I have been warning that the drive has been renewed to expand the number of organ donors by opening the door to killing for organs, in this column about. Now, another article in the journal Bioethics, by Christian Coons and Noah Levin, add new targets to the list of potential (killed-for-organs) donors–people who want assisted suicide and prisoners due to receive capital punishment.
First, they claim that the Dead Donor Rule (DDR)–that prohibits killing for organs–is untenable and should be rejected. They go into a lot of detail about the reasons, but that, I think, is too arcane to deal with here. Then they argue that if someone is going to die inevitably anyway, why not take their organs even though it causes death. They illustrate their point with a silly mind game. From the article (link to Abstract):
A prospective killer buys a top-of-the-line ‘killing machine’ with all the latest bells and whistles. After it is turned on, the machine will terminate a victim in 15 minutes – and once it is turned on, it cannot be stopped. However, after it is activated, one can choose or change the method by which the machine kills…Suppose our killer selects a victim and turns the machine on. Before the 15 minutes elapse, the victim…requests that the machine be set to ‘anesthetize and remove vital organs’…
While changing the setting is a clear violation of DDR, we submit that if saving the patient is impossible in this case, then the killer does no wrong by changing the setting at the victim’s request. It also seems clear that third parties – including doctors – would do no wrong by doing the same. Three conditions make termination by RVO [removing vital organs] compelling in this case: First, the victim’s fate is sealed – she will be terminated, and terminated at a known time. Second, the patient requests the method. Third, the use of this method does not cause more harm to self or other than other possible methods
This mind game then justifies killing for organs for people who want euthanasia or who are to receive the death penalty:
We take no stand on the permissibility of voluntary active euthanasia (VAE) or capital punishment (CP). However, where these practices exist, termination by RVO may meet the conditions outlined above. We take it as obvious that termination by RVO would meet the first two conditions. Termination by RVO need not hasten death. The method of termination should have no significant bearing on the time selected for termination. Additionally, patients seeking VAE and the condemned could autonomously express a wish to be killed by RVO without choosing death for the removal of organs.
They proceed to argue that so doing would not violate any recognizable rights:
If a patient opts for VAE in a society that permits it, and then chooses termination via RVO, it seems clear that no more harm is done to others than if he were terminated by any other means. Indeed, the effect on others is quite the opposite because termination via RVO can save multiple lives. Admittedly, the case is less clear when we turn to CP. Again, multiple lives may be saved if the criminal chooses and receives termination by RVO.
The authors eventually put in the typical hedge seen in papers of this sort, claiming:
[W]e are not committed to a policy that allows subjects of VAE or CP to choose death by RVO we are not committed to a policy that allows subjects of VAE or CP to choose death by RVO, but we maintain that it is irrelevant that such policies would violate DDR. To our minds, the only relevant concerns here are whether VAE and CP are justified practices and the worry that legalizing RVO in these cases will cause the public to believe that subjects are being involuntarily killed for their organs.
The main point of this article was to argue against the dead donor rule. But I think it’s implicit utilitarian amorality illustrates something very disturbing about the current trend in bioethics and our public philosophical discourse. Arguing on behalf of killing for organs as a part of euthanasia and the death penalty is the logical destination of the current moral direction in which we are traveling;
- in which choice matters, not life;
- killing is only wrong when the killed is capable of–and does–wish to live; and,
- human beings can be looked upon as objects and used instrumentally as mere natural resources, etc..
Accept those and other such premises, and the kind of thinking exhibited by these writers becomes inevitable. Indeed, to show you how far it has already advanced, the authors express the exact view of Jack Kevorkian, once an outcast and now receiving a hefty $50 K per speech, as his values are elevated into a matter for respectable discourse in a major professional journal. Meanwhile, China has been roundly condemned for harvesting (and selling) the organs of its executed prisoners. If any of these unfortunates gave consent, do we now say that tyranny did nothing wrong in those cases?
Unless we return to a bold and unapologetic embrace of human exceptionalism, these kinds of arguments will become more mainstream in bioethics and among the medical and legal Intelligentsia. Once that happens, policy often follows.
