Organ transplant and euthanasia hit the headlines this week as two people seeking euthanasia ask that their organs be donated. Tony Nicklinson of Melksham, Wiltshire communicates by blinking or nodding his head at letters on a board. His legal team have issued legal proceedings asking the DPP to clarify whether he would authorise proceedings against Mrs Nicklinson if she were to end her husband’s life. If this was the case then the lawyers will argue that the current murder law infringes Mr Nicklinson’s rights to respect for his private life under article 8 of the European Convention on Human Rights. Said Nicklinson, “I cannot scratch if I itch. I cannot pick my nose if it is blocked and I can only eat if I am fed like a baby – only I won’t grow out of it, unlike a baby.” In February 2010 the DPP issued guidance covering England, Wales and Northern Ireland regarding assisted suicide. But the guidance does not extend to so-called mercy killing or euthanasia. Even if it was with consent it would lead to charges of murder or manslaughter in England, Wales and Northern Ireland and homicide in Scotland.
Meanwhile in Cherokee County, Georgia, America, Gary Phebus has motor neuron disease and has decided to donate his organs. But he wants to do it now, which would kill him. “I have a death sentence. It is just a matter of time,” he said. “I know people are waiting on organs. If I am going to die, why not – while my organs are still viable – go ahead and save five to 10 people.” Phebus said he wants to see a law passed that would allow someone in his position to donate organs while still alive. wants to give the organs while they’re viable, but also avoid years of medical bills and insurance claims. “I’m dead anyway,” he said. “I want to live, but I don’t see any way out.” In Georgia alone, there are more than 3,000 people waiting for an organ transplant. Thomas E. Goodwin, a physician who founded a right-to-die network in 2004, is currently facing criminal charges of violating Georgia’s law against assisted suicide in the 2008 death of a 58-year-old man at his home near Atlanta, Georgia.
Obviously there are ethical as well as legal challenges. A person’s wish to die at a time of their own choosing must not be due to coercion or pressure. Whether it is relatives that want hold of an inheritance or lack of palliative care or a feeling that one ‘ought’ to die and give someone else one’s organs.
Is our legal system up to it? Quite possibly. Currently, the medical team in charge of organ donation has to be separate from a palliative care team that might employ the doctrine of double effect – whereby a person may be given necessary pain relief even if a secondary effect is that it may shorten their life. Their can be no conflict of interests. Similarly, counselling or the law must be able to ascertain clearly whether a person is making a free and informed decision. Things that are far easier in an open and transparent system than in a country where the only euthanasia happens behind closed doors and in secret.
But say I have decided to end my life tomorrow. I start putting my affairs in order. I want to leave the best for my loved ones that live on. Is it not natural and laudable that I might want to give them an inheritance? And in my care for the world that I am leaving, is it not something I might want to do to leave my organs in good shape to better mankind? If I end my life by my own hand, the chances are that any organs will no longer be usable by the time my body is found. The window of opportunity is very narrow after all.
At EXIT workshops, people frequently ask, how can I donate my organs if I die at a time of my own choosing? The short answer is, you probably can’t.
We must protect the vulnerable. The law is quite good at that in the sense that the ultimate arbiter of capacity is the courts, not doctors. We must protect the feelings of those that might feel pressured, even if their rights are in reality protected. But must we not also protect the good and beneficent wishes of those that want to control their own living and dying?
It is tempting to look abroad for examples. To use them to justify our support or opposition to the idea. This is rather poor logic at best – the situation in other countries may not be the same. Euthanasia was legalized in Belgium ( a country whose euthanasia figures have been repeatedly misquoted in the popular press) in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients expressed their will for organ donation after their request for euthanasia was granted. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is to be maintained.
In an forthcoming article in Bioethics entitled, Organ Donation Euthanasia, ethicists Wilkinson and Savulescu note, “Donating your organs is one of the most important ways that we can help others. After all there are not many times when you can save the life of up to nine other people at no personal cost. But most people who would like to donate their organs are not able to. ”
What would you want for yourself? Is it possible to have your wishes respected and also respect those with opposite views?
Locked-in man seeks right to die (BBC News)
Man tries to donate organs – now (Cherokee Tribune, Georgia)
Organ Donation Euthanasia (Bioethics)
Organ Procurement After Euthanasia: Belgian Experience (Elsevier)
Should organs from patients in permanent vegetative state be used for transplantation? (The Lancet)
The Dead Donor Rule: Can It Withstand Critical Scrutiny? (Journal of Medicine & Philosophy)
End-of-life care and organ procurement for transplantation: Palliation or euthanasia? (Critical Care Medicine)
Rethinking the Ethics of Vital Organ Donations (Medscape/Hastings Center)
Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation (Medicine, Health Care and Philosophy)
Exit Euthanasia Blog also had an earlier article on this issue here.