I’m a little late on this, but William Saletan, national correspondent for Slate.com, wrote a pretty thoughtful analysis of the current medical debates regarding the definition of death. First published as an essay on Slate, “The Doctors Who are Redefining Life and Death” was published in the Sunday, Oct. 5th edition of the Washington Post.
Saletan shares a some of the debates raging in medical circles in regard to defining death. He makes it clear that the driving force behind the efforts to expand the definition of death is the desire to obtain more viable organs for harvesting and transplantation.
From the essay:
Robert Truog, an ethicist who supports the Denver protocol, says this redefinition of death has gone too far. Let’s accept that we’re taking organs from living people and causing death in the process, he argues. This is ethical as long as the patient has “devastating neurologic injury” and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he notes. Why not treat donations similarly? Traditional safeguards, such as the separation of the transplant team from the patient’s medical team, will prevent abuse. And the public will accept the new policy since surveys suggest we’re not hung up on whether the donor is dead.
But down that road lies even greater uncertainty. How devastating does the injury have to be? If death is vulnerable to redefinition, isn’t “devastating” even more so? The same can be asked of “futility,” the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressure to donate? Even if each family makes its own choice, aren’t we loosening standards for termination precisely to get more organs?
Saletan has zeroed in on the questions that “experts” like Truog would like to pretend aren’t relevant. Saletan is to be credited for this amount of analysis, since he doesn’t seem to be aware of just how much evidence there is that the pressure to obtain organs is already impacting life and death decisions.
What evidence?
- How about the gruesome death of Ruben Navarro?
- How about the ethical pitfalls (Navarro being an example) of non heart-beating donations?
- Zack Dunlap, declared “brain dead,” prepared for organ harvesting, who “miraculously” woke up.
- The rash of “rush to judgment” cases over the past two years.
It’s good to see Saletan turning his attention this way. He’s a thoughtful analyst that isn’t someone easily pigeonholed as “liberal” or “conservative” in his approach. I hope to see more from him on this and related topics in the future. –Stephen Drake
NOTE: Anyone interested in reading more by Saletan should check out the Human Nature section on Slate.