We must not yield to the utilitarian temptation in health care.

Good motives sometimes lead to terrible places. Such is the case with the understandable desire to increase the organ supply, which for years has tempted some bioethicists to stretch the ethics of transplant medicine beyond the breaking point.

Now, in the New York Times, three doctors promote the idea of “redefining death” to allow patients to be killed for their organs. First, the authors lament the difficulty of obtaining healthy organs from people whose hearts stop irreversibly after the removal of life support. They also bemoan the shortage of “brain-dead” donors. Then, after discussing a controversial approach that restarts circulation after cardiac arrest (but not to the brain) — which I have posted about before — they get down to the nitty-gritty of redefining death. From “Donor Organs Are Too Rare. We Need a New Definition of Death“:

The solution, we believe, is to broaden the definition of brain death to include irreversibly comatose patients on life support. Using this definition, these patients would be legally dead regardless of whether a machine restored the beating of their heart.

So long as the patient had given informed consent for organ donation, removal would proceed without delay. The ethical debate about normothermic regional perfusion would be moot. And we would have more organs available for transplantation.

Then, they depersonalize people with severe cognitive disabilities:

Apart from increased organ availability, there is also a philosophical reason for wanting to broaden the definition of brain death. The brain functions that matter most to life are those such as consciousness, memory, intention and desire. Once those higher brain functions are irreversibly gone, is it not fair to say that a person (as opposed to a body) has ceased to exist?

No, it is not! Redefining as dead someone who is actually living would subjectivize the value of human life. We are either all equal while alive, or we are not. And if we are not, kiss universal human rights goodbye and say hello to increased oppression and exploitation of those deemed by those with power to be expendable or less than human.

The authors hint at the recent exposé published by the Times — which we discussed here the other day — that showed that ethical corners are being cut in some hospitals, which is leading to organ procurement from patients who might not be dead. Don’t they think that will also happen — probably with greater frequency — if doctors harvest the organs of the (believed to be) irreversibly comatose? Nope:

That sort of concern, however, is about practicalities such as whether doctors are following protocol properly and whether external pressures are creating perverse incentives for doctors and other medical workers to be careless. These are critical issues, to be sure. But it remains possible (and common) to responsibly determine whether someone is irreversibly comatose, and in such cases a judgment of brain death is merited, as the law should be revised to reflect.

But even if patients were in an irreversible coma, they would not be dead. Therefore the proposal to redefine death is in fact a push to lie about the killing of living human beings for their organs. And if all that matters is consent, why limit the donors to the comatose? Why not kill anyone who really wants to die by organ-harvesting, which has been repeatedly proposed by bioethicists.

One last point. Studies have shown that some people thought to be unconscious are actually aware. Given the mistakes we see being made now in the organ donor system, imagine the damage that would be done to public trust in transplant medicine if the seemingly or actually unconscious were dehumanized into so many organ farms.

We must not yield to the utilitarian temptation in health care. Pretending that a patient is dead does not make him deceased. This proposal — and others like it — have the awful potential to seriously corrode trust in the ethics of transplant medicine among an already wary public. In the end, if potential donors are scared away from giving the gift of life, those who would ultimately suffer the most would be organ recipients.