As I have often warned, the next big agenda item in organ transplant medicine is gaining license for transplant surgeons to kill the cognitively devastated and imminently dying patients for their organs. Such a policy is pushed from two different angles, both of which try to convince us that killing for organs would really be a case of no harm, no foul. First, they argue that if one is only “biologically alive,” e.g., in persistent vegetative state, the rational part that makes them human is gone,–and so it is perfectly proper to treat as if they were dead. The second main argument is that death is a process, and since we cannot know the exact moment when life actually ceases, we do no harm in allowing surgeons to hasten the time in cases where a patient is thought to be actively dying.
A physician named Darshak Sanghavi pushes the second argument in today’s piece in the Times Magazine. Ostensibly, the article is about Donation After Cardiac Death (DCD), that is patients who are allowed to go into cardiac arrest in an operating room after the removal of life support, and after five minutes without heart beat or respiration declared dead. (We have also discussed this often at SHS.) Then, the organ procurement team takes over the patient’s care and removes the organs.
Unwisely, Sanghavi creates a strong subtext, arguing that surgeons should just be able to take the organs without waiting the five minutes, indeed, before the heart even stops. From the article:
If people with no hope for meaningful recovery can be kept alive artificially, shouldn’t they also be permitted to die artificially?
Let’s examine this: People who die after removal of life support die naturally of their injury or illness. Thus, the writer seems to be advocating that people kept alive “artificially” via medical means such as a respirator, should also be allowed to have their live ended “artificially,” by organ removal.
My suspicion about this was heightened when Sanghavi claimed that people harvested after five minutes of no heart beat may not really be dead:
There were two crucial conditions. First, families could not be pressured to stop life support; they had to come to the decision on their own, in consultation with their relative’s doctor. No member of the organ-procurement team could participate in the family’s decision or declare death. Second, “irreversible cessation” of cardiac function meant that at least five minutes had to pass without a heartbeat. That interval was arbitrary — the panel of experts made no reference to supporting research — and they admitted that “this recommendation is only an expert judgment.”
Shanghavi more than hints that these patients aren’t really dead because their organs remain viable. But cellular life isn’t integrated bodily life. Before the cessation of circulation, the body is functioning as an integrated body. Afterward, it isn’t functioning as a body at all. If the body isn’t functioning as a body, and without intervention such cessation is irreversible, then the patient is dead. This is true even if the kidneys cells remain viable. The same is true of the liver. If blood will never again circulate through it, the liver ceases its function of filtering the blood for the now dead body. The fact that cells have not died does not mean the patient himself is alive.
Adding to my concern, Shanghavi supports a Denver hospital’s protocol that permits organ harvesting of infants only one minute after cardiac arrest. He also seems to promote relativism in determining when death has occurred:
Moving past a binary concept of life and death is, for most of us, an uncomfortable process. It’s worth considering how various cultures think about the beginning of life. Tibetan monks believe a new life begins around the time of a mating couple’s orgasm; many Catholics posit that it starts at the union of an egg and sperm; Roe v. Wade effectively established a legal threshold of life at 24 weeks of fetal gestation; some consider meaningful life to begin at birth; the Navajo think a baby is fully human when it laughs for the first time. If the emergence of life occurs on a continuum, perhaps the same is true of life’s recession.
Roe established no such thing, but that issue and when Tibetan monks believe a new life begins, are beside the point. Death is a biological determination. If it becomes a sociological construct, then there is no way to maintain trust in the organ transplant system. Indeed, Shanghavi reports how supposedly brain dead babies often don’t receive all the tests necessary to make a proper determination of death by neurological criteria. The answer to that is to set uniform standards and enforce them, not loosening the definition of death. Indeed, if we have abuses with determining brain death, imagine the abuses that could come from turning surgeons into killers.
December 20th, 2009 | 7:23 pm
[...] This post was mentioned on Twitter by Vince Humphreys and Debbie Myatt, Wesley J. Smith. Wesley J. Smith said: Killing For Organs Promoted in the New York Times Magazine » Secondhand Smoke | A First Things Blog – http://shar.es/aDV9d [...]
December 20th, 2009 | 7:33 pm
Who gets to decide meaningful recovery or meaningful life? That word meaningful is and will be used to dispose of people not wanted or not esteemed by those with the power to decide who do and do not possess a “meaningful” life. These little words are used to scrub society of people not deemed life worthy of life.
