Killing the Dead Donor Rule: Why Should We Trust the Promises of Regulatory Control?

This is Part 2 of my deconstruction of an article in the NEJM proposing to end the dead donor rule in organ transplantation. Hit this link to read Part 1:

In the end, since the authors of “The Dead Donor Rule and Organ Transplantation” apparently believe we can’t really get many viable organs from truly dead patients, they seek to shift the ethical ground. Restricting donation of vital organs to the truly dead is to be discarded, and in its place they propose that old catchall—“choice:”

Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered. With proper safeguards, no patient will die from vital organ donation who would not otherwise die as a result of the withdrawal of life support.

No. No. No. First, not all patients whose life support is removed necessarily die, for example the terrible case in California where the surgeon was charged with trying to hasten the death of a prospective donor (charges that now appear likely to be dropped) when the patient did not go into cardiac arrest after cessation of life support. More to the point, why should we trust bioethicists and organ transplant professionals to enforce “proper safeguards” when this article claims that the current safeguards aren’t adequate despite being told for years that they are? And if the only thing that matters is consent, why not let any seriously ill patient be killed for their organs? Yes, this has been seriously proposed, as I discussed in Culture of Death.

Besides, “the bioethicists” have a terrible record overall of keeping to their solemn promises about control, guidelines, and limitations, to wit:

- Dehydration of the cognitively devastated, as originally packaged, was only to be permitted in cases of patients unquestionably in PVS. Now, conscious patients are dehydrated all the time.

- When ESCR broke on the scene, we were told that “all” the biotechnologists wanted were the “leftover” IVF embryos. Now, the National Academy of Sciences has given its ethical imprimatur to creating embryos for research whether through fertilization or cloning, and cloning is pursued at Harvard, Stanford, and other facilities.

- Assisted suicide is supposed to be limited to the terminally ill for whom nothing else can be done to alleviate suffering. We have seen in Oregon and elsewhere that that promise has certainly not been kept. Indeed, they kill babies in their cribs in the Netherlands based on eugenic criteria.

And now, we are urged to move from taking vital organs from the dead, to taking them from the living who will die anyway.

This is the ultimate point: Across a broad front we are being pushed toward objectifying and instrumentalizing human life by treating some of us as mere resources to benefit those whose lives are deemed to have better quality, and hence, greater moral worth. That is not only unethical, it is profoundly immoral. And if it continues, it will lead to a collapse in the public’s trust in medicine, bioethics, and bioscience.