Experimenting With Live Patients

Some experts think it's OK to use vegetative human subjects Original Article

In the new novel “Hunters of Dune,” biotechnologists of the future create “ghoulas” — clones made from the dead — in breeding contraptions known as “axlotl tanks.” About 100 pages into the novel, the reader is shocked to learn that axlotl tanks are really unconscious women whose bodies have been expropriated to serve the greater good as so many gestating vats.

Happily, “Hunters of Dune” is science fiction. In the real world, we have a higher sense of morality and ethics. We would never use catastrophically disabled human beings so crassly. We understand that treating people as mere things violates the intrinsic dignity of the individual and the equal moral worth of all human life.

Well, most of us do.

Unfortunately, many bioethicists would feel right at home in a world in which unconscious people are converted into mere biological machines. Indeed, some of our most prominent bioethical and philosophical thinkers have published articles in the world’s most respected medical and bioethical journals proposing that unconscious patients (those diagnosed as in a persistent vegetative state) be used both as vital organ donors and the subjects of human medical experimentation.

Those we would exploit, we must first dehumanize. A favored proposal for stripping these vulnerable patients of their humanity is to redefine a diagnosis of persistent vegetative state into the legal equivalent of death — even if the “dead” patient breathes without assistance.

“The essence of human existence,” the influential Georgetown University bioethicist Robert Veatch wrote several years ago in the Journal of Clinical Ethics, “is the presence of integrated mind and body. … For the human to exist in any legal, moral or socially significant sense, these two features must be present.” And, since those diagnosed as vegetative are thought to be unaware, according to Veatch and many of his colleagues, they are merely “respiring cadavers” who could even be buried except that it “is simply unaesthetic to bury someone while still breathing.”

The proposed redefinition of these living patients into dead, albeit breathing, bodies is intended to pave the way for using them as so many organ farms.

A 1996 article in the British medical journal Lancet put it this way: “If the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function, it would be possible to take the life of a patient (or more accurately to stop the heart, since the patient would be defined as dead) by a ‘lethal’ injection and then remove the organs needed for transplantation, subject to the usual criteria for consent.”

More recently, the notion that the bodies of persistent vegetative patients should be exploitable has been extended to the realm of cutting-edge medical research — perhaps for the purpose of using these profoundly disabled people in place of primates or other animals.

Illustrating how respectable these radical views have become among the medical intelligentsia, articles and letters published during the past two years in the Journal of Medical Ethics have gone so far as urging that vegetative patients be used to test the safety of “xenotransplantation,” that is, of transplanting animal (usually pig) organs into humans.

The usual ethical approach in medical research is to complete animal testing and then cautiously move into human trials with patients who could conceivably benefit from the experimental drug or procedure. But some bioethicists worry about the social, personal and sexual contacts of early pig organ recipients allowing a porcine virus to cross the species boundary and setting off a pandemic.

But quarantining pig organ recipients is seen as violating their personal autonomy. The proposed “ethical” remedy for this conundrum is to use persistent vegetative bodies in place of patients who actually need new organs in early xenotransplantation experiments.

“If it can be agreed upon that PVS bodies can be regarded as dead,” Belgian professor An Ravelingien and several co-authors wrote in 2004, “then experimenting on them is legitimate under the same conditions as experiments on cadavers,” so long as they consented to be used in this fashion prior to their impairment. To illustrate the extent to which these bioethicists dehumanize people diagnosed as , Ravelingien asserts that “living cadavers” in persistent vegetative state should not be called “patients” because that wrongly humanizes them and “impedes the discussion.”

This year, Heather Draper, a bioethicist from Birmingham, England, took Ravelingien’s argument one step further: “My own view is that people in a PVS are still alive,” she wrote. But this seemingly obvious observation should not, in Draper’s view, preclude these helpless patients from being used in animal organ transplant experiments. “I see no objection in principle to the proposal that competent people can decide, in advance, to participate in research when they become incompetent.”

Nor, apparently, would Draper limit such human experimentation to those believed to be unconscious. “Helping others by taking part in clinical research is undoubtedly a good way to live out what may be years in a PVS or other less-compromised states,” she writes.

Consider the kind of scenario this advocacy contemplates: Alice, a woman in her late 20s, nearly drowns. Aggressive CPR restarts her heart but she remains unresponsive for six months. Doctors tell her husband Jack she is in a persistent vegetative state — and although the diagnosis is difficult to make with certainty and is often wrong — they conclude she will never awaken.

Since the law now considers a persistent vegetative state the same as being dead, the state issues a death certificate. Jack assures doctors that Alice wanted her body used for science if she ever died or became profoundly incapacitated. Accordingly, her “breathing cadaver” is transferred from a nursing home to a major organ transplant center. Soon, her kidneys are removed for transplantation into renal patients. Doctors then implant pig kidneys. Alice survives the surgery and continues to breathe on her own. She lives for years in isolation as researchers continually test for dangerous porcine viral infections. When the experiment concludes, Alice is lethally injected — which is not considered euthanasia because she is already legally dead — and her remains are cremated.

It’s an ugly picture, and it is important to emphasize that transplant surgeons do not currently harvest the organs of vegetative patients, nor do medical researchers use these most vulnerable people in unethical medical experiments. But if we want to keep it that way, we will have to make it unequivocally clear to the bioethicists and our lawmakers that patients diagnosed with persistent vegetative state are people, too. It’s wrong to reduce them into the nonfictional equivalents of axlotl tanks.

Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.