Rethinking the ethics of vital organ donations

Hastings Center Report

Volumn 38, Issue 6, 2008, Pages 38-46

  Miller, Franklin G ^a   Truog, Robert D ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BRAIN DEATH; CONSCIOUSNESS; ETHICS; HOMICIDE; HUMAN; INFORMED CONSENT; ORGAN TRANSPLANTATION; PASSIVE EUTHANASIA; RESUSCITATION; TRANSPLANTATION; TREATMENT WITHDRAWAL;

ADVANCED CARDIAC LIFE SUPPORT; BRAIN DEATH; CONSCIOUSNESS; EUTHANASIA, PASSIVE; HOMICIDE; HUMANS; INFORMED CONSENT; ORGAN TRANSPLANTATION; THIRD-PARTY CONSENT; TISSUE AND ORGAN HARVESTING; TISSUE AND ORGAN PROCUREMENT; WITHHOLDING TREATMENT;

EID: 57849108174     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (46)

1. R.M. Arnold and S.J. Youngner, "The Dead Donor Rule: Should We Stretch It, Bend It, or Abandon It?" Kennedy Institute of Ethics Journal 3 (1993): 263-78;
2. N. Fost, "The Unimportance of Death," in The Definition of Death, ed. S.J. Youngner, R.M. Arnold, and R. Schapiro (Baltimore, Md.: The Johns Hopkins Press, 1999), 161-78;
3. I.H. Kerridge et al. "Death, Dying and Donation: Organ Transplantation and the Diagnosis of Death," Journal of Medical Ethics 28 (2002): 89-94;
4. D. DeGrazia, Human Identity and Bioethics (New York: Cambridge University Press, 2005), 152-58;
5. R.D. Truog, "Brain Death - Too Flawed to Endure, Too Ingrained to Abandon," Journal of Law, Medicine & Ethics 35 (2007): 273-81.
6. G. Greenberg, "As Good As Dead," The New Yorker, August 13, 2001, 36.
7. Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, "A Definition of Irreversible Coma," Journal of the American Medical Association 205 (1968): 337-40;
8. F. Plum, "Clinical Standards and Technological Confirmatory Tests in Diagnosing Brain Death," in The Definition of Death, ed. Youngner, Arnold, and Schapiro, 34-65.
9. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: Medical, Legal and Ethical Issues in the Determination of Death (Washington, D.C.: Government Printing Office, 1981), 2.
10. R.D. Truog and J.C. Fackler, "Rethinking Brain Death," Critical Care Medicine 20 (1992): 1705-1713;
11. R.D. Truog, "Is It Time to Abandon Brain Death?" Hastings Center Report 27, no. 1 (1997): 29-37.
12. R.D. Truog and W.M. Robinson, "Role of Brain Death and the Dead Donor Rule in the Ethics of Organ Donation," Critical Care Medicine 31 (2003): 2391-96.
13. J.L. Bernat, C.M. Culver, and B. Gert, "On the Definition and Criterion of Death," Annals of Internal Medicine 94 (1981): 389-94.
14. J.L. Bernat, "Refinements in the Definition and Criterion of Death," in The Definition of Death, ed. Youngner, Arnold, and Schapiro, 83-92.
15. D.A. Shewmon, "The Brain and Somatic Integration: Insights into the Standard Biological Rationale for Equating 'Brain Death' with Death," Journal of Medicine and Philosophy 26 (2001): 457-78;
16. D.A. Shewmon, "Chronic 'Brain Death': Meta-Analysis and Conceptual Consequences," Neurology 51 (1998): 1538-45.
17. See also R.M. Taylor, "Reexamining the Definition and Criteria of Death," Seminars in Neurology 17 (1997): 265-70.
18. M.A. DeVita et al., "Observations of Withdrawal of Life-Sustaining Treatment from Patients Who Became Non-Heart-Beating Donors," Critical Care Medicine 28 (2000): 1709-12;
19. R. Steinbrook, "Organ Donation after Cardiac Death," New England Journal of Medicine 357 (2007): 209-213.
20. Arnold and Youngner, "The Dead Donor Rule," 267.
21. D.W. Brock, "The Role of the Public in Public Policy on the Definition of Death," in The Definition of Death, ed. Youngner, Arnold, and Schapiro, 298.
