Only ethicist Arthur Caplan has the nerve to say it: Years ago, when he moved from Minnesota to Pennsylvania, he was reapplying for his driver’s license, and advised by the clerk: Don’t mark that: If you do, they will let you die.

The fact that the governor quickly got a heart/liver transplant made a lot of folks suspicious of the scheme to get more organs: The governor was rich of course and the donor was a black homicide victim. In reality, he got the organs because they fit (you have to use a heart from a donor the same size as you are, although livers can be divided up). But the idea that “they might let you die” lurked below the surface. Indeed, when we would air flight our brain damaged rednecks to Pittsburgh “for higher care”, the ambulance crews would joke it was a “Body run”: I.e. not to benefit the patient, but so the corpse would be closer to the transplant team.

The brain death criteria is strict (but not always followed, alas, although few talk about that either). As one ethicist pointed out: In brain death, you remove the machines and the patient’s body dies.

As a Catholic, we allow such things (traditionally “extraordinary” treatment, including breathing machines, but not feeding by tube or spoon, is called “extraordinary treatment”. Until a few years ago when they started deliberatly starving brain damaged  folks to kill them, tube feeding was also considered optional).

Ah, but now the powers that be are trying to change the practice to include “heart beat death” instead of brain death. In other words, if you are in bad shape, they will sedate you until your breathing and heart stops, and then get the organs.

Uh, that means you might still have a brain functioning when you cut the guy to remove his organs out. (All of this reminds me of the macabre musings of Camus about how long those killed by the Guillotine stayed aware of their surroundings)

On the other hand, we again come to the question of who is dead, and if  you might be able to restart the heart and have the person live.

And then we come to the problem: What about those who might recover but might be mentally damaged? Is it justified to stop treatment if someone might not want a life lived on machines, but it’s another thing if maybe they will live without machines if you give them awhile, and it’s a third thing that if you decide to stop the machines so that the person absolutely dies without seeing if he will recover (and if you think docs are good at predicting this, then ask your doc, or better yet, a cynical nurse, how often such predictions turn out wrong.)

And then we come to this one: How often are machines removed and the family convinced that the person is in a coma, but the coma is actually due to the medicines he is getting?

In one case in California, the family of a mentally disabled man was under the impression he was brain dead, but he wasn’t. The doctor involved got upset when the patient didn’t die after the machines were stopped, so he encouraged the patient to die by increasing his sedative medications.

LATimesstory here

 

The San Luis Obispo County district attorney’s office accused Dr. Hootan Roozrokh, 33, of dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose.

The surgeon allegedly ordered massive amounts of narcotic painkillers and sedatives for Ruben Navarro, a physically and mentally disabled man, on Feb. 3, 2006. In addition, Roozrokh is accused of administering the antiseptic Betadine through a feeding tube into Navarro’s stomach, a sterilization procedure typically done after a donor is dead.

“The law and the facts indicated that Dr. Roozrokh … tried to accelerate [Navarro’s] death to facilitate the harvesting of his organs,” said Chief Deputy Dist. Atty. Stephen Brown.

Navarro survived for more than seven hours after he was removed from life support and given the drugs. By that time, his organs were no longer viable and could not be recovered.

If I remember correctly, the doc got off scot free.LINK
There is supposed to be strict criteria for brain death, and a strict line between those caring for the patient and those who want the organs.

The NDY site quotes a physician blogger who just found out what is being proposed, and he is shocked, shocked, that such shennanigans go on.link

One is happy that NPR carried the story…NPR LINK

None of this affects us in the rural Philippines, where our cousin was shot in the head during a political hit job by the mayor, and died without anyone getting his organs. It is a 3-4 hour drive to Manila, so no organs were removed after he died, but in Chicago he would have been put on machines to get his healthy organs. (I should add that here in the Philippines, there is an underground organ buying scam in Manila, where the docs and the middlemen get most of the money, but that’s another story).

Why worry about such things? Well, if you don’t think that major changes in the law about life and death can be made by unelected panels with little or no public discussion, then you are naive.

The disability group “Not Dead Yet” has been on top of the argument link

You see, there is a bias in doctors and by the public against the disabled, and many of them have been “encouraged” to chose “non treatment” (i.e. to die) rather than the alternative (i.e. to live a life despite their disability).

It doesn’t take a lot of paranoia to see the problem: As one of my patient’s mothers sarcastically told us: “Too often I take my beloved autistic daughter to the doctor, but all they see is a potential organ donor”…

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Nancy Reyes is a retired physician living in the rural Philippines. A shorter version of this was posted to her Xanga blog.

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