A recent bioethics paper raises some age-old arguments around an issue that strikes at the heart of ethical organ donation: organ donation euthanasia or ODE.
Organ donation can be a generous and lifesaving gift. But like many things, this gift can be misused. Organ donation is a very delicate procedure balancing the need to keep the organs healthy to ensure a successful donation, the dignity of the person donating, and the need to ensure the individual donating is, in fact, truly deceased.
The Dead Donor Rule (DDR) is cornerstone to the public trust and ethics of organ donation. But for some, including Dr. Didde B Anderson, limiting the donation pool only to those actively dying or dead violates a principle of personal autonomy and is “paternalistic.”
As summarized in Psychology Today (PT), Anderson argues that healthy people who wish to donate an essential organ – a heart, for example – to save the lives of others should be allowed to do so, at the cost of their own lives.
One of Anderson’s main arguments is that allowing someone to choose to commit suicide for organ donation would lead to better organ viability. Yet this is a calculating, utilitarian argument that has no place in a society that values both individual rights and human dignity. There are circumstances under which someone’s bodily autonomy only goes so far, as Live Action News has reported — like in the case of a person’s choice to kill another living individual, like a preborn baby, or killing a terminally ill person. Inherent human dignity dictates that a patient’s autonomy should not be “respected” if they — for instance — requested death by firing squad.
Anderson responds to these criticisms by claiming that, even though people killing themselves to donate organs would incur significant harm, it’s also harm to deny this decision (“unacceptably paternalistic to refuse people this option” says Psychology Today). Besides, she argues, it would do more good for people who need the organs than the healthy people who don’t want them anymore.
Organ donation must not be linked to euthanasia.
Now published in @wileyinresearch #Bioethics, I explain why. I welcome any/all respectful discussion.
The brief version follows in the the ? below [1/21]
The full version is available here: https://t.co/KENJnK7g2v
— Jonah Rubin MD (@JonahRubinMD) January 29, 2023
In a 2022 paper for Bioethics (summarized in a Twitter thread linked above) Dr. Jonah Rubin of Harvard Medical School points out a massive problem with Anderson’s argument.
Rubin says that creating a system that ignores the DDR — where an otherwise physically healthy person could request euthanasia for the purposes of organ donation — would inevitably create perverse incentives and unintended social consequences. If killing oneself for organ donation becomes a praiseworthy act, the mere mention of organ donation on a suicide-minded patient increases psychological pressure and starts to erode their autonomy.
If organ donation, freely chosen, is such a positive good, then one who dies without donating his or her organs could be perceived as selfish. And in turn, people considering euthanasia would feel pressure not to change their minds about ending their lives.
When the stakes are such that the lives of others hang in the balance, there arises a perverse sense of obligation to carry out one’s suicide. Simply reminding patients that they can change their mind – frequently the only “safeguard” against external or internal pressure – does not remove this pressure.
In countries where mentally ill patients are candidates for euthanasia, such as in the Netherlands and Belgium, it is easy to see how people who feel no other purpose in their lives might find euthanasia for organ donation preferable — ending their lives early for the sake of someone else. Live Action News has reported on similar things happening in Canada already. As assisted suicides increased by over 40% in Alberta, the state also saw a massive increase in organ donation.
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