Should surgeons be allowed to euthanise patients by removing their hearts and other organs while they are still alive?
The idea, called “death by organ donation,” would enable euthanasia patients to donate their organs for transplantation in a way that would make them more likely to be usable. Due to this procedure he will also die.
“It would be an ethical thing to do because it’s something patients have chosen for themselves,” says Dr Robert Truog, a physician and bioethicist at Harvard Medical School who co-authored the paper ‘Outline of death by organ donation’ in the New England Journal of Medicine. “He has thought very generously: ‘How can my death help other people?’ This is a very charitable, generous act.”
But the idea is controversial for several reasons, including that it goes against the fundamental principles that have guided organ donation for decades. The deceased donor rule requires that the patient be dead before any organs can be removed. Doctors cannot even kill the patient during the organ removal process.
This rule has long generated intense debate, including controversy over how to accurately determine when a person has died, as well as the development of new methods to extend the lives of dying patients. Recover usable organs for transplant.
At the same time, many countries, including Canada, the Netherlands and Spain, have made it legal for doctors to help patients die through euthanasia.
“What if they chose to become an organ donor? The problem is that under current standards doctors are not supposed to cause death in the process of procuring organs for transplant,” Truog says.
Therefore, hearts, lungs, livers and kidneys can be removed from euthanised patients only after they have received lethal doses of drugs, making their organs, especially their hearts, much less useful for transplantation.
“Why wouldn’t it be OK for patients to say, ‘I choose to die by lethal injection? Is there no way I can help others?’ They should be able to donate organs as a permanent gift to others. And they don’t see any point in denying them that option,” Truog says. “I would say a more appropriate framework is that patients who wish to die by euthanasia can also combine euthanasia with organ donation.”
A “scary idea” that may have merit
In euthanasia, doctors administer lethal medicines that cause the death of the patient. The practice is illegal in the US, but a growing number of states have legalised assisted suicide, in which doctors give patients lethal drugs to take at home.
Instead of a doctor giving a patient a lethal drug, organ donation would end the lives of dying patients by anaesthetising them and then removing their organs while they were still working.
“So the organs will still be in ideal condition,” Truog says.
Some other bioethicists say the argument may have merit.
says, “The idea of death by donation is very disturbing at first. It’s a scary thought.” Ruth Faden: A bioethicist at Johns Hopkins University. But if you look at it critically in terms of fundamental ethical considerations, it’s not as troubling as it first seems.
She explains that the prevalence and acceptance of euthanasia, along with the willingness of some patients to become organ donors, is the reason.
Faden states, “If we are committed to respecting the autonomy of individuals at the end of their lives, we must also ensure that their choices are honoured and supported.” And if they choose to maximise their well-being at the end of their lives, that is a moral justification for death by donation. She says it will be important to implement strong safeguards to ensure full informed consent and protect patients from abuse.
A change could undermine patient trust
But some other bioethicists are horrified by the mere notion.
“This procedure is asking surgeons to take a living person into the operating room and bring a dead person out, which I think is murder,” says Lanny Friedman Ross, a bioethicist at the University of Rochester. “There are certain limits to consent. And one of the things we’re not allowed to do is consenting to say someone else can murder you.”
Others worry that this approach will undermine trust in both organ donation and end-of-life care at a time when some potential donors are already wary. There are controversies about this organ procurement effort.
“You can do real harm to both the physician-assisted suicide system and the organ donation system,” says Lori Andrews, a bioethicist and professor emerita at Chicago-Kent College of Law. “This approach may give people the image that these are vultures who don’t wait until you’re dead to attack. It harkens back to the philosophy of body snatchers of previous centuries.”
Critics also fear that allowing death by donation for euthanasia patients may someday mean that it will be an acceptable practice for physician-assisted suicide patients and even potentially hospice patients.
But others argue that this approach may currently be considered for at least some euthanised patients.
“If there are people who want to donate organs, such an approach would be a way to maximise their wishes and their altruistic goal of helping others,” says co-author Dr Carter Winberg, a Canadian critical care physician working on a master’s degree in bioethics at Harvard. New England Journal of Medicine paper. These are people who are already consenting to voluntary euthanasia and organ donation. It requires a new conversation about whether this is pthe practicebly ethical.”
