Mininyx Doodle/iStockphoto//Getty Images For stories about healthy living, subscribe to NPR Health Bulletin. Should surgeons be allowed to perform euthanasia by removing patients’ hearts and other organs while they are still alive? The idea, called “Death by Organ Donation,” would allow patients undergoing euthanasia to donate organs for transplants in a way that would make
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Should surgeons be allowed to perform euthanasia by removing patients’ hearts and other organs while they are still alive?
The idea, called “Death by Organ Donation,” would allow patients undergoing euthanasia to donate organs for transplants in a way that would make their organs more likely to be usable. It would kill them too.
“It would be ethical because it is something that patients have chosen for themselves,” says Dr. Robert Truogphysician and bioethicist at Harvard Medical School, co-author of a paper describing Death by Organ Donation in the New England Journal of Medicine. “They’ve thought very generously: ‘How could my death help other people?’ “It’s something very altruistic and generous.”
But the idea is controversial for a number of reasons, including because it goes against the fundamental principles that have guided organ donation for decades. He Dead donor rule requires that patients be dead before any organs are removed. Doctors also cannot kill patients in the process of organ harvesting.
The rule has long generated intense debate, including disputes over how to accurately determine when a person is dead, as well as the development of new ways to prolong the lives of dying patients and recover usable organseither transplants.
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 decided to be organ donors? The problem is that, under current rules, doctors must not cause death in the process of obtaining organs for transplants,” Truog says.
Therefore, hearts, lungs, liver and kidneys can only be removed from euthanasia patients after they have received a lethal dose of drugs, making their organs, especially the heart, much less useful for transplant.
“Why wouldn’t it be okay for patients to say, ‘I’ve chosen to die by lethal injection? Isn’t there some way to help others?’ They should be able to donate organs as a lasting gift to others. And denying them that option doesn’t seem to make any sense,” Truog says. “I would say a more appropriate framework is that patients who choose to die through euthanasia can also choose to have euthanasia linked to organ donation.”
A “creepy idea” that might have merit
Euthanasia involves doctors administering lethal drugs to cause the death of a patient. The practice is illegal in the United States, but a growing number of states have legalized assisted suicide, in which doctors give patients lethal medications to take at home.
Instead of a doctor administering lethal medications to a patient, death by organ donation patients would end the patient’s life by anesthetizing them and then removing their organs while they are still functioning.
“This way, the organs would still be in ideal condition,” says Truog.
Some other bioethicists say the argument might have merit.
“The concept of death by donation is at first glance an extremely disturbing notion. It’s a creepy idea,” he says. Ruth Fadenbioethicist from Johns Hopkins University. “But in fact, if you look at it critically in terms of fundamental ethical considerations, it is not as disturbing as it seems at first glance.”
This is due, he says, to the spread and acceptance of euthanasia and the desire of some of these patients to be organ donors.
“If we are committed to respecting the autonomy of individuals at the end of their lives. And if they prefer to maximize the good that their bodies can do at the end of their lives, that is the ethical justification for death by donation,” Faden says. He adds that it would be important to implement strong safeguards to ensure full informed consent and protect patients from abuse.
A change could undermine patient confidence
But some other bioethicists are horrified at the very idea.
“It’s about asking surgeons to take a live person into the operating room and leave with a dead person, which I think is murder,” he says. Lainie Friedman Rossbioethicist at the University of Rochester. “There are limits to consent. And one of the things we’re not allowed to do is consent to say that someone else can just murder you.”
Others worry that this approach will undermine confidence in both organ donation and end-of-life care at a time when some potential donors are already cautious due to controversies about organ procurement efforts.
“There could be real harm being done to both the physician-assisted suicide system and the organ donation system,” he says. Lori Andrewsbioethicist and professor emerita at Chicago-Kent Law School. “It could give people the image that they are vultures that no longer wait until they die to attack. It does reveal visions of body snatchers from previous centuries.”
Critics also fear that allowing death by donation for patients receiving euthanasia could open the door to one day saying it would be an acceptable practice for physician-assisted suicide patients and potentially even hospice patients.
But others argue that for now this approach could be considered at least for some euthanasia patients.
“If there are people who want to donate organs, this would be the way to maximize their desires and their altruistic goal of helping others,” says Dr. Carter Winberg, a Canadian critical care physician working on his master’s degree in bioethics at Harvard and who is a co-author of the study. New England Journal of Medicine paper. “These are people who are already consenting to voluntary euthanasia and are already consenting to organ donation. That warrants a new conversation about whether this is possibly ethical.”
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