Acts, omissions, and euthanasia for organ donation

Xavier Symons
September 3, 2016
Reproduced with Permission

With the push to legalise assisted dying in several Western countries, bioethicists are starting to consider the possibility of "organ donation euthanasia". In a new article in the Journal of Medical Ethic s, Warwick University bioethicist Zoe B. Fritz suggests that it is permissible to actively end the life of a terminally ill patient -- either conscious and consenting or unconscious and not consenting -- for the sake of harvesting their organs. Indeed, this would allow clinicians to avoid the problem of premature organ desiccation.

Doctors and surrogate decision makers are supposed to act in the "best interests" of an incapacitous patient. Dr Fritz puts forward an ingenious interpretation of "best interests" which allows euthanasia followed by organ transplants. "'Best interests' should be interpreted broadly to include the interests that people have previously expressed in the well-being of others," she writes. "It could, therefore, be in the 'best interests' of an unconscious patient to donate a non-vital organ to a family member." She discusses the hypothetical case of a mother who jumps in front of a truck to save her son, an accident which leaves her in a permanent vegative state and her son with a damaged liver.

"To not carry out the transplant is in neither of their best interests: imagine the mother surviving her injury, regaining consciousness and discovering that her son had died because the family was not sure that she would have wanted her kidney to be donated.

Fritz also argues that there is no morally relevant difference between withdrawing artificial nutrition and hydration for the sake of organ harvesting and administering euthanasia for the sake of organ donation.

"The current practice of withdrawing CANH from patients in PVS or minimally conscious state - with the inevitable consequence of death - is ethically inferior to actively ending life with a drug that would stop the heart. The 'act' rather than the omission would allow families to be present at the death of their loved one and obviate the potential for the physiological signs seen with starvation and dehydration...And it would allow those who had previously expressed a desire to donate their organs to do so allowing their altruistic desires to be respected as part of a wider interpretation of best interests."

Earlier this year a group of researchers from Belgium and the Netherlands reported on the practice of organ donation euthanasia in their countries, and said that it had been performed in a small number of cases with good results.