It is written in oh so politically correct language, but it should set off alarm bells. A US government appointed ethicist at the National Institutes of Health just wrote an article in the Journal of Medical ethics (which can be read at the British Medical Journal website)  proposing the handicapped should be killed for organ donations.


What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Got that? The article explains that since disability is worse than death, so why worry if you kill a theoretical lady named Betty.

  We see nothing to make Betty’s death worse than her total disability. This intuition seems to be widely shared, since many people dread death no more than and for the same reasons that they would dread total disability. There is nothing to be dreaded about death that wouldn’t also be dreaded about total disability. Indeed, one of us even finds it plausible to see total disability as worse than death, because there is disvalue in a disordered state of consciousness with no control over experiences. In any case, Betty is not worse off dead. In our view, then, what explains the wrongness of Abe’s act of killing Betty is not that he caused her death but only that he caused her total disability.

They then go on to argue that the rule “thou shalt not kill” is always nuanced, but since disabling someone is also wrong, why bother to have two “rules”?

That  makes sense, you might say. Except it doesn’t stop there.

However, it is not clear what work is done by the rule against killing if the rule against disabling is already in place. If Betty is no worse off being dead than being totally disabled, as we suggested, then it does not seem any worse to kill Betty than to totally disable her (and possibly worse to totally disable her than to kill her).

Well, fine. Except it doesn’t stop there either:

Traditionalists might object that morality still needs a rule against killing because it would be wrong to kill Betty after she became totally disabled. But why? If Betty is no worse off being dead than being totally disabled… then killing her does not make her worse off if she was already totally disabled. But if killing her does not make her worse off, then why is it bad to kill her?

(emphasis mine).

They then go into a long sarcastic spiel about why religious folks are mistaken.

Then they say killing is worse if you kill someone young and healthy than if you kill someone old or helpless.

Indeed, even the rule ‘Don’t kill’ runs into problems of equality if it is wrong to kill because it is wrong to cause loss of life. After all, some people have more life left than others. Causing death is usually just shortening life, since we will all die someday. But then, if it is bad to shorten life, it is presumably worse to shorten it more, and greater shortening is worse because more life is better than less life. That implies that young people’s lives have more value than old people’s lives, since the young have more life left.

Actually, this is not true, since most religions and ethical systems (e.g. Confucius) see respecting and caring for the elderly and handicapped as an ethical imperative, and sees the killing of the vulnerable as more evil than killing for other reasons, because there is no reason (e.g. no element of self defense) in such killing.

But the authors then justify the killing: To get organs.

Traditional medical ethics embraces the norm that doctors (and other healthcare professionals) must not kill their patients. This norm is often seen as absolute and universal. In contrast, we have argued that killing by itself is not morally wrong, although it is still morally wrong to cause total disability. Abandoning the norm prohibiting killing has important implications for a variety of moral issues, but here we will discuss only one example: practices of vital organ donation.

Well, it took awhile for physicians to make full brain death a criteria: but if the brain is dead, you stop the machines and the body dies.

But recently, a disturbing trend has been to take organs from those who are not brain dead, but whose heart has stopped:

A secondary and growing source of vital organs is from neurologically damaged (but not ‘brain dead’) patients determined to be dead following withdrawal of life-sustaining treatment. A short interval after the heart stops beating (typically 2–5 min), the patient’s death is declared and organs are procured.

The authors argue that since CPR could revive such people that they aren’t really dead and since we’re taking organs from non dead people, what’s the big deal if we go on and kill Betty for her organs?

Once we recognise that the prohibition of killing has no moral force independent of disability, we can focus on the ethically relevant question: When is it morally justifiable to procure vital organs? Fortunately, it is not ethically necessary for vital organ donors to be dead. It suffices for them to be totally disabled, with no prospect of recovery of any human abilities or experience.

Ah, but that doesn’t mean they will actually kill people, folks. Don’t worry: Trig Palin is safe:

Critics might object that abandoning the dead donor rule will take us down the slippery slope to procuring vital organs from the mentally retarded or other groups of vulnerable individuals with disabilities. Absolutely not. We can hold the line for vital organ donation by continuing to restrict it to those in a state of total (universal and irreversible) disability.

Except, of course, it is these very same “ethicists” who will decide the criteria for “total (universal and irreversible) disability.

A final objection: ‘Your radical departure from traditional morality and medical ethics suggests that you are radically wrong’. As philosophers committed to fallibilism, we recognise this possibility. However, having laid out our arguments for conceiving morality and medical ethics without a norm prohibiting killing, we submit that the burden of proof is on our critics to demonstrate where and how we have gone astray.

Yes, they are actually daring you to tell them why killing Betty is wrong.

But of course they are being ingenuous.

They know very well that there are many ethicists who are trying to change the rule that what gives a person his human rights is their “personhood”, not the fact that they are a human being.

Starting in the 1970’s, some “ethicists” such as Joseph Fletcher have been proposing  that we use the criteria for “personhood” to decide who has human rights, instead of just granting human rights to humans and their offspring.

Joseph Fletcher, Episcopalian theologian and bioethicist, argued for a list of fifteen “positive propositions” of personhood. These attributes are: minimum intelligence, self-awareness,    self-control, a sense of time  a sense of futurity, a sense of the past, the capability of relating to others, concern for others, communication, control of existence, curiosity,  change and changeability,  balance of rationality and feeling, idiosyncrasy neocortical functioning.[149]…

Source: Joseph Fletcher, Humanhood: Essays in Biomedical Ethics (New York: Prometheus Books, 1979 )….

This extensive list suggests that most individuals, at one time or another are not persons.[151] Fletcher’s comments that a severely retarded Down’s syndrome child was not a person

Well, maybe Trig isn’t a person at all by his criteria, which Fletcher elsewhere puts at an IQ of 20, perhaps 40, and includes children under age two as only possibly meeting the criteria. Nor is Fletcher the only prominent “ethicist” who would justify killing infants and the disabled.

The dirty little secret is that medical ethics, a discipline that was devised to analyze the thorny and complex issues at the end of life, has morphed into what Human rights activist Nat Hentoff calls “apologists for death”: because too often those on the leading edge of Medical ethics cannot explain why we should love and care for Betty (out of respect for filial piety, as in Confucian ethics, or because God loves the least of our brethren, as in the three monotheistic religions). But by god they can explain why we should be allowed to kill someone.

The moral collapse of what passes for medical ethics is now almost complete.

Since academia insists on “freedom of expression” we poor laypeople can’t do much about it.

But when one of the authors of the article cited is on the bioethics board of the NIH, it means that our taxpayer money is paying for such opinions, and that the government has not objected to publishing the article.

true, the article insists that

  • The opinions expressed here are those of the authors and do not reflect the position or policy of the National Institutes of Health, the Public Health Service or the Department of Health and Human Services.

But when I was a government employee and published a paper (on antibiotic interaction with seizure medicine) I had to get it approved of by my employer.

So the bad news is that apparently no one at the NIH ethics board thinks that these opinions reflect badly on them or the Federal government, and they allowed it to be published, not in an ethical journal such as the  “Hastings Journal” (which is behind a firewall requiring you pay to find out what is being written) but in the BMJ, which posted it on line for all to see.

And they are doing so on our taxpayer money.

No problem here, folks, just move along…

And that alone is a reason to be afraid, be very afraid, for these are the folks who will be justifying the ethics of our medical treatment in the near future.


Nancy Reyes is a retired physician living in the rural Philippines. She writes about medical issues at HeyDoc Xanga blog, and has published an article on medical ethics in the past.

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