“Neither will I administer a poison to anyone when asked to do so, nor will I suggest such a course.”–from the Hippocratic Oath.
Bollen and others recently published a piece examining one aspect of the question whether patients recently euthanized could be good sources of organs for transplantation. Their abstract says:
“Organ donation after euthanasia involves patients whose request to undergo euthanasia has been granted and who voluntarily want to donate their organs after death. It requires patients to undergo euthanasia in the hospital, and organ donation is performed after circulatory death. The practice is controversial and currently only allowed in Belgium and the Netherlands. Even in these countries, it is rarely performed; as of August 2016, 43 patients undergoing euthanasia had donated organs…”
Jan Bollen, Tim van Smaalen, Rankie ten Hoopen, et al., “Potential Number of Organ Donors After Euthanasia in Belgium,” 317 (14) JAMA 1476-77 (2017), http://jamanetwork.com/journals/jama/article-abstract/2616383.
As practiced in Belgium and the Netherlands, patients to be euthanized are given lethal medications administered to them as inpatients, not at home. In 2015, just over 2000 patients elected to die in this fashion. From them, 260 kidneys were harvested. The researchers concluded that a maximum of about 10 percent of all patients undergoing euthanasia could potentially donate at least one organ, with 684 organs potentially available for donation that year.
The authors note that medical suitability implies that a patient is a possible organ donor only. They stressed the need to ascertain consent carefully:
“Even if only a small percentage of the patients undergoing euthanasia donated an organ, donation after euthanasia could potentially help reduce the waitlists for organ donation. Nevertheless, it is essential that the primary goal of organ donation after euthanasia remains the same as for any patient donating an organ — to enable patients to carry out their last will of donating organs to help other people, after their own death.”
Comment:
There is no doubt at all that many more organs are needed. Nor is there any that a part of that need could be met by organs harvested from cadaveric organs. Where there is doubt is whether euthanasia, if permitted at all, should be harnessed as a mechanism to do so.
The risk with “right to die” reasoning is that the right could become a duty. Here in the US, as rationing becomes ever more widespread, and indeed accepted as necessary for fiscal stability, professionals and more especially administrators and policy makers are questioning the primacy of the traditional, Hippocratic ethic of saving life. The highly touted “triple aim” and the emphasis on “population health” implicitly accept the idea that there are limits to what we as a society are willing, and should be willing, to do to save lives. Where that leads is debatable, but the slope is slippery.
And now, in Belgium and the Netherlands, even more so. Now, the virtue of the euthanized may not be confined to celebration of their concern for the fisc. It might extend to honoring their contributions to the supply of organs. Whatever the circumstances of voluntary donation, there is no doubt whatever that donors’ generosity is laudable, indeed heroic. To spare another years of dialysis and to lengthen his likely span of years for altruistic reasons is grounds for secular canonization. But what if the virtue perceived in doing so becomes so widely recognized, so highly praised, as to become coercive? What if praise for the practice becomes so pervasive as to create an expectation? Troubling questions, these. The wisest course seems to be caution.
At Washington and Lee University, where I had the privilege to study in the 1970s, the motto is “Non incautus futuri”: “Not unmindful of the future.” Proponents of this method of organ procurement should contemplate that motto, and the wisdom underlying it. They should think even more carefully about the consequences of allowing a.) the intentional killing of a patient by a doctor and b.) the subsequent harvesting of the organs of the newly deceased. Man is not a means to an end, but an end in himself. Can one name a society oblivious to that principle that has not been a tyranny?