Canadian legislation and medical protocols need to be tweaked to allow euthanasia with organ donation, according to an opinion piece in the New England Journal of Medicine. Two doctors from Western University, in Ontario, and Robert Truog, a Harvard Medical School bioethicist, outline the changes that will be needed to ensure that patients can give as many healthy organs as possible.
Euthanasia offers significant advantages for transplant surgeons. The normal protocol is to wait for a couple of minutes after blood circulation ceases (donation after cardiac death). But even in that brief space of time the quality of the organs declines. If they were removed in a coordinated operation from a euthanasia patient, they would be as fresh as possible.
To achieve this, a few changes need to be made. The staff of intensive care wards are trained to keep people alive; in organ donation after euthanasia they would have to kill the patient. At the moment, too, a firewall exists between the staff handling withdrawal of life support and the staff handling organ donation so that patients are not killed for their organs. But with legalised euthanasia, there will be no need for the firewall.
Conscientious objectors could pose an obstacle, given the radical change in attitude.
Hospitals and organ-procurement organizations must therefore have protocols that allow clinicians who object to opt out. Organizations also need to consider where to draw the boundaries of legitimate conscientious objection. Does the right to opt out extend to laboratory and pharmaceutical staff? What about the disposition of these organs — should clinicians be permitted to opt out of participating in the transplantation of donated organs, and should potential recipients be informed about the source of the organs in case they may want to decline transplantation?
It would also be necessary to do away with the dead donor rule – that a patient must be dead before donating. Among transplant surgeons, this is almost a divine commandment. But it would have to be discarded as well. Presumably most euthanasia patients would agree to death caused by the act of donating. But according to Canadian law, a euthanasia death must be caused by the administration of a “substance”, not by organ retrieval. The law would have to be amended.
The patients would be affected as well. One of the attractions of euthanasia is the prospect of dying peacefully surrounded by family and well-wishers. But with organ donation euthanasia patients would die in the sterile atmosphere of an operating theatre. It might not be exactly what they envisaged when they agreed to donate their organs.
Is this the future of euthanasia in Canada? Will desperately ill patients who feel lonely and unloved seek meaning for their lives by donating their vital organs? Will transplant surgeons encourage them? Will relative and friends – even Facebook friends – urge them on? It’s a terrifying revolution in medical ethics.
Michael Cook is editor of MercatorNet.