35 J. Med. Ethics: Death and Organ Donation: Back to the Future.

AuthorMiller, F.G.
PositionReprint

The practice of transplantation of vital organs from "brain-dead" donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnoses as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the late 1960s.

Four options seem most salient. First, we can follow the lead of Hans Jonas by adopting a stance of deontological rectitude that abandons vital organ procurement from brain-dead, but still-living patients. This position is logically tidy and unassailable if its major premises are endorsed: (1) doctors must not kill patients; (2) brain-dead patients are alive; (3) procuring vital organs from brain-dead patients would cause their own death; therefore, (4) this practice is wrong and must cease.

A second position attempts to justify vital organ donation while maintaining (at least nominally) the dead donor rule by appealing to a distinction between the death of the human being and the death of a biological organism. According to this position, Jonas is right that the brain-dead patient is biologically alive; however, what matters ethically with respect to vital organ procurement is whether the human being has ceased to exist. Once human life has ceased, stopping life-sustaining treatment is appropriate (or imperative), and there can be no ethical objection to extracting vital organs beforehand.

A third position justifies vital organ donation while retaining the traditional cardiopulmonary criteria for determining death by biting the bullet of abandoning the dead donor rule. This position sees vital organ procurement...

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