Organ Transplantation and Euthanasia

It was bound to happen, once euthanasia was legalized in the Netherlands in 2002. If a patient can legally elect to be killed by lethal injection, why can’t the proximate cause of death instead be the surgical removal of vital organs so that they become available for transplantation to someone else? At least that way some good will come from it – or so goes the rationalization.

That’s just what a team of Dutch and Belgian physicians proposed last month in the Journal of Medical Ethics. The concept still strikes many as chilling, and it may indeed hit a new low. Nevertheless, it must also be said that proposals and ongoing practices of this sort have, in the main, been collectively greeted with far too much apathy. Carnage on this bioethical front is not pleasant to ponder, but has regrettably become as predictable as the latest round of Islamic terror in the Low Countries.

Speaking of which, there were reports several months ago that ISIS put out a fatwa against children with Downs Syndrome. Whether or not that report is substantiated, there can be little doubt that ISIS and their ilk would have as little compunction about dispatching the disabled as they do other innocents.

You might think that such a report would give considerable pause to, say, the campaigners and authorities aiming to make Denmark totally Downs Syndrome-free within the next couple decades. Who in their right mind would want to share with the likes of ISIS such an unflatteringly low regard for whole classes of persons? And where does such a low regard for our fellow men come from?

Curiously, those who often seem so interested in the “root causes” of social problems ignore the whole realm of underlying belief on these sorts of questions. As it turns out, the postmodern gods (i.e. Progress, Choice, Tolerance) have large appetites, as did the primitive gods of old. Having turned its back on the God who literally feeds fallen mankind with His Body and Blood, the postmodern and supposedly “enlightened” West consorts with gods that demand to be fed with human blood. Poor bargain, that.

For the moment, tying euthanasia and organ harvesting together seems out of bounds here in the United States, even if it is advancing elsewhere via the abuse of language – of important words like compassion and mercy, rights and freedom. But what, really, is to stop that from eventually coming here?

Saturn Devouring His Son by Peter Paul Rubens, 1636 [Museo del Prado, Madrid]
Saturn Devouring His Son by Peter Paul Rubens, 1636 [Museo del Prado, Madrid]
Assisted suicide is already on the books in several states. A few years ago, a controversial proposal emanating from Brown University sanctioned the removal of both kidneys from a prospective donor before life-sustaining therapy is withdrawn. The envelope, it seems, is always being pushed.

Holding fast to principle is the only way to stay the hand that would strike down human life. With respect to organ transplantation, the ethical linchpin has long been the Dead Donor Rule: vital organs may only licitly be taken from those who have already died. Yet there are methods of organ procurement that are much less egregious than active euthanasia, but that nonetheless skirt the Dead Donor Rule – or at least come far too close for comfort.

For instance, what would you think about the removal of organs from a patient who has in good conscience decided to withdraw life support, and is clearly dying – whose heartbeat has just ceased – but is not quite dead yet? That is happening now, here in the United States.

Most organ procurement derives from donors who have been declared brain dead. The looser protocols utilize the circulatory criteria for determining death. The problem is that we don’t have the necessary confidence that the patient has in fact died when organs are harvested a couple short minutes after circulation ceases. (It is possible, for example, to resuscitate a person after much longer periods of time.)

Many practitioners are deeply uncomfortable with this procedure; the general public is largely unaware of them. There have been a couple of calls to halt these protocols (or to alter existing laws so as to circumvent the existing conflict) in various locales, but they seem to be safely entrenched at the moment.

The Church, to my knowledge, has not weighed in on this specific practice. She has recognized the legitimacy of brain death in that, as St. John Paul II taught, it “does not seem to conflict with sound anthropology.” (Death in the classical Catholic anthropological vision, formally established at the 1312 Council of Vienne, refers to the separation of the soul from the body; that, obviously, cannot be directly observed.) Pius XII and John Paul II stressed that the Church does not make technical decisions, but rather recognizes the specific competence of medical authorities.

But here’s the rub: the foremost medical authorities openly concede that donors declared dead by the circulatory criteria cannot actually be said to be dead at the time organs are extracted. This is not what they say with respect to brain death. So the medical authorities are taking an ethical position that the Dead Donor rule can be overlooked in this scenario rather than asserting that this method of pronouncing death is objectively, technically sound.

Much of this argument is driven by claims about the organ “shortage.” In even shorter supply, as ethical boundaries keep getting more elastic, is a genuinely reverent and humane philosophy – which the likes of Plato and Cicero, after all, regarded as tantamount to a meditation on death.

Some Catholic bioethicists with sound pro-life credentials feel that this particular procedure is acceptable. But we’re in an uncertain area in an age in which we’re becoming increasingly unclear about respect for the whole of life from conception to natural death. Therefore, at least to my way of thinking, there are serious grounds for calling for a moratorium on this, and other such, practices.

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.