Death By Organ Donation

I have to hand it to the trio of “doctors” who wrote the peer-reviewed NEJM paper “Contextualizing the Dead Donor Rule in an Era of Voluntary Euthanasia“. They didn’t seek refuge in a hoary euphemism and instead called the cutting open a living person to steal his organs exactly what it is: “death by organ donation”.

Only they are not exactly against it.

The trio is, and I quote, “Carter Winberg, M.D., Ian Ball, M.D., and Robert D. Truog, M.D.”. The “M.D.”s do not, as you might have expected, stand for Mortuary Disrespecter, but medical doctor. Physicians have the bad habit of appealing to authority by putting their credentials next to their names in academic papers (which you won’t see rocket scientists do). Here they have no authority: none whatsoever. Determining whether it is right and moral to slaughter someone for their pancreas is not a question science can answer.

The old paradigm, frightening in its own way, was “the DDR”, the dead donor rule. Men would stand by stropping their scalpels as they waited for a patient to gasp his last. Fresh organs are, after all, like fresh fish, and vice versa. But now that doctors are actively killing their patients, on purpose, and often by patient request, a new idea arises.

Our trio uses the term “’voluntary euthanasia’ to refer specifically to clinician-administered life-ending interventions.” Here they slipped into euphemism: life-ending intervention is killing. Aided, abetted, or even committed by those donning white coats.

Under the DDR, “patients must be dead before organ procurement”:

Yet scholars continue to debate whether the DDR fundamentally requires the donor to be dead or whether its ethical essence lies entirely in the prohibition against killing.

Scholars. The fellas said scholars. If you value your liver, stay away from scholars.

This small paper, with the one exception noted at the beginning, is a small treasure of how academics invent and use language to avoid plain speaking. Take this:

Current organ-donation guidelines state that the DDR “must always be respected.”

Respected here is, logically, miles away from “must be obeyed.”

This immediately follow:

Over time, such guidelines have preserved the DDR either by maintaining a clear boundary between life and death or by enforcing strict limits on a physician’s duty not to kill. But changes in end-of-life care challenge both concepts.

One concept is that, now, you are alive-alive, which is equivalent to not-dead-alive, but which is morphing into organ-donor-worthy-dead-alive. The other concept, which you will have noticed, is the old duty of a physician to save lives is transforming into the duty to kill.

I have told you, and it is true, that doctors as doctors have no authority in the ethics of killing, except in the now defunct sense that if one has sworn to do no harm, and that killing is maximum harm, then one has the positive duty not to kill. Doctors no longer take that vow.

They also aren’t to up on their biology, either, given this next sentence:

Advances in life-sustaining technology have increasingly blurred distinctions between life and death…

No they haven’t. The line is as sharp as it ever was, or ever will be. The prospect of cutting out a juicy heart has blurred their vision, and is another reason I always warn people not to get sick.

What is true is that machines have made it possible to extend lives. It can be, and often happens, that a person removed from a machine will almost certainly die. But when they are on it, they are not dead, but alive-alive. The doctors confuse this with death, a category mistake. It is an excellent question whether and to what extent people ought to be put on machines. It’s likely that, at the end of life, we mustn’t make it a habit to let people eek out a few extra weeks just because we can. The costs are one thing, the false hopes even bigger.

But however we decide that, alive-alive is not dead-dead.

Possibly because they are enamored at the lovely employment prospects of stitching old spleens into new (ish) bodies, these doctors seek ways to redefine death so that we need not wait so damned long for the real thing. They say things like (I’m approximating), “I didn’t see a wiggle on this brain machine. Let’s cut him open before he goes off.” I may have approximated, but I do not jest.

It’s true that because of propaganda, government actions (in some countries), and our increasingly utilitarian attitude, more people are seeking to have doctors kill them. The trend is only up. This being so, our trio argues that as long as we’re slicing throats, we may as well carve out a colon or two while we’re at it. And, as I said, they rightly call this death by organ donation.

But this, of course, does involve physicians in the act of killing. And while doctors no longer swear an oath against doing harm, it is still somewhat disquieting to them. So they say things like this to make themselves feel better:

The categorical constraint on physician killing, for its part, is legally and ethically circumvented by voluntary euthanasia.

Circumvented my oh-so-healthy lungs! Which they cannot have, because I’m using them. Even if a rich man wants them.

Now, my dear friends, it is true that I am not as young as I once was, but I am not so far gone, neither. My lungs might not fetch as pretty a price as Sidney Sweeney’s, but they’re still above thrift-store level. Still, it cannot be denied that parts lifted from the young parts are better than those scavaged from the old. Nobody wants the kidney from a fat gasping 90-year-old who decided to kill himself. But how about the set from that kid who’s therapist recommended for MAID because of “depression”? (MAID is Canada’s euphemism for doctor killing.)

If doctors are allowed to kill to get organs, they will soon find excuses to kill those in possession of better organs. This is called the Slippery Slope, and I defy anybody to bet against it. Definitions of death will become looser, eligibility will become broader. This is about as certain a sociological bet as you can make.

Already in Canada official statistics are that “Of the 888 deceased donors in 2025, 62% donated following neurological determination of death, 30% donated following death determination by circulatory criteria (non-MAID) and 8% donated following MAID.”

The first two categories were people not yet dead, as our trio anticipated, but were certainly dead after have their guts removed.

The Boomers are, as all know, now on their way out. They don’t like it. “Half in love with easeful Death,” many of them will surely have doctors kill them “painlessly”. But it is also an easy prediction that at least one aged Boomer will be the recipient of some younger MAiD victim. Indeed, this is surely happened but hasn’t made the “news”.

I don’t see anything stopping this. You cannot expect a profession that finds it okay to drug and butcher children (and adults!) so that they can pretend to be the opposite sex will have any qualms about utilitarian killing. You have to understand, too, that doctors are asymmetrically awarded. Points for lives saved, and no demerits for killing the willing. If they can remove parts from the killed and insert them into those that want to live, they get double the score, as it were.

By far my favorite part of the paper was our trio’s repeated use of the word “safeguards”. If you can’t find humor in that, then nothing I can say can help you.

Video…to come

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