This month, the New England Journal of Medicine featured an opinion article proposing changes to Canadian law that would allow for euthanasia by organ donation. Authors Ian Ball, Robert Sibbald, and Robert Truog suggest that Canada should change its assisted suicide guidelines so that patients can consent to death by the process of organ donation — or, in other words, the ethicists propose that patients could choose to be anesthetized and be killed as surgeons remove vital organs. This would ensure that organs are in the best possible condition for transplant recipients. The ethical implications of this process are highly problematic, to say the least.
Currently, assisted suicide is legal in Canada and on the rise. The legal mechanism for assisted suicide is the administration of a lethal substance by a qualified medical professional. Michael Cook of Mercatornet explains, “At the moment, too, a firewall exists between the staff handling withdrawal of life support and the staff handling organ donation so that patients are not killed for their organs. But with legalised euthanasia, there will be no need for the firewall.”
In the NEJM article, Ball, Sibbald, and Troug state:
Although some patients may want to be sure that the organ procedure 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.
This alleged goal of some patients is hindered by the requirement that the organ donor be declared dead, a problematic ethical question in its own right. The authors propose eliminating the so-called “dead donor rule” to allow patients to donate fresher organs.
Following the dead donor rule could interfere with the ability of these patients to obtain their goals. In such cases it may be 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).
Alex Schadenberg of the Euthanasia Prevention Coalition succinctly summarizes the article, writing, “The authors are promoting organ donation by euthanasia. They argue that organ donation by euthanasia is only another method of killing.” Doctors would not only cooperate with a patient’s wish to die, but would actively kill the patient through deliberate and careful surgical procedures aimed at preserving organ function while ending the patient’s life.
Assisted suicide advocates claim that doctors could ensure the patient’s wishes are respected because of the safeguards written into the law, including multiple requests from the patient and multiple doctors signing off on the decision. Writing for Live Action, Cassy Fiano-Chesser explains why the supposed safeguards in Canadian law have proved ineffectual:
Quebec, for example, is considering allowing people with Alzheimer’s to be euthanized, withouttheir consent. Doctors have pressured parents to euthanize their disabled children. A study is taking place to determine if people with mental illnesses should qualify for euthanasia. The euthanasia of children is under consideration. Doctors are even claiming that they are being forced to participate in assisted suicide.
These abuses are not limited to Canada. Dr. Joseph Marine, member of the American Medical Association and associate professor of medicine at Johns Hopkins University, writes that where assisted suicide has been legalized in the United States, similar abuses have arisen. He notes that in the United States, “drugs have been given to patients with severe depression and dementia, and at the urging of relatives rather than a patient’s independent request.”
When you examine patient motivations for assisted suicide, these abuses of the law are not surprising. Multiple studies have shown people seeking assisted suicide do so not out of fear of death or pain, as is often assumed, but due to feelings of hopelessness and depression. In other words, patients seeking assisted suicide are often motivated by the same reasons an otherwise healthy person might seek to end his or her life.
Additionally, the economic effects of intensive medical care can be staggering. While patients have the option to opt out of courses of treatment, they should not be forced to. The sale of organs can also be lucrative. As seen with Planned Parenthood’s sale of the body parts of aborted babies, third-party firms could profit tremendously from the proposed euthanasia program.
Underlying and undiagnosed depression coupled with economic pressure and the increasing use of rhetoric that living with medical challenges is “not dignified” are a recipe for severe coercion. As Dr. Grazie Pozo Christie wrote, the choice to die can soon become a duty to die. In this medical environment, how much more pressure to opt for suicide would the organ donation proposal inflict? In this scenario, “voluntary euthanasia” would be in most cases be anything but an altruistic and autonomous choice.
Doctors would also face coercion to participate, whether directly or indirectly, in the unethical killing of euthanasia patients for the use of their organs, a reality that undermines the Hippocratic Oath and the very foundation of medicine.
Death by organ donation would not offer a meaningful and compassionate solution for ailing patients, but would usher in a disturbing new paradigm, in which some human lives are treated as more valuable than others. The more disturbing reality is that this paradigm of inequality is already implicit in the legalized killing of some patients through assisted suicide.