Defining killing down

From my hero Wesley J. Smith.

Wesley is the most dedicated defender of human life I know. He brings attention to a terrifying shift in bioethics. I see it happening as well in my own practice. There is a rapid shift from traditional understandings of the ethics of organ donation and of care for the disabled to the new paradigm: bring severely disabled people into the organ donor pool and end their lives with organ donation in mind.

Wesley Smith:

The killing-for-organs pushers 

By Wesley J. Smith

If you want to see where our culture may next go off the rails, read professional journals. There, in often eye-crossing and passive arcane prose of the medical intelligentsia, you will discover an astonishing level of antipathy to the sanctity of human life — to the point now that some advocate killing the profoundly disabled for their organs.

Case in point: “What Makes Killing Wrong?” an article published in the January 19, 2012 edition of the Journal of Medical Ethics. The authors argue that death and total disability are morally indistinguishable, and therefore harvesting organs from living disabled patients is not morally wrong. Bioethicists Walter Sinnott-Armstrong, of Duke University, and Franklin G. Miller, from the National Institutes of Health’s Department of Bioethics (which should really get the alarm bells ringing!) arrive at their shocking (for most of us) conclusion by claiming that murdering the hypothetical “Betty” isn’t wrong because it kills her, but rather, because it “makes her unable to do anything, including walking, talking, and even thinking and feeling.”

How do they get from deconstructing the definition of death to harvesting the disabled? First, they change the scenario so that Betty is not killed but severely brain damaged to the point that she is “totally disabled.” But their definition of that term encompasses hundreds of thousands of living Americans who are our mothers, fathers, children, aunts and siblings, uncles, friends and cousins — people with profound disabilities like that experienced by Terri Schiavo and my late Uncle Bruno as he lived through the late stages of his Alzheimer’s disease:

Betty has mental states, at least intermittently and temporarily, so she is not dead by any standard or plausible criterion. Still, she is universally disabled because she has no control over anything that goes on in her body or mind.

Since Betty “is no worse off being dead than totally disabled,” they opine, it is no worse “to kill Betty than to totally disable her.” Not only that, but according to the authors, “there is nothing bad about death or killing other than disability or disabling,” and since she is already so debilitated, then nothing wrong is done by harvesting her organs and thus ending her biological existence. And thus, in the space of not quite five pages, killing the innocent ceases to be wrong and the intrinsic dignity of human life is thrown out the window, transforming vulnerable human beings into objectified and exploitable human resources.

Alas, Sinnott-Armstrong and Miller are not on the fringe. And while they certainly don’t represent the unanimous view, they can hardly be called radical — at least by the standards of the medical/bioethical intelligentsia. Indeed, for more than a decade articles have been published in the world’s most notable medical and bioethics journals arguing in favor of killing profoundly disabled patients for their organs. Here is just a sampling:

● Bioethics: “If a patient opts for VAE [voluntary active euthanasia] in a society that permits it, and then chooses termination via RVO [removing vital organs], it seems clear that no more harm is done to others than if he were terminated by any other means.”

● Journal of Medical Ethics: “In the longer run, the medical profession and society … should be prepared to accept the reality and justifiability of life terminating acts in medicine in the context of stopping life sustaining treatment and performing vital organ transplantation.”

● Nature: “Few things are as sensitive as death. But concerns about the legal details of declaring death in someone who will never again be the person he or she was should be weighed against the value of giving a full and healthy life to someone who will die without a transplant.”

● New England Journal of Medicine: “Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered.”

● The Lancet: “If the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function, it would be possible to take the life of a patient (or more accurately stop the heart since the patient would be defined as dead) by a lethal injection and then to remove the organs for transplantation …”

● Critical Care Medicine: “We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be able to donate their organs without first being declared dead.”

It is important to note here that transplant medicine remains an ethical enterprise and that doctors are not yet doing the deed. But if we want to keep it that way, it is important that these proposals not be allowed to germinate.

Here’s the good news. Sunlight is the great disinfectant. Most people will oppose killing for organs. Thus, the best way to prevent this dark agenda from ever becoming the legal public policy is to expose it in popular media every time it is proposed.

This is a surprisingly rapid shift taking place in bioethics. The trend is to narrow the gap between severe disability and death. It's most recent iteration began with the creation of a faux diagnosis-- Persistent Vegetative State-- and more recently with the creation of Minimally Conscious State, to be applied to those PVS folks who didn't get the memo that they weren't supposed to be aware.

The overall goal seems to be to certify severely disabled people unworthy of resources to keep them alive so that their lives can be intentionally ended, and to make them organ donors.

This is real, and it is coming.