Tuesday, October 7, 2008

Are doctors redefining life and death?

A recent article written by William Saletan that was published in the Washington Post asks the question whether doctors are redefining death in order to make more organs available for organ donation.

I have written about this topic before and I have quoted Wesley Smith on this topic. I agree that the urge to change our definition of death in order to increase the availability of organs for organ donation will only undermine the concept of organ donation within society.

Saletan is writing about the recent New England Journal of Medicine article about the direction of the Children's Hospital in Denver who are now declaring children dead after 75 seconds of heart failure, rather than waiting the conventional 5 minutes.

Since death is defined as the irreversible stoppage of the heart, therefore declaring someone dead after 75 seconds in order to remove the heart of the child may represent a redefination of death, since the heart can resume beating and has been known to do so after 75 seconds.

Saletan explains the issue this way:
How can we get more organs? By redefining death. First we coined "brain death," which let us take organs from people on ventilators. Then we proposed organ retrieval even if non-conscious brain functions persisted. Now we have "donation after cardiac death," the rule applied in Denver, which permits the harvesting based on heart, rather than brain, stoppage.
Saleton then quotes ethicist Robert Troug who actually supports the Denver protocol:
This redefinition of death has gone too far. Let's accept that we're taking organs from living people and causing death in the process. Troug believes this is ethical as long as the patient has "devastating neurologic injury" and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he noted.
Further Troug stated:"
The public will accept the new policy since surveys suggest we're not hung up on whether the donor is dead.
In other words Troug is saying that we have already redefined death. He believes its time to simply allow the removal of organs from people who have consented to the act or who have provided consent through a surrogate decision maker or power of attorney who would have legal authority to make such decisions.

This sounds very familiar to the reasoning behind euthanasia and assisted suicide and the arguement about who should make these decisions. There is no concern about whether or not doctors should be healers who abstain from killing, and no real concern about the plight of the vulnerable in society who lack social, economic or cultural support.

Saletan asks some very important questions:
How devastating does the injury have to be? If death is vulnerable to redefinition, isn't "devastating" even more so? The same can be asked of "futility," the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressures to donate? Even if each family makes its own choice, aren't we loosening standards for termination precisely to get more organs?
As the culture of death continues to permeate every corner of medical ethics we need to recognize the importance of push back. Simply informing the public of the ethical quandries that are coming our way won't slow their progression. There needs to be a more organized push that is orchestrated on the medical institutions, the intellectual research and publications and the government bodies that oversea standards.

We cannot simply make commentary about the culture of death, we must oppose it.

Link to the article in the Washington Post:
http://www.washingtonpost.com/wp-dyn/content/article/2008/10/03/AR2008100301974.html

Link to the previous comments by myself on the Troug and Miller article in the New England Journal of Medicine:
http://alexschadenberg.blogspot.com/2008/08/dead-donor-rule-and-organ.html

Link to blog article about Wesley Smith's response to the Children's Hospital in Denver cardiac death protocol:
http://alexschadenberg.blogspot.com/2008/08/undermining-public-trust-in-organ.html

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