22. E.D. Pellegrino, "Doctors Must Not Kill," Journal of Clinical Ethics 3 (1992): 95-102;
23. D. Callahan, The Troubled Dream of Life (Washington, D.C.: Georgetown University Press, 1993), 76-82;
24. B. Brody, "Withdrawal of Treatment Versus Killing of Patients," in Taking Issue, ed. B. Brody (Washington, D.C.: Georgetown University Press, 2003), 158-72.
25. T.L. Beauchamp, "Introduction," in Intending Death, ed. T.L. Beauchamp (Upper Saddle River, N.J.: Prentice Hall Press, 1996), 1-22.
26. D.W. Brock, Life and Death (New York: Cambridge University Press, 1993), 158-213.
27. In order to preserve the notion that withdrawing life support does not cause the death of patients but merely allows them to die, Baruch Brody argues (not persuasively in our opinion) that the person who maliciously turns off the ventilator does not kill the patient (see Brody, "Withdrawal of Treatment Versus Killing of Patients," 169-70).
28. D. Callahan, The Troubled Dream of Life, 77.
29. H.L.A. Hart and T. Honore, Causation in the Law, second ed. (New York: Oxford University Press, 1985).
30. Ibid., 29.
31. Ibid., 40.
32. B. Brody, "Special Ethical Issues in the Management of Persistent Vegetative State (PVS) Patients," in Taking Issue, ed. Brody, 179-80.
33. A. Meisel, "The Legal Consensus about Forgoing Life-Sustaining Treatment: Its Status and Prospects," Kennedy Institute of Ethics Journal 2 (1992): 309-45;
34. N.L. Cantor, "Twenty-Five Years after Quinlan: A Review of the Jurisprudence of Death and Dying," Journal of Law, Medicine & Ethics 29 (2001): 182-96.
35. R.D. Truog et al., "Recommendations for End-of-Life Care in the Intensive Care Unit: The Ethics Committee of the Society of Critical Care Medicine," Critical Care Medicine 29 (2001): 2332-48.
36. F.G. Miller and H. Brody, "The Internal Morality of Medicine: An Evolutionary Perspective," Journal of Medicine and Philosophy 26 (2001): 581-99.
37. M.B. Green and D. Wilder, "Brain Death and Personal Identity," Philosophy & Public Affairs 9 (1980): 105-33;
38. K.G. Gervais, Redefining Death (New Haven, Conn.: Yale University Press, 1986);
39. R.M. Veatch, "The Impending Collapse of the Whole-Brain Definition of Death," Hastings Center Report 23, no. 4 (1993): 18-24.
40. See D. DeGrazia, Human Identity and Bioethics, 124-41, for an illuminating philosophical critique of the higher brain standard of death.
41. L.A. Siminoff and A. Bloch, "American Attitudes and Beliefs about Brain Death: The Empirical Literature," in The Definition of Death, ed. Youngner, Arnold, and Schapiro, 183-93;
42. L.A. Siminoff, C. Burant, and S.J. Youngner, "Death and Organ Procurement: Public Beliefs and Attitudes," Kennedy Institute of Ethics Journal 14 (2004): 249-60.
43. A.M. Capron, "Brain Death - Well Settled Yet Still Unresolved," New England Journal of Medicine 344 (2001): 1244-46.
44. A.M. Capron, "The Bifurcated Legal Standard of Determining Death: Does It Work?" in The Definition of Death, ed. Youngner, Arnold, and Schapiro, 130. Interestingly, Capron faults the Pittsburgh DCD protocol for being incompatible with the UDDA because the cessation of circulatory and respiratory functioning is not irreversible when death is declared. Given that DCD protocols work well in practice despite this theoretical incoherence, Capron's criticism, which we share, also runs afoul of the maxim, "If it ain't broke, don't fix it."
45. Brock, "The Role of the Public in Public Policy on the Definition of Death," 302-6.
46. Truog, "Too Flawed to Endure, Too Ingrained to Abandon."