November 2nd, 2009 | 12:09 am
[...] Killing for Organs: Should We Harvest Those Wanting Euthanasia or … [...]
November 2nd, 2009 | 8:38 am
Definitely not. No, no, no. Harvesting a euthanized or executed person’s organs without that person’s permission violates the individual’s integrity. We don’t do that here in the US of A.
November 2nd, 2009 | 11:47 am
Obviously no. The “killing machine” example can be refuted quite simply — doctors don’t know when any given patient will die. I have at least five examples *in my family alone* whereby death was certain either within a day or within a month that resulted in near complete recovery. Even naturalist doctors who don’t believe in miracles know this.
As for capital punishment, there are four counter arguments:
(1) Some people believe it is wrong, so two wrongs don’t make a right. The Nazis gained a tremendous amount of knowledge through their immoral human experiments. It would be wrong, however, to use them as foundations for our medicine. We also don’t use the skin of the dead as cheap leather or the bones of the dead in place of ivory.
(2) As with the use of embryonic stem cells which would the disposed of anyway, if capital punishment is deemed useful, the pressure will be high to keep it in place even if it is deemed ultimately wrong.
(3) Even if capital punishment is okay, we do not know if the prisoner will get a last minute reprieve, so death is my no means certain.
(4) Even if capital punishment is okay, if the prisoner is retarded or of low regard but innocent, the pressure to free this innocent is low since “his organs are more useful in the body of someone who will amount to nothing”.
Using this to justify Euthanasia merely illustrates the “gravity of logic” also known as the slipper slope. We may want our logic to only go so far and no further. But gravity of logic inevitably pull things down the slope to their logical conclusion. It’s happened with the abortion debate. It’s at risk of happening in the courts of British Columbia, Canada with polygamy and possibly child brides being okay because same same marriage is okay.
Amazingly this one column illustrates a few steps in the “gravity of logic” quite nicely.
If killing for organs of the “inevitable” is okay, then “killing those who don’t value their own lives” is okay (instead of providing mercy, love, and comfort we provide the lethal injection with a cold grimace watching the clock with anticipation). Then “killing those who don’t have ‘negative” social value” is okay. Then “killing those who don’t have ‘no’ social value” is okay. Then “killing those who are not ‘perfect enough because of some genetic defect that might possibly cause some problem in the future’” is okay. The “killing those who are not ‘genetically perfect enough’” is okay.
The line of reasoning is identical, especially if you assume the previous place up the slope is valid. Accept one, and you accept all. Logic cannot defy gravity no matter how much you may want it to.
November 2nd, 2009 | 1:14 pm
[...] can be a tool for promoting life. However, it can also be a tool used to justify death. In this article, you can see the scare ahead for the weak, the elderly, or the criminals. The article in [...]
November 2nd, 2009 | 1:45 pm
[...] Smith writes at the First Things Secondhand Smoke Blog: “aI have been warning that the drive has been renewed to expand the number of organ donors [...]
November 2nd, 2009 | 8:48 pm
How about harvesting the ones who want euthanasia assisted suicide futile care theory DNR etc. for OTHER people, and who natter on about “end of life” and “ethics,” and don’t leave out the doctors who participate, either. Now. As if any sane person would want any part of them.
November 2nd, 2009 | 9:29 pm
Remember the saying, “What is this, Russia?” Well now it’s “What is this, China?”
As long as doctors and lawyers are regarded as intelligentsia, and as long as “intelligentsia” are regarded as intelligent, and as long as there IS “bioethics,” it’s going to keep on this way and getting worse.
HW: That’s right. The thing is, things are done here in the USA that you and others are too trusting to believe could go on, but they do. Trusting in the intelligentsia, e.g. doctors, as a matter of fact. Simple common sense is enough, better, and safer.
November 2nd, 2009 | 11:31 pm
SICK. Absolutely SICK.
November 3rd, 2009 | 10:51 am
[...] Smith has a longish post at Secondhand Smoke: “Killing for Organs: Should we Harvest those Wanting Euthanasia or Due to Receive Capital [...]
