Given the national publicity surrounding the death of Ruben Navarro, I thought the time could be ripe for a renewed discussion of the ethics surrounding the increasing implementation of the “non heart-beating donor” protocol. According to Maurice Bernstein, on his bioethics discussion blog, there’s a bunch of ethicists discussing whether or not the public is ready to accept this protocol on some email list. That’s the wrong discussion to be having.
The real question, which the Ruben Navarro case reveals, is whether or not medical professionals have the ability to competently and ethically implement the protocol.
(For a review of the details of the Navarro case, please check “Ruben Navarro and Our Need to Speak Out.” A transplant surgeon is facing serious charges for an alleged attempt to “hasten” Navarro’s death during this protocol when his heart refused to stop beating after a ventilator removal. No other professionals in the room – who stood by and did nothing – have faced consequences in terms of criminal charges or disciplinary actions by their respective review boards.)
I had reason to think that we all might revisit the complications and the high standard of performance that has to exist if this protocol can be defended. It was clear from a number of news stories that transplant advocates were worried about the impact of the publicity surrounding the Navarro case.
Well, it looks like they’ve gotten over being worried about it – or at least a reporter at the NY Times and her interviewees failed to show any need to discuss concerns.
The August 28th story by Jane E. Brody titled “The Solvable Problem of Organ Shortages,” falls short of real reporting and can best be described as a public relations piece for the NHBD protocol and the medical institutions implementing the protocol.
When I checked, it looks like the NY Times was one of the few major papers that published only one short AP story on the Navarro case. I can wonder why the Times didn’t find the story worth publishing, but the absence of that coverage certainly helped to provide cover in parts of the story that begged for some reference to the case. For example, there is this paragraph with a blanket and unchallenged statement about “strict regulations”:
Although willingness to donate has risen in recent years, major hurdles remain. Some people, for example, believe incorrectly that patients who might otherwise be saved are sometimes “killed” for their organs. Strict regulations are in place to prevent this.
Anyone familiar with the details of Ruben Navarro’s death would know that, at least in his case, “strict regulations” meant absolutely nothing when a transplant surgeon took over his “care” while Navarro was still alive. The surgeon then allegedly directed massive amounts of morphine and ativan be given to Navarro, which the authorities have said were intended to “hasten” Navarro’s death so his organs would be usable. Anyone who fears being “killed for their organs” now has evidence that this can happen.
Navarro’s unfortunate demise was connected to the practice of planning a death ahead of time, at a convenient time, which has obvious advantages for transplant teams:
Dr. Steinbrook said potential donors included patients on ventilators after devastating and irreversible brain injuries, as might follow a hemorrhagic stroke, as well as patients with high spinal cord injuries and terminal musculoskeletal diseases like ALS, for whom further medical treatment is deemed futile
This is the minefield that Ruben Navarro was placed in. In a wrongful death suit, Navarro’s mother has claimed that she was told the hospital had a policy that limited ventilator connection for coma patients to five days. If the allegation is true, it means that her “consent” to disconnect the ventilator could be viewed as coerced.
The paragraph that follows the discussion of the potential candidates contains some very troubling language:
These patients are technically not dead.
Odd. I would think that someone with high spinal cord injuries or a person with ALS would be considered both legally and “technically” very alive. What’s being implied here?
What it sounds like, is “these patients aren’t technically dead but we can treat them as though they really are dead.”
Patients like Ruben Navarro. –Stephen Drake