Organ donation and permanent vegetative state

Abstract

Raymond Hoffenberg and colleagues (Nov 1, p 1320)1Hoffenberg K Lock M Tilney N et al.Should organs from patients in permanent vegetative state be used for transplantation?.Lancet. 1997; 350: 1320-1321Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar discuss whether organs from patients in a permanent vegetative state (PVS) should be used for transplantation. They debate whether a patient's death might be accelerated by lethal drug injections, after the decision to withdraw nutrition and fluids has been made. A natural death after nutrition withdrawal would yield organs no longer in optimum condition. Although active killing is still illegal, the authors believe that there is no ethical difference between the omission of treatment and more active ending of life. If a patient, family, or both refuse life-sustaining interventions, the cause of death will be the underlying disease. The intention is here not to sustain life by means of senseless technical support. By contrast, by euthanasia, active killing is intended and the cause of death is the injection of a lethal drug.2Annas GJ The bell tolls for a constitutional right to physician assisted suicide.N Engl J Med. 1997; 337: 1098-1103Crossref PubMed Scopus (21) Google Scholar The authors argue that if the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function such as PVS, it would be possible to stop a patient's heart by a lethal injection and remove organs for transplantation. To my mind, this demonstrates the difficulty with definitions of deliberate death which have emerged with high-technology medicine.This argument is presented by a distinguished international group and was published in The Lancet without an editorial or commentary. As a German, I am sensitive here, recalling the euthanasia during the Nazi era. The Hippocratic oath reminds us “I will never give a lethal remedy” and the biblical commandment “Thou shalt not kill” is recognised by the Jewish and Christian religions. However, the imperative to do everything that is technically possible is a dominating feature today. Raymond Hoffenberg and colleagues (Nov 1, p 1320)1Hoffenberg K Lock M Tilney N et al.Should organs from patients in permanent vegetative state be used for transplantation?.Lancet. 1997; 350: 1320-1321Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar discuss whether organs from patients in a permanent vegetative state (PVS) should be used for transplantation. They debate whether a patient's death might be accelerated by lethal drug injections, after the decision to withdraw nutrition and fluids has been made. A natural death after nutrition withdrawal would yield organs no longer in optimum condition. Although active killing is still illegal, the authors believe that there is no ethical difference between the omission of treatment and more active ending of life. If a patient, family, or both refuse life-sustaining interventions, the cause of death will be the underlying disease. The intention is here not to sustain life by means of senseless technical support. By contrast, by euthanasia, active killing is intended and the cause of death is the injection of a lethal drug.2Annas GJ The bell tolls for a constitutional right to physician assisted suicide.N Engl J Med. 1997; 337: 1098-1103Crossref PubMed Scopus (21) Google Scholar The authors argue that if the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function such as PVS, it would be possible to stop a patient's heart by a lethal injection and remove organs for transplantation. To my mind, this demonstrates the difficulty with definitions of deliberate death which have emerged with high-technology medicine. This argument is presented by a distinguished international group and was published in The Lancet without an editorial or commentary. As a German, I am sensitive here, recalling the euthanasia during the Nazi era. The Hippocratic oath reminds us “I will never give a lethal remedy” and the biblical commandment “Thou shalt not kill” is recognised by the Jewish and Christian religions. However, the imperative to do everything that is technically possible is a dominating feature today. Organ donation and permanent vegetative stateAuthors' reply Full-Text PDF