“MAID” and organ donation

An article in the Journal of Medical Ethics (JME) assesses the ethical issues around organ donation by someone who requests assisted suicide or (“voluntary”) euthanasia.  (Subscription or purchase is required for access to the full article.)  The authors, specifically looking at the situation under current law in Canada, refer to assisted suicide and euthanasia with the blanket term “medical assistance in dying,” or “MAID” for short.  As if it’s truly a service…

It’s a logical step, if one accepts assisted suicide specifically or “MAID” more broadly.  It can readily be seen as a form of organ “donation after cardiac death” (DCD), in which people who have suffered severe neurologic injury but are not brain dead have their organs harvested after removal of life-supporting, intensive medical treatment.  In that case, the big issue is how long a doctor must wait to be sure someone has really died, so that the organ donation is not the cause of death.  But those folks are usually unconscious.  Rarely, someone with severe neurologic injury may be conscious, and could conceivably request removal of life support and consent to or request organ donation in the DCD setting.   I have previously added my voice on this blog to those who worry that DCD is at serious risk for jumping the gun.  (Google it if you will, I don’t immediately recall when I last posted on this.)

So of course, there are ethical “issues” (an awfully anodyne word) with this.  It’s seen as an exercise in autonomy but is the potential donor free from being pressured, or having his own life devalued, by himself or others, as merely a source of spare parts?  Is the person really dead according to the so-called dead donor rule, which entails that the donation itself not cause the person’s death?  Living donation of organs where that can be done—specifically, of a kidney—is rejected by the JME authors as adding pain and suffering to a person who hopes to escape that by dying.  What of informed consent—presumably it should be required, but doesn’t the process involve a suggestion, a wink and a nudge, hint-hint?  How is confidentiality handled?  Is it possible clearly to separate the person’s choice to seek death from a decision about organ donation?  What of conscientious objectors—medical workers who don’t want to participate in this act and people who don’t want to receive an organ so obtained?  And finally, for the donation to work, the death would have to take place in a hospital.  That last point alone seems to turn death into a macabre harvesting exercise.

Euthanasia—where the doctor actively kills someone, not just prescribes a lethal dose of a drug to someone wanting to die, for that person to take himself—is legal in Belgium, the Netherlands, and Luxembourg.  Read more about the situation in Belgium and Holland here.  In those countries, organ donation has been done after euthanasia at least 40 times, with “good medical results in the recipient[s] of the organs.”  Such organ donation is not allowed, yet, in Luxembourg, nor after assisted suicide in Switzerland or the U.S. states where that practice is legal.  In Canada, assisted suicide for people covered by Canadian health insurance is now permitted nationwide by law, and euthanasia is specifically sanctioned by law in Quebec.  The JME authors think that Canada can, and probably should, see its way to allowing organ donation afterward, if “acceptable policies” are developed, although they think the practice will be rare.

Once again, a “hat tip” to Wesley Smith, who decried this step in a recent National Review Online post as well as 1993 Newsweek article, accessible (for free) here at the Discovery Institute website.  “We don’t,” he wrote, “get to the Brave New World in one giant leap.  Rather, the descent to depravity is reached by small steps.”

If we make death into a good, a “medical” service, the risks to vulnerable people, and the commodification of the human body, are not far behind.  And as Margaret Mead said, it is the duty of society to protect physicians—and, all of us, I might add—from such things.

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