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“Dead Donor Rule” in Danger!

The Hippocratic Oath is dead. “Do no harm” medicine is fast becoming extinct.

Our health care protocols are increasingly under the sway of a utilitarian bioethics that appears to be making the elimination of suffering the primary objective. In the past traditional standards of medical morality deemed all human life equally worthy of care and protection; this is no longer the case.

A few highlights from this slippery slope:

In 2005 doctors in the Netherlands created a bureaucratic checklist called the Groningen Protocol in which terminally ill or seriously disabled babies could be lethally injected and thus euthanized.

In 2010 the idea of invidious health-care rationing measure known as the QALY (“quality-adjusted life year”) was advocated by the New England Journal of Medicine, the adoption of which has the effect of limiting care to the disabled and disadvantaged whose lives are bureaucratically rated as lower in quality than the lives of others.

In the summer of 2016, during a special session of the California legislature a bill was passed that brought Physician Assisted Suicide to California. And recently (Sept 2018) Governor Brown signed legislation that permits any person to “aid, advise, and encourage” suicide under the state’s assisted suicide law. Previously these actions were felonies (and still are EXCEPT in the case of Physician Assisted Suicide), as the state has had a longstanding policy to protect people from self harm.

Recently discussions have begun regarding the protocol standards for patients who are prospective organ donors and have requested euthanasia. Belgium and the Netherlands already allow the conjoining of organ donation and euthanasia, and Canada is debating whether to follow. A radical proposal has been presented that would demolish the ethical foundation of transplant medicine—the “dead donor rule” that requires donors be declared dead before vital organs are procured and that the removal of organs for surgical transplant procedure not be the cause of the donor’s death.

Dr. Ian M. Ball and bioethicists Robert Sibbald and Robert D. Truog, in a recent article in the New England Journal of Medicine “Voluntary Euthanasia—Implications for Organ Donation,” recommend that this rule be loosened.

Although some patients may want to be sure that organ procurement won’t begin before they are declared dead, others may want not only a rapid, peaceful, and painless death, but also the option of donating as many organs as possible and in the best condition possible. Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases, it may be ethically preferable to procure the patient’s organs in the same way that organs are procured from brain-dead patients (with the use of general anesthesia to ensure the patient’s comfort).

In other words, rather than wait for the patient’s heart to stop after lethal injection—as currently is done in the Netherlands and Belgium—the patient could be anesthetized and his organs procured while he is still alive. Conjoining euthanasia with organ donation would thus send the insidious message to vulnerable people that their deaths have greater social value than their lives. For the particularly vulnerable, that could be the point that tips their decisions.

NEVER AGAIN? Leo Alexander, a psychiatrist and medical adviser to the office of chief counsel at the Nuremberg war crimes trials, warned that the utilitarian infection that destroyed German medical ethics could spread:

Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.

Is the “Slippery Slope” detailed above, and the path of the conjoining of organ donation and euthanasia the authors urge transforming a life-saving medical sector into one that also ends lives, imposing on transplant specialists the dual role of both healer and killer.

What happened to the Hippocratic Oath and the medical profession’s dictate of “Do No Harm”? Has the utilitarian bioethics that makes the elimination of suffering the prime directive led to caregivers, clinicians and worst of all transplant teams becoming “Grim Reapers?”

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