No Longer Science Fiction

When Jack Kevorkian advocated harvesting organs from assisted suicide victims in his 1991 book Prescription Medicide, people were appalled. What could be more dangerous than giving depressed people with severe disabilities the idea that their deaths would have greater societal value than their lives? Then, when he actually acted on his beliefs, stripping the kidneys of Joseph Tushkowski, a quadriplegic ex police officer Kevorkian assisted in suicide, offering them at a press conference, “first come, first served,” people were stunned. Who could be so ghoulish? Article Link

However, Kevorkian’s macabre notion had turned a key in the deadbolt. The idea of coupling euthanasia with organ harvesting began to receive respectful consideration in medical and bioethics professional journals. Thus, the respected organ transplant ethicists, Robert M. Arnold and Stuart J. Youngner wrote a hypothetical scenario for consideration in a 1993 article published in the Kennedy Institute of Ethics Journal:

A ventilator-dependent ALS patient could request that life support be removed at 5:00 p.m., but that at 9:00 a.m. the same day he be taken to the operating room, put under general anesthesia, and his kidneys, liver, and pancreas removed. Bleeding vessels would be tied off or cauterized. The patient’s heart would not be removed and would continue to beat throughout surgery, perfusing the other organs with warm, oxygen-and nutrient-rich blood until they were removed. The heart would stop, and the patient would be pronounced dead after the ventilator was removed at 5:00 p.m., according to plan, and long before the patient could die from renal, hepatic, or pancreatic failure.

Rather than being critical or appalled, the bioethicists validated the utilitarian potential:

If active euthanasia – e.g., lethal injection – and physician-assisted suicide are legally sanctioned, even more patients could couple organ donation with their planned deaths; we would not have to depend only upon persons attached to life support. This practice would yield not only more donors, but more types of organs as well, since the heart could now be removed from dying, not just dead, patients.

The writers even nodded to Kevorkian’s contribution to the debate:

The irresistible utilitarian appeal of organ transplantation has us hell-bent on increasing the donor pool…Are we headed for the utilitarian utopia espoused by Jack Kevorkian, where organ retrieval and scientific experimentation are options in every planned death, be it mercy killing or execution? If a look into such a future hurts our eyes, (or turns our stomachs) is our discomfort any different from what we would have experienced 30 years ago by looking into the future that is today?

Opponents of legalizing euthanasia—of which I am one—were well aware of these and other articles, which served to normalize the idea of coupling physician-prescribed death with organ procurement and transplantation. But, we knew of no cases where the deeds had actually been coupled. So we waited, fearing that the shoe would drop, but praying it would not.

Clunk! That sound you just heard was the euthanasia/organ harvesting shoe slamming with great velocity into the hardwood floor. Writing in the journalTransplant International (Vol. 21, p. 915, 2008) several physicians reported that they had participated in the euthanasia and concomitant organ retrieval of a totally paralyzed woman:

This case of two separate requests, first euthanasia and second, organ donation after death, demonstrates that organ harvesting after euthanasia may be considered and accepted from ethical, legal and practical viewpoints in countries where euthanasia is legally accepted. This possibility may increase the number of transplantable organs and may also provide some comfort to the donor and his (her) family, considering that the termination of the patient’s life may somehow help other human beings in need for organ transplantation.

In other words, we did it, ergo, it is proper. Talk about ethical bootstrapping!

And now proponents of euthanasia/harvesting have taken to the road in Europe, arguing in particular for coupling the procedures on patients with neuro-muscular disabilities and diseases—because they can provide “high quality” organs. Article Link

Apologists for the euthanasia/organ harvest protocol defend the idea based on the procedural requirement that different medical teams be involved in the euthanasia and the organ harvesting. But that supposed protection is meaningless. Once a society decides that some of its members have a life of such low quality that it is acceptable for doctors to kill them, and once these patients—many of whom already feel like burdens—learn that they can save lives by their suicides, the seductive pull of asking for euthanasia/organ harvesting could reach gravitational strength. We have entered exceedingly dangerous territory, made the more treacherous by doctors and bioethicists validating the ideas that dead is better than disabled and approvingly recounting how patients can be viewed as a natural resource. If we are to avoid devolving into a Kevorkian-style society, we must resist the siren song of euthanasia/assisted suicide at all measures.