient from whose body the organs are retrieved, it is also a form of homicide. The desperate demand for life-saving transplantable organs can never serve as justification for killing a human being (even with his consent) in order to meet that need.
The emergence of this macabre practice of organ procurement should give all of us – theologians, ethicists, doctors, policy-makers and the public – pause. It should force us to return to the older ethical issues related to organ donation and transplantation with fresh questions.
We should revisit the different criteria of ascertaining death and the conundrums that accompany that whole debate, especially with regard to the neurological criterion. Ball et al. have used the practice of procuring organs from brain dead patients to suggest that this new approach should be seen as part of that continuum.
We should also return to the question of the legalisation of physician assisted suicide and the utilitarian philosophy that undergirds and nourishes it. We should reflect on just how misleading and deceptive the ‘greater good’ argument can be, especially when it is energised by a pragmatic ethic that argues implicitly or explicitly that the ends always justify the means.
And we should re-examine the practice of obtaining informed consent against the background of a culture which promotes the self-determination of the patient and which upholds autonomy as the most superior principle in medical ethics. We should prevent this legal document from becoming a license to commit homicide.
This gruesome practice of organ retrieval should cause us to reflect on the true goals of medicine, and on how the nobility of this healing art can very quickly and easily be ravaged by the barbarity of our prevailing culture, which the late Pope John Paul II has described as the ‘culture of death’.
It should force us reflect on what such practices have forced our society to become. It should make us painfully aware of the fact that the achievements of our civilisation have not expunged the perverseness that sin has brought about, namely, our inability to see the evil that we are willing to do for the sake of the greater good.
Wesley Ely, ‘Death by Organ Donation: Euthanizing Patients for Their Organs Gains Frightening Traction’, USA Today, 2 May 2019, https://www.usatoday.com/story/opinion/voices/2019/05/02/organ-donation-physician-assisted-suicide-death-disability-column/3628448002/
Ian M. Ball, Robert Subbald, Robert D. Troug, Voluntary Euthanasia – Implications for Organ Donation’, The New England Journal of Medicine, September 6, 2018, 379: 909-911.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor for the Ethos Institute for Public Christianity.