When you agree to leave your vital organs for transplantation after death, you do so with the expectation that the doctor will indeed wait for you to die before removing them. In the transplant field this is called rather blandly the “dead donor” rule.
That rule has been, till now, sacrosanct. The American Medical Association’s Council on Ethical and Judicial Affairs would like to change that.
Three years ago in Florida, the parents of an anencephalic newborn (a child born without the major, thinking part of the brain) wanted to donate the baby’s organs. Anencephalics live only a few days. If you give the child those few days to live, its organs will begin to die with the child. At death, they will be useless. Removing the organs for transplantation while the child is still alive might allow a child elsewhere to live.
The parents wanted some good to come out of their tragedy. But a Florida court said no. One does not do good by doing evil. One does not deliberately shorten an innocent human life, even for the sake of others.
The restless utilitarians of medical science do not countenance such squeamishness. The AMA’s ethics council has just published a statement supporting the use of anencephalics as organ donors–even before they die. There is a great need for their organs, writes the council, but current law “requires persons to be dead” first. In the case of anencephalics, such legal scrupulousness must be overcome. You can kill an anencephalic with moral impunity, they argue, not because (as some have suggested declaring) it is dead at birth–it is obviously not–but because it is not really human. Because it has no capacity for consciousness, thought, even pain, it cannot be said to possess (as other humans do) “interests,” even an interest in its own life. Taking it, therefore, violates no ethical norms.
Now, first of all, how can the council’s nine Solomons be so certain about the blankness of the anencephalic’s experience? The council concedes that these babies “may be able to breathe, suck, engage in spontaneous movements of their eyes, arms and legs, respond to noxious stimuli . . . and exhibit facial expressions typical of healthy infants.” While “all this activity gives the appearance” of “some degree of consciousness,” they are absolutely certain that there is none.
How do they know? There is neither unanimity among experts on this issue nor any way ever to know for sure. Consciousness is an entirely subjective experience. As pediatric neurologist Alan Shewmon and associates have pointed out, these babies “can manifest a surprising repertory of complex behaviors.” Some can even distinguish their mothers from others. Who can say for sure they feel no pain?
Second, what about the age-old principle of respect for innocent life? No problem, says the council:
“First, it is important to emphasize that respect for the essential worth of life is an absolute value in the sense that it exists irrespective of a person’s quality of life. However, it is not an absolute value in the sense of overriding all other values. Rather, it must be balanced with other important social values, including, as in this case, the fundamental social value of saving lives.”
This is incoherent nonsense. If respect for life is an absolute value “irrespective of a person’s quality of life,” then respect for the anencephalic must be as absolute as respect for the neurologically intact baby–and we don’t go around taking out the hearts of neurologically intact babies while they are still alive. And what can it possibly mean to call something “an absolute value” in one sentence, then assert that it must give way to other values in the next?
This miscarriage of moral reasoning reveals an argument that does not have the courage of its own convictions. Instead of admitting that it is doing something wrong but in the name of some higher good, the council is trying to pretend that even the wrong it is doing is right.
It isn’t. Why not admit it? Why not say: Harvesting the organs of not-yet-dead anencephalics is wrong, but the good that can come of it is so great–so many other lives salvaged–that, damn it, we are prepared to transgress, just this once, the principle of the sanctity of every individual life. Their case for committing this transgression would still, in my view, be terribly flawed, but at least it would be morally honest.
Philosopher Paul Ramsey called this kind of moral honesty “sinning bravely.” When violating a fundamental moral principle, he wrote, “we should not seek to give a principled justification of what we are doing.” The doctor you can trust is the one “who does not deny the moral force of the imperative he violates.”
Don’t trust these doctors.
