By Michael Cook
Is it morally wrong to kill people? Not really, argue two eminent American bioethicists in an early online article in the Journal of Medical Ethics. Walter Sinnott-Armstrong, of Duke University, and Franklin G. Miller, of the National Institutes of Health believe that “killing by itself is not morally wrong, although it is still morally wrong to cause total disability”.
Ultimately their aim is to justify organ donation after cardiac death (DCD). This is a state in which a patient is neurologically damaged and cannot function without a respirator. Within minutes of withdrawing this, the organs are removed. However, the authors state frankly that the patient is not dead at that point because it is possible that the patient’s heart could start beating again. (Other bioethicists disagree, vehemently.)
“[T]he criterion of irreversibility has not been satisfied; hence, these patients are not known to be dead at the time of organ procurement.”
In view of well-publicised organ shortages, transplant surgeons are eager to increase the number of available organs. DCD is an important avenue. However, a nagging suspicion that these patients might not be dead is still a substantial stumbling block because the medical profession insists that donors must always be dead. But Sinnott-Armstrong and Miller have an solution:
“[T]he dead donor rule is routinely violated in the contemporary practice of vital organ donation. Consistency with traditional medical ethics would entail that this kind of vital organ donation must cease immediately. This outcome would, however, be extremely harmful and unreasonable from an ethical point of view [because patients who could be saved will die]. Luckily, it is easily obviated by abandoning the norm against killing.”
This radical conclusion may shock some readers, but the authors are not murderers. They want to bring greater precision to what we mean by killing. Rendering someone totally and permanently incapacitated is just as bad as taking a life, or so they contend. Killing totally disabled patients does them no harm.
“Then killing her cannot disrespect her autonomy, because she has no autonomy left. It also cannot be unfair to kill her if it does her no harm.”
Nor, they say, is life “sacred”. The only relevant difference between life and death is the existence of abilities – and a brain-damaged person no longer has these.
“[I]f killing were wrong just because it is causing death or the loss of life, then the same principle would apply with the same strength to pulling weeds out of a garden. If it is not immoral to weed a garden, then life as such cannot really be sacred, and killing as such cannot be morally wrong.”