As a result of the practice of organ transplantation, do we ultimately require a re-thinking of the meaning of death?

Résumé du document

Ever since its inception in the 1950s, organ transplantation has been accompanied by questions about the ethics of taking organs from the dead and living and giving them to others. Discussions abound among physicians, ethicists, policy makers, and the public. At first living and willing relatives were used as organ sources for transplantation, due to antigenic incompatibility between unrelated persons. But with the development of powerful immunosuppressive drugs came an increase in cadaveric grafts. The supply shortage of transplantable organs stimulated society to search for new ways of procuring them. At the end of the 1960s, when surgeons first contemplated the systematic use of irreversibly unconscious patients as a source of human organs, a new legal definition of death was urgently needed to protect physicians from being charged with murder. It was essential that the new death be a diagnosable event and that it be timed to allow the removal of organs before onset of ischaemia.

Extraits

[...] Letter. Youngner SJ, Arnold RM. "Ethical, psychosocial, and public policy implications of procuring organs from non-heart beating cadaver donors". JAMA. 1993; 269:2769-2774. Pellegrino ED, Thomasma DC. The Virtues in Medical Practice. New York, NY: Oxford University Press; 1993:124. Jonsen AR. What does life support support? In: Winsdale ed. [...]

[...] An earlier act of retrieval to obtain viable transplantable organs would kill the patient and is illegal. As the law stands, there is no way out of this dilemma and it is not possible to use the organs of patients in PVS for transplantation. However, although the means by which death is attained has legal implications, there is no clear moral distinction between allowing to die by omission of treatment and more actively ending life. The outcome is the same.[38] Serious changes to the law would have to be made such as changing the legal definition of death to include irreversible loss of higher brain function; or to not declare such individuals legally dead, but rather to exempt them from the normal legal prohibitions against "killing". [...]

[...] Grigg MM, Kelly MA, Celesia GG, et al. "Electroencephalographic activity after brain death". Arch Neurol. 1987; 44:948-954. Ibid Troug RD, Fackler JC. "Rethinking brain death". Crit Care Med. 1992; 20(12):1705-1713 Hall GM, Mashiter Lumley et al. Hypothalamic-pituitary function in the "brain dead" patient. Lancet. 1980; 2:1259. [...]

[...] Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996; 313: 13-16.- The House of Lords in Airedale NHS Trust v. Bland [1993] 1 All ER 821, [1993] 2 WLR 316 ultimately had to decide whether that young man should live or die. Anthony Bland had been in a PVS for four years when his family and doctors applied to the Court for a declaration that to withdraw nutrition and hydration would be lawful. Their lordships were in complete agreement that a doctor is under no duty to provide or continue treatment which is not in the patient's best interests and that Tony Bland's condition was irreversible, rendering the continuation of treatment “futile”. [...]

[...] Joanne Lynn, "Are the Patients Who Become Organ Donors Under the Pittsburgh Protocol for 'Non-Heart-Beating Donors' Really Dead?" Kennedy Institute of Ethics Journal 3 (1993): 167-78. David Price, DPT, “organ transplantation initiatives: the twilight zone” (1997) 23 JME 170 John A. Robertson, "Relaxing the Death Standard for Organ Donation in Paediatric Situations," Technology: Ethical, Legal, and Public Policy Issues, ed. D. Mathieu ( Boulder, Col.: Westview Press, 1988), pp. 69-76; Arnold and Youngner, "The Dead Donor Rule." Linda L. Emanuel, "Re-examining Death: The Asymptotic Model and a Bounded Zone Definition," Hastings Center Report 25, no (1995): 27-35. [...]