The paper in the oh-so-prestigious New England Journal of Medicine is “Voluntary Euthanasia — Implications for Organ Donation” by Ian M. Ball, Robert Sibbald, and Robert D. Truog, a couple of docs and somebody else. We shall see that this paper at least proves knowing the knee bone is connected to the thalamus, or whatever, does not train one especially well to make ethics decisions.
Now doctors don’t kill patients, except by accident or neglect. Executioners kill people by design, on purpose, and with no legal culpability. When a person who was formally a doctor on purpose or by design kills somebody (and is not in the military engaged in war and such like), he is no longer a doctor but an executioner. You can never again have the same trust you had in this individual that he has your best interest in mind when you suspect he might be smiling at you because he likes the shape of your liver.
Doctors, as I know by many, many years association with them, really do think well of themselves. Because they are, mostly, engaged in enhancing and saving lives, this excess ego can be forgiven them. Unless it causes them to start believing their own press.
We can look to doctors regarding the ethics and morality of organ donation in the same way we look to physicists about the capabilities of nuclear weapons. The physicist can tell us what will happen, and of the nature of the effects, but the physicist is in no way especially competent to say when and under what circumstance such weapons should be used. Physicists are not moralists. Neither physicians, though they do gain some practical experience in the area.
This means we cannot leave physicians to themselves to decide what is best and what worst and what is anathema about killing somebody to take their organs. For the least proof of this we see that few or no doctors yet (to my knowledge) have embraced the term executioner, even as they advocate the active killing of patients.
Secondly, they never say killing and always employ a euphemism. Euphemism, except for comedic effect, always indicate somebody is hiding something. The euphemism (in this paper and elsewhere) “voluntary euthanasia” is interesting. Why the “voluntary”? Why its emphasis? (These are rhetorical questions.)
If you’re in the market for used spleens, you can’t be thrilled when a spleen holder dies at home, far from a hospital and its facilities for spleen removal. Bodies left to linger for even small amounts of time are like fish left in the sun. First thing you can do, then, if your hunger for used spleens is to encourage people to come to (warm, quiet) hospitals to die. Dying, it seems, requires expertise (just like births). The authors of this paper do not say “Do not die at home”, but the bias for a hospital death is there.
The dead donor rule — a traditional ethical principle guiding organ procurement — states that vital organs may not be retrieved before the patient’s death and that the procurement of organs may not cause the patient’s death. This principle assures patients and the public that physicians will be bound to the interests of their patients before the interests of potential organ recipients.
The dead donor rule doesn’t do that for me, because of the suspicion a doctor turned executioner will hasten the patient’s death. Assisted suicide is the euphemism. Our authors aren’t keen on the rule, either, because of the possibility of spoilage (my emphasis) done by the killing method.
Although some patients may want to be sure that organ procurement won’t begin before they are declared dead, others may want not only a rapid, peaceful, and painless death, but also the option of donating as many organs as possible and in the best condition possible. Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases, it may be ethically preferable to procure the patient’s organs in the same way that organs are procured from brain-dead patients (with the use of general anesthesia to ensure the patient’s comfort).
Whose goals? Drug ’em up and start cuttin’. What can’t be used is easily disposed of.
Patients who want a rapid, painless, and peaceful death while optimizing the number of organs they can donate are best cared for in an operative setting, where they can be fully anesthetized and where optimal organ procurement is supported.
There’s the death-in-hospital preference, even for patients the doctors kill.
The authors also recognize the idea of “non-therapeutic practices” has to be jettisoned. Pumping chemicals into a body you’re about to go shopping in is not by definition therapeutic.
Well, once you’ve given up on the idea physicians should do no harm, abandoning the rest of traditional medical ethics is far less painful.
Categories: Culture, Philosophy
MIT’s Technology Review online edition reports that a Bay Area startup, Ambrosia Medical LLC, is selling young folks’ blood for transfusions. Ambrosia has a website, and is looking for investors. Obviously, some businesses need to keep donors alive, at least nominally so.
A related business model might want to broker pre-payment for spare parts. Bay Area residents who do well be doing good, and whose time and real estate is so valuable, should be able to contract volunteers in case organ donation is needed.
And an Uber-style business model for short-notice, on-demand livers, spleens, lungs, etc might get good traction.
Timely post, Briggs.
Executioner is the correct term and should be used. Organ donation is a money making business and high demand one. They no longer care where the organs come from—my mother was 69, went to the doctor weekly and was hooked on prescription narcotics for 20+ years, but hey, her organs were “fine”. No, they were not fine. I stopped believing in the “miracle” of organ donation at that point.
This probably sets the wrong tone for the discussion, but the video seems relevant to live organ donation: https://www.youtube.com/watch?v=Sp-pU8TFsg0
Hey why not? So-called “doctors” have been hacking up dead babies for fun and profit for decades. The babies were murdered first, involuntarily on their part.
