Beruflich Dokumente
Kultur Dokumente
.
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i. Introduction
theuse
MedicalAssociation
current
regarding
policyof theAmerican
deceasedis toactonlywhen1) thedeceasedis
oforgansfrom
therecently
and2) no member
totheuse ofhisorherorgans,
knowntohavenoobjections
thedeceased'sorthe
use
of
vetoes
oftheimmediate
family,
uponconsultation,
thedeceased'swishes
gans.Thispolicyhasbeencalledthe'doubleveto'i1either
members
orthewishesofthefamily
hisorherremains,
surviving
concerning
thedeceased.
oforgansfrom
tostoptheprocurement
thedeceased,is sufficient
the
Ifeither
vetoesthedecisiontousethedeceased'sorgansfortransplant,
party
will
not
take
of
as
a
matter
place.
policy,
procurement,
I willnot,
I willarguethatthispolicyoughttobeabandoned.
Inwhatfollows,
I
all else.Rather,
shouldtrump
ofthepatient
however,
arguethattheautonomy
on thepartof
consent
reasontotake,without
willarguethatthereis sufficient
is entirely
As I hopetoshow,thisposition
thedeceased,thedeceased'sorgans.
to
we
have
a
facie
view
that
with
the
obligation respectthe
prima
compatible
wishesofthedeceased.
2. Patient Autonomy and the Double Veto
defenseof (at leastpart)of thecurrent
The primary
policy(knownas the
to
relieson theviewthatwe havea moralobligation
Protocol"2)
"Pittsburgh
This
view
can
die.3
these
of
even
after
the
patients
respect autonomy patients,
Whatthe
thanothers.4
in severalways,somemorecontroversial
be defended
in
determinas
one
the
of
is
thus
would
want
deciding-features
regarded
patient
or notsaidpatient's
policyin
organsmightbe used.The current
ingwhether
wouldnot
thata patient
is to presume
medicalpractice
andBritish
American
theorgansof a
consentto organdonation.5
Thus,giventhispolicy,removing
289
290
291
itwouldfollowthatanyautopsywouldgo againsttheinterests
ofthedead.10This
would be so even if said autopsywere necessaryin bringingaboutjustice for
evidencethatwouldlead to thecaptureof
thedeceased,perhapsby uncovering
that
it would seem
thedeceased's murderer.
Presuming thedead have interests,
of
thenthatsome loss of bodilyintegrity
(an autopsy)wouldbe in theinterest
of thