The medical slippery slope

Monty

Thank you for publishing the letter from the bereaved mother. As a result, I will be much less likely to agree to organ donation should any member of my family ever be in such a critical condition in hospital. There have been too many reports of "brain dead" patients recovering. My objections are not religious, but they are moral. I do not kill anyone, much less my loved ones.
But once a doctor has requested organ donation and been refused, he or she should not be allowed to supervise the patient. The bond of trust between family and doctor is broken.
We have a massive crisis looming in the NHS, over the perception, rapidly gaining force, that the medical profession seeks only to treat those patients considered worthy, and devil take the rest. That is tragic.

Corin

You are so right. A little over a year ago , I watched a young man fighting for his life on a road in a Mediterranean island. I saw thick blood crawl from his ear. I stoppe dhim being taken by car and waited, interminably, until the anbulance eventually arrive. He was in a coma for months. He was flown to Isarael and thanks to the skill of the israeli doctors he is now, a year later, compos mentis and will, we trust, eventually walk. He has a future and a life. At the time, there were those who had written him off as dead. Ironically, it was his friends who had given up on him and the victims of his foolish driving who sought to save his life. His Orrthodox family prayed for him, his Protestant victims prayed for and protected him, and the Jews saved him. Plenty to think about, not least that a young, healthy man is not a source of organs for the rich and powerful, but an investment in the future. Whatever hapened to the Hippocratic Oath?

Spencer de Vere

I suspect you are pulling against the tide, Melanie. Socialized medicine has no time for "selfish" individual scruples. The logic is this: If you are benefitting from "free" state medical services, then you OWE society. To a certain extent, society OWNS you....and, all those internal organs are a 'natural resource' that only the most evil, anti-social fascist could consign to the grave or crematorium when there are so many organ-needy souls out there.

elixelx

Ms. Phillips, I have often written to you on this blog in complete support of your criticisms of those mundane minutiae you expose as short-sighted, untrue, and cowardly. Nevertheless today I take issue with you on a matter of PHILOSOPHY and the sweeping generalization that mars this otherwise concise and feisty column--your assertion "in essence that bad means are justified by good ends. That is ultimately the way to tyranny and mass murder." I would now ask two questions--was the ongoing attempt to free Iraq from Saddam accomplished by good means or bad to achieve a good end or bad? I would ask the same question about a possible Israeli attack on the Iranian nuclear facilities, given that there will almost certainly be collateral damage. I beg to differ then with your assertion that bad means, although they lead to good ends, are also the way to tyranny and mass murder. The strategies and tactics we use to achieve our ends are therefore inconsequential in deciding what happens after the end has been gained or lost! Remember Hamas was ELECTED by an imposed democratic template. So was Hitler. In both cases the bad means, war, brought about a desired end, democracy, which then itself turned out to be a way to tyranny and mass murder. Thank you.

Ray

Sadly Joseph Mengele would have found much to admire in the way a vocal minority within our medical establishment seeks to railroad through this kind of slippery practice.

M Clyde

Spot on, Melanie. I too view with horror this proposal of 'presumed consent' as I too have had a close friend sustain severe brain damage due to a car accident and be on a ventilator. I think you are right that there is great ignorance amongst the public about this, who assume people are actually 'dead' when organs are removed, when in facr they are 'dying'; or worse still, in a state between life and death whose outcome is indeterminate. I cite the instance of the former Scottish football captain, Colin Hendrie. Here was a noble example of a refusenik. Mr Hendrie's wife was on a life support machine after contracting septicaemia following botched cosmetic 'tummy tuck' surgery in which her bowel was accidentally perforated. Mrs Hendrie now regrets her 'vanity' and feels guilty that she risked her life for looks, when she had so much else to be grateful for. But if it was not for the stubborness of her husband she would not be alive today. For her deterioration after surgery had been so rapid she was on a life support machine in a matter of hours. A shocked Mr Hendrie was advised to give consent to turn it off, but he refused. He was not ready to say goodbye to her. In a matter of weeks she began to show signs of recovery and today, though not completely back to normal, she enjoys life and their three children have a mother. In the case of my friend there was never any suggestion that the medics were not fighting to save his life, as recovery was always considered to be a possibility. But I too would have resisted calls to turn off the ventilator. People have revived after months of little brain activity. Medics speak not of 'unconsciousness' but of 'conscious level'. I fear that pressure will be put on families to end patients lives for organ harvest, especially in the instance of young car crash victims with head injuries who are otherwise healthy. At the same time, I am bound to report in all fairness that during the time my friend was in hospital I have seen the results of revived patients who were apparently brain dead for fifteen minutes or more as medics sought to save them. I have listened to tearful relatives cry, 'I wish he were dead'. What you come back with is not always worth having; even close relatives will admit that.

(Dr) David Evans

Medical prognosis can never be 100% certain. One of the most powerful weapons available to doctors in its aid is the passage of time. This is denied to doctors who are pressed to certify the death of those regarded as certain to die soon from brain damage so that their organs may be removed, without legal problems, while they are still alive - oxygenated blood continuing to be circulated throughout their bodies (including parts of their brains) by their naturally beating hearts. So alive are those organ "donors" - certified "dead" on the unscientific and philosophically controversial "brain stem death" criteria and concept - that they have to be paralysed with drugs to facilitate the procurement surgery. Even so, they exhibit blood pressure and heart rate rises in response to the trauma which are identical to those seen in everyday therapeutic surgery and which, in that context, are regarded as an indication that the patient might be feeling pain. However certain it may be that patients thus identified as organ "donors" really are very close to death, the removal of their organs while there remains the slightest possibility that they are still sentient, or could regain sentience under the stress of the surgical procedure, has always seemed to me an horrific abuse of the dying. It has been said that the treatment of its most vulnerable and defenceless members is a measure of a society's degree of civilization. In our society, there are surely none more defenceless than the so-called "brain stem dead".

(Prof.) Michael Potts

Melanie, thank you for your fine article. The United States uses the so-called "whole-brain death criterion," but since EEG activity, control of blood pressure, and control of body temperature continue in many of these brains, the "whole brain" is clearly not dead in many of these patients. The "waiting period" from hospital admission to certification of "brain death" has been shortened from 24 hours in 1968 to 6 hours today. How many patients have had their organs removed who may have at least partially recovered if not for overzealous "organ harvesters"? How many people are aware when they sign an organ donor card that if they are declared "brain dead," their hearts will be beating when they are brought to surgery to remove their organs? How can anyone rationally support "presumed consent" when even the current "voluntary" system of organ donation lacks adequate informed consent?

Tony Allwright

"That means donors are dying but not dead; and that means the removal of the organs kills them. And call me old-fashioned, but I happen to believe that killing sick patients is wrong." By comparison with the abuses you highlight, one has to admire the moral clarity of the Chinese Army. It routinely kills healthy Falun Gong prisoners by removing their organs for commercial transplantation into patients (particularly foreign "transplant tourists") who can pay. For details, see " Chinese Communists Harvest Live Human Body Organs"