After all, how will Superman ever walk again after falling off his polo pony and breaking his own fool neck without dead baby tissues? He’s already passed, you say? Do you mean to tell me that 75,000,000 dead babies weren’t enough to save Superman?
And what about the rock stars who need new livers? The rock star lifestyle can be hell on livers, you know. Hack, hack, hack away medical professionals. It’s your calling (but who exactly is making the call?)
“….the same way we look to physicists about the capabilities of nuclear weapons. The physicist can tell us what will happen, and of the nature of the effects, but the physicist is in no way especially competent to say when and under what circumstance such weapons should be used. Physicists are not moralists.”
One could substitute for “physicist” and “physicists” any number of comparable specialized experts, for example, oh say, how about … “statistician” and “statisticians”. That would lead us to conclude that, like a physicist, a statistician being expert with statistics is in no way qualified to render opinions of merit regarding morality.
I can’t seem to “put my finger on it” but that line of reasoning seems to have some sort of fundamental flaw…..
I don’t believe the figures on abortion. None of them can possibly be remotely accurate.
It is not a common thing. Nor is it appropriate for seedy old men to insinuate women of their fancy have had abortions. It’s sick. Maybe women of certain races have more abortions? Dependant on colour?
In taking history manually, directly, for each and every patient, even where immediate access to paper notes, or paperless ones, was an option in most venues, and in accordance with correct practice, terminations or abortions were almost never on the list of surgeries in past medical history of women of child – bearing age.
Private healthcare is a compromise of ethics, from the start.
Nor is the NHS an example of ideal.
Nor is it morally right to remove organs from living humans!
Nor the opting ‘out’ of organ donation, as opposed to card carrying, as is advocated by many do gooders.
Healthcare is an ever growing cost as new treatments become available, life expectancy increases and borders are open for healthcare holidays. Recovery times and hospital stays shorten, but this does not keep pace with the aging population brought by improved health.
My time in cardio-thoraccic physio was as a student at Harefield. There were no live organ removals. The patients had all died in RTA’s or on ITU. I realise that times have changed since then. Especially on care of the elderly ward and in care homes, ‘end of life plan’, to me, is a murderous thing. Not as it is intended, but as it is implemented, cynicly.
Blood and plasma transfusion is organ donation, too, so ‘we’ could ‘arbitrarily bin’ those people as well. Just to make sure the offending Drs don’t have an ego, or suffer from ‘high self esteem, leaving only non medical drs with the odious privilege.
The premise of the essay seems to be something along the lines, ‘if it is allowed it will be done,’ with the risk being that if doctors are allowed to harvest organs from those willing to die and be harvested, doctors will abuse the law. (especially when they can make a lot of money in the process)
But note that China is doing something similar, on a massive scale that seems to include the on-demand use of political prisoners as on-demand (demand by the patient in need) organ donors, apparently to include the harvesting of organs from the living. And, they’re going about this in a very inefficient way (such that some recipients need multiple organ replacements because best-match is not the approach taken). See the following site, which includes downloadable reports: http://www.chinaorganharvest.org
With the exception of bone and corneas, organs MUST be removed from living patients to be viable. And yes, there is evidence of organ procurement orgs pressuring hospital staff to hasten the process. The patient must be declared “brain dead”. This term didn’t exist until transplants were a medical option. The tests are neither conclusive, nor sophisticated. The “patient”/donor is given no anesthesia – only paralytics. This video below explains the process in detail, and made me decide to never check the donor box, lest I get cut up while conscious.
I don’t need to view gory videos to see or know what goes on. I’ve been in theatre many times, did dissections as a student. I would never donate my organs nor my body for medical research. Just my naturally selfish way. There are enough bodies at UCL at last count. A sea of them. Each one kindly giving their body.
It all depends upon perfusion of the tissue and temperature of the body part.
Without going into gory details, which some ‘philosophers’ might enjoy, there are instances where tissue is living and the person is dead, it just has to be left there.
As to brain dead? Already commented on that.
There aren’t enough staff, or rather there isn’t enough space or money to contain all the patients who would still be alive if the term brain dead were not permissible.
The very first patient I treated was a patient in a rare condition post routine surgery where his body reacted allergically to the anaesthetic and he never came round. He was nursed impeccably, no bed sores. I often wonder what happened to him in the end. All his joints had full range of movement despite his recurrent associated reactions into a spastic pattern.
I immagine he was transferred and sircummed to a chest infection at a care home.
I wonder how many other ‘subscribers’ to breitbert magazine, or however it’s ‘spelled’, received an email saying,
“click your poison”.
When unsubscribing because the editor and chief was telling porkies on TV, Fox news, which I miss in the UK, about what you can and cannot do in England. The man has an English accent, presumably the news as it is repeated never loses anything in the telling.
Then received an email saying,
“OH DON’t go! I need you in my spiritual corner”!
Then a further seven or eight emails of the same ilked title which weren’t opened.
It’s all a bit yellow if you ask me.
This comment should be on today’s witchcraft post.