Ethical line is crossed as pressure on ill to die mounts
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Doctors in the Netherlands are working on a scheme to increase the number of life-saving organs available for transplant – by harvesting them from people who want to be euthanased.
Erasmus Medical Centre in Rotterdam and the University Hospital of Maastricht have already written national guidelines which are being studied by the Dutch Transplant Foundation.
If the procedures are approved, they would be binding on hospitals and doctors throughout the country.
Spurring on this study is the feeling among transplant surgeons that healthy organs are sometimes wasted when patients are euthanased. In the words of a medical ethics expert with the Royal Dutch Medical Association (KNMG), Gert van Dijk, “An estimated 5 to 10% of people who are euthanased could be considered for organ donation. Five percent does not seem like much, but this still means 250 to 500 potential organ donors every year.” He believes that Dutch doctors could even double the number of organs available for life-saving procedures.
Technically, linking euthanasia and organ transplants has many advantages. It is a “living donation”, so the organs are fresher and more viable than if they are taken from someone who has suffered brain death and is being kept alive artificially. And unlike most living donations, all the organs – both kidneys, both lungs, the whole liver, the heart, the corneas etc – will become available. This way of crossing the bar could also give donors the consolation of knowing that they are saving lives even if they themselves are about to die.
Up to now, there have only been six case of organ donation after euthanasia in the Netherlands. More have been done in neighbouring Belgium, where euthanasia is also legal.
While getting euthanasia patients to donate organs might sound like a snap, in practice there are a number of difficulties. Most euthanasia patients have cancer and so their organs are not suitable for donation. The most suitable patients are those with neurodegenerative diseases like ALS or multiple sclerosis, who constitute only a small fraction of the total number of Dutch who are euthanased every year. Even though they are afflicted with creeping paralysis, their organs are healthy.
There are administrative issues as well. Most hospitals are adverse to allowing doctors to perform euthanasia if they are not staff members. Many euthanasia patients want to die at home, but if they want to donate their organs, they have to die in an operating theatre, away from their loved ones. It will be a lonely and clinical death, very different from the one most of them have envisaged.
The protocol will probably create some firm guidelines to ensure that patients are not killed for their organs, thus fulfilling the gloomiest of prediction about legalised euthanasia.
- Procedures for euthanasia and organ donation must be completely separate. Only if a person fulfils all the criteria for euthanasia would he be eligible for organ donation.
- The idea of donating organs must come from the patient, not the doctor.
- Only a doctor who is not involved in the organ donation can confirm the patient’s eligibility for euthanasia.
- The euthanasia doctor must sign a statement indemnifying the hospital against future lawsuits.
This is not a new idea. It was seriously proposed in 2010 by Oxford bioethicist Julian Savulescu and a colleague, Dominic Wilkinson in an article in one of the leading bioethics journals, Bioethics. They wrote:
“Organ Donation Euthanasia would conflict with the dead donor rules, and the injunction against physician killing. Yet it would not (if appropriate safeguards were provided) lead to the death of any patients who would otherwise live. … if we can save even one life, that is something of great moral importance. Many lives could be saved even if only a small percentage of people opted for ODE… We should encourage and support such altruistic desires.”
The astonishing thing is not that some ethicists approved of the notion of organ donation euthanasia. Crackpot ideas are a dime a dozen in bioethics journals. The astonishing thing is that the leading doctors’ group in The Netherlands is about to adopt this policy.
Can’t it foresee the appalling abuses which will take place? The most obviousis that patients with neurodegenerative conditions will feel immense pressure to end their lives so that others can live longer. Their lives will resemble the cloned young people who are raised from childhood to be organ donors in Kazuo Ishiguru’s novel Never Let Me Go. Their teachers and carers teach them submissiveness and resignation to their fate. Death is called “completion”; they have finished the task they were born for.
Similarly, poor Dutch people afflicted with ALS or multiple sclerosis will be constantly reminded that the longer they live, the more younger, more active people will have to suffer. Their lives will only be meaningful if they choose euthanasia. Direct pressure will not be necessary; they will get the message every day on the radio, on the television news, in the glossy weekend magazines. In the words of the KNMG ethicist, Gert van Dijk:
“Saving lives is the main motive for donating organs for people who will die through euthanasia. They know that they are going to die and they want to give this meaning by donating their organs. It can even be a consolation for those who survive them. And given the effort that these brave people have to make, they deserve respect and great support from caregivers.”
The Dutch are also extending euthanasia to people who are just tired of living. Sooner or later, ethicists will whisper to them that they, too, can leave life and give it to others.
Fine words cannot disguise the fact that organ donation euthanasia is sheer barbarism. One of the core convictions of Western civilisation is that individuals must be treated as ends in themselves and not simply as means to an end. The Dutch are on the verge of repudiating this wisdom and replacing it with the basest utilitarianism. Good luck to them.
Michael Cook is editor of Mercator.Net where this article was originally published.
