Wesley Smith - Criticism of organ donation article. My article stands.

This article was published by National Review online on December 31, 2025.

I republished Wesley Smith's article - Bioethicist: Let Surgeons Kill Patients During Organ Harvesting on December 29, 2025. This is Wesley Smith's response to criticism of his article.

Wesley Smith

By Wesley J. Smith

I welcome Lawrence Masek’s response to my criticism of his journal article. I am sorry he didn’t appreciate my perspective, but I take nothing back.

Let’s start with a matter of little importance. Masek claimed I said his article would curl your toes. No, I wrote that I cover articles published in the professional journals because “some” of them would. Whether your digits react to his effort thusly is a matter for you to decide.

As to the substance of his rebuttal, Masek claims at great length that the dead donor rule, which forbids killing for organs, would also prohibit many common interventions in clinical medicine as “suicide.” He writes:

Permitting lethal organ procurement would enable patients to commit suicide by donating their vital organs, but the same is true of permitting lethal palliation and the refusal of life support.

This is verifiably untrue. Dying from a side effect of an ethical medical treatment like palliation is not suicide any more than a patient dying during heart surgery is euthanasia.

As for refusing life support, that is beyond a reasonable doubt, not suicide.

• First, the patient might not die. Take out a vital organ and there can be no other outcome.
• When refusing life support, if the patient dies, it is from the illness or injury. In contrast, removing a vital organ causing death is not a natural demise.
• Finally, the issue of whether removing or refusing life support is suicide was decided in 1997 by the Supreme Court in Vacco v. Quill, in which the Justices ruled unanimously: “The distinction between letting a patient die and making that patient die is important, logical, rational, and well established.”

I can understand that as a professor at a Catholic university (which I didn’t think relevant), he would eschew a utilitarian label. But his article is certainly utilitarianish. The following is from his conclusion. You be the judge (my emphasis):

I conclude with an assertion that seems plausible but for which I do not have an argument: If an action would save someone’s life without killing anyone, then the burden of proof is on those who say that the action is wrong, not on those who say that the action is right. If this principle is correct, the burden of proof belongs to proponents of the DDR, specifically the version that prohibits procuring vital organs in a way that would not kill the donor.

Someone might adopt this version of the DDR as a way to avoid killing a donor, but I have argued that procuring a vital organ in a way that kills the donor is not always wrong. I hope my arguments will persuade proponents of the DDR to reconsider the rule or to defend it without relying on principles of ethics that are too strict or views of intentions that are too broad.

In the real world, you can’t procure vital organs without ultimately killing donors. Distorting definitions to allow the ethically impermissible to serve a greater good sure seems utilitarian to me.

That Masek doesn’t offer specific policy proposals is irrelevant. The implications of his argument are quite clear.

Frankly, if his intention was to toe the line of permissible ethical argumentation from a sanctity of life perspective or to somehow fortify the defense of the DDR, it didn’t work.