November 11th, 2009 | 5:38 pm
I would volunteer to be euthanized so my organs coule be donated if it were legal. I have kidney failure and have already had two kidney transplants. The one I have now will eventually fail, and I do not want to be on dialysis again and not sure I want to have third transplant. I am still young and my heart, lungs, liver, pancreas, are all in great shape. I could just be put to sleep and donate my good organs removed I could help a lot of people. If I get to the point where I am gonna die in a few weeks if I don’t go on dialysis what would be so horrible about them euthanizing me and taking my healthy organs and giving them to other people who need transplants. I will also avoid the process of suffering and dying of kidney failure as well, it would be just like going to sleep for surgery except that I would never wake up!
November 12th, 2009 | 1:24 pm
I have read the paper being discussed and am concerned about the number of ways in which it is being misrepresented. First, nowhere in the paper do the authors support either euthanasia (VAE) or capital punishment (CP). This is, in fact, expressed explicitly in the quotes above, though Smith chooses to gloss over this or refer to it as “hedging.” It is not hedging; the authors’ goal in this paper is to make a technical point: IF we are going to allow VAE or CP, THEN removal of vital organs (RVO) should not be ruled out as a means of death, PRESUMING CONSENT. What’s more, as Smith notes, the main goal of this paper is to attack the dead donor rule (DDR). In fact, the authors’ main problem with DDR is that DDR DOES NOT entail a prohibition on killing for organs. Thus, their main conclusion is friendly to those of you who think killing for organs is always wrong (contra their other arguments) since they point out that the current rules (DDR) is of no help to you! Smith clearly misses or ignores this fact, given that he writes: “First, they claim that the Dead Donor Rule (DDR)–that prohibits killing for organs–is untenable and should be rejected.”
I also want to address Ronald Devin’s arguments, which often suffer from this same conflation between arguments for VAE/CP and arguments for RVO GIVEN VAE/CP:
“The “killing machine” example can be refuted quite simply — doctors don’t know when any given patient will die. ”
In cases where VAE is GIVEN, the doctors DO know, with certainty, when death will occur; it will occur when they cause it. That doctors don’t know when patients will die “naturally” is an argument against VAE, not against RVO given VAE, and thus not against the paper under consideration.
“Some people believe [CP] is wrong, so two wrongs don’t make a right.”
The authors never claim that the possibility of VAE/CP by RVO makes VAE/CP permissible, and thus that “two wrongs make a right.” They simply claimed that RVO would be no worse (and perhaps better) than other means of VAE/CP given consent, which says nothing about whether VAE/CP themselves are right or wrong.
“Even if capital punishment is okay, we do not know if the prisoner will get a last minute reprieve, so death is my no means certain.”
This does not show that RVO is an inappropriate means of CP, any more than it could show than anything else is an inappropriate means of CP. It shows, rather, that RVO should be used no sooner than the moment of execution (just as no other means of death should be used sooner than the moment of execution). But this is entirely in line with what the authors argue.
“”As with the use of embryonic stem cells which would the disposed of anyway, if capital punishment is deemed useful, the pressure will be high to keep it in place even if it is deemed ultimately wrong. . . . Even if capital punishment is okay, if the prisoner is retarded or of low regard but innocent, the pressure to free this innocent is low since “his organs are more useful in the body of someone who will amount to nothing”.”
These arguments are not really arguments that RVO is inappropriate as a means of CP, but that allowing RVO in these cases will lead to further wrongs. First, it is worth mentioning that the authors are arguing only for CONSENTING RVO, which means that the severely retarded would be unlikely candidates for the practice. Second, the authors address “slippery slope” concerns like these in their paper, so perhaps going to the actual text would be useful here for those of you with such concerns. For my own part, I find such arguments to rely on an unrealistically cynical view of the moral climate. I see no reason to think that the public would be any less responsive to arguments against CP or to evidence of innocence because they’ve become somehow organ-hungry. If the merits of such arguments stand on their own, then whether or not consensual RVO is a possible means of death where and when VAE/CP are permitted seems unlikely to matter.
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