I agree we need standards that have to be enforced, but the way abortion standards are not kept, or laws regarding infanticide when the mother kills the child, doesn’t give me much hope.
December 20th, 2009 | 9:21 pm
Why are these arguments always made in emotional terms? His scientific points–for example, that no heart has ever stopped and restarted spontaneously after 65 seconds– should be the basis for a strong argument. But he rests the strength of the thing on making sure that realtives feel better about their loved one’s death by getting those organs donated.
Ugh. It’s ironic that he speaks in terms of being more comfortable with death: “moving past the binary” when, a lot of this is a function of people being unable to face a death without the “meaningful gesture” of organ donation.
And, perhaps I am just a terrible and unsympathetic person, but: Why should I feel moved by the parents who “would have permitted simply taking out [their brain damaged baby] Addison’s heart under complete general anesthesia — without the intermediate process of the choreographed death — which would have been a painless way to end their child’s life, had it been legal.”
They sound like monsters to me.
Wesley J. Smith Reply:
December 21st, 2009 at 12:15 am
holyterror: They’re made in emotional terms because the emotional narrative drives much of society today. The point is to overcome principle.
December 20th, 2009 | 9:22 pm
Also, to be clear, I do not agree with his argument or wish it to be stronger. I don’t think he can make it in any ethical way without relying on the “we will make people FEEL better!” theme.
December 21st, 2009 | 1:07 am
Wesley, I don’t know if I believe that everybody like the author of the NYT piece is out to “overcome principle.”
Actually I would say that it is more like that emotional realities are being elevated to the status of moral absolutes in the minds of such people.
Either way, I am constantly amazed at how unscientific and irrational our supposedly science-driven world has become. “Tibetan monks” indeed!
Can you imagine an article about climate change which stated the varying beliefs of people all throughout history about what the earth is for, and used it to make the argument that we should be changing our attitudes about who deserves to use the earth’s resources and which countries shoud be allowed to use more in order for the people in them to feel better about themselves?
And progressives are always accusing those who disagree with them of being anti-science.
December 21st, 2009 | 1:40 am
I should say, “progressives” in the ole scare-quotes because, really, I can’t think of anything more bizarre and regressive than arguing to convince medical professionals to cultivate and cannibalize small, helpless and sick humans for their organs so that other people might “make use” of them.
December 21st, 2009 | 7:30 am
Social comments and analytics for this post…
This post was mentioned on Twitter by CO2HOG: Killing For Organs Promoted in the New York Times Magazine http://bit.ly/5OfcmT…
December 21st, 2009 | 12:05 pm
If you don’t want to be an organ donor, the best way to protect your rights is to sign up at http://www.DoNotTransplant.com. No other organ donor registry in the United States will record your decision to say “no” to organ donation. Organ procurment organizations in 40 states are required to check the DoNotTransplant.com registry before taking anyone’s organs.
December 21st, 2009 | 12:07 pm
The final paragraph you quote is stunning in its complete failure as a piece of rhetoric–coupled with the author’s apparent belief that an actual argument has been made. Let’s see: different people have had different criteria for establishing when life begins, and this means that “the emergence of life begins on a continuum”? Um, really? Someone needs to go back to school and review “evidence” and “assertions.” But what’s scary to me is how many people will read that, nod their heads and say “Yes! A continuum! Completely divergent opinions are, in fact, a continuum!” Good grief.
December 21st, 2009 | 3:47 pm
While we’re on this topic, Wesley, have you seen the latest allegation that Israel harvested tissue and organs from dead Israelis and Palestinians in the 1990s without the families’ approvals? Even the JTA (Jewish Telegraph Agency) has this as a story out of Jerusalem.
As the New York Times Magazine piece you cite shows—everybody wants to grab organs! It’s not just China any more! Tattooing the words “ORGAN KEEPER” on my chest looks like a better and better idea all the time.
Wesley J. Smith Reply:
December 21st, 2009 at 4:25 pm
I did see that in today’s paper. Very disturbing.
January 1st, 2010 | 12:02 am
Forgive me but why should I give a damn what the Tibetan monks or Navajo think? I don’t expect anyone to take my word about conception because it is an article of Catholic faith, but because it is logical and definable; it is not arbitrary and does not change.
Links
Blogs
Find Us
Contact