Monday, November 7, 2011

More On Undead Donors

Ugh. Here is Wesley Smith claiming that "they" "still" "really want" to "kill" people to get their organs for transplantation. What he's reporting on is the recent paper, which I briefly mentioned here, advocating the abolition of the dead donor rule, fundamentally because it relies on two definitions of death ("total" brain death and "irreversible" cardiac death) which only occur problematically, if ever. Smith claims that he "still believe[s]" that "properly diagnosed and with proper protocols, the current system is ethical." What this means is that he thinks there's a clear line at which we can stop, beyond which we're killing people for organs, and before which we're not. But the current system doesn't actually supply a clear line--which is the paper's point. What the paper says (and what some similar papers by Dr. Robert Truog have said) is that hardly anyone who is pronounced "brain dead" actually meets the legal criterion for brain death, which is total cessation of upper-brain and brain-stem activity; and that those who meet the "irreversible cardiac death" definition often only meet it because someone actively decides not to try to reverse their cardiac death. In other words, under the current system, we're not really using a clear "dead donor" rule. We're using a small, constrained element of judgment to determine who counts as dead enough to be a donor.

Is that a problem? I think not, because I believe that physicians declare people brain-dead, or cardiac-dead, only in situations when those people are irreversibly and severely compromised, beyond recovery, and bound shortly to die. But Smith (who imagines a world full of "utilitarian bioethicists" who actively want to kill people if they can't fence, ace a calculus exam, and sing an aria from Aida) doesn't trust judgment, because judgment leads to slippery slopes. Give them an inch, and "they" will "really want" to "kill" people for organs. What he's missing is: they already have their inch. The current system gives them the inch. Eliminating the dead donor rule, according to these papers, is no erosion--it's just honesty.

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