AUTHOR: Richard Barager | POSTED: 09/5/11 9:22 PM
I have previously written in this space about the remarkable case of Jean-Dominique Bauby, the editor-in-chief of Elle magazine who in 1995 suffered what is known as “locked-in syndrome”—a stroke resulting in quadriplegia and speechlessness, but with preservation of consciousness and intellect. http://richardbarager.com/literary-prescriptions/a-corpse-with-living-eyes/
Bauby chose to deal with this incredibly cruel medical circumstance by writing a book—The Diving Bell and the Butterfly—that he “dictated” by blinking out a code with his left eyelid to a bedside scribe.
I recently came across an article about another patient with locked-in syndrome who chose to deal with her circumstance in quite a different, though no less admirable, way.
The case occurred in Belgium, which along with the Netherlands and Luxembourg are the only three countries in the world to date to legalize euthanasia. The United States has three states—Oregon, Washington, and Montana—that allow physician-assisted death (the prescription to a patient of Nembutal, modern-day Hemlock that the patient then self-administers), but not physician-conducted, active euthanasia. Here’s an excerpt from the journal reporting the case, Transplant International. http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2008.00701.x/full
“A 44-year-old woman was suffering from locked-in syndrome after brain stem vascular accident . She was fully conscious and communicated only with eyelid movement. She spontaneously breathed through a tracheostomy and was fed through a gastrostomy. After 4 years of this assisted life, she asked for physician-assisted suicide according to the Belgian law. She was examined by a psychiatrist and a neuropsychologist who excluded depression and confirmed preserved cognitive function, and by an independent palliative care physician who confirmed dismal medical prognosis and the patient’s willingness to die. Euthanasia was granted and scheduled for a month later, as required by the Belgian law.
The day before the euthanasia, the patient expressed her will of after-death organ donation. The ethical and legal possibility of combination of the two separate processes, physician-assisted suicide and after-death organ donation was then considered and agreed by the institutional ethical committee president.
The intravenous euthanasia procedure was performed according to the regular protocol, in the presence of the patient’s husband, in a room adjacent to the operative room. The patient was in her regular hospital bed. No member of the transplant team was present during the euthanasia. When the patient’s death was declared by three independent physicians after 10 min of absence of cardiac activity, her cadaver was placed on the operative table. The liver and both kidneys were harvested and transplanted according to the regular Eurotransplant organ allocation rules for after-death organ donation .
Currently, more than 1 year later, all three recipients are enjoying a normal graft function.
This case of two separate requests, first euthanasia and second, organ donation after death, demonstrates that organ harvesting after euthanasia may be considered and accepted from ethical, legal and practical viewpoints in countries where euthanasia is legally accepted. This possibility may increase the number of transplantable organs and may also provide some comfort to the donor and his (her) family, considering that the termination of the patient’s life may somehow help other human beings in need for organ transplantation.”
The issue is this: is the linkage of organ donation to euthanasia unethical because it gives society (in the form of patients on the waiting list for organs and transplant centers wanting to do transplants) a stake in the deaths of those with terminal conditions? Or, for patients who want euthanasia in countries that allow it, is voluntary organ donation following euthanasia a life-ending but life-affirming altruistic act that allows another human being to benefit from the Gift of Life? And, if you believe the latter, does it then follow that patients in Oregon, Washington, and Montana who avail themselves of “the Nembutal” should be permitted to voluntarily donate their organs as well?
As committee chairman, I will be posing these fascinating ethical questions at my local hospital’s next Bioethics Committee meeting, but there’s no reason to wait until then for the debate to begin.
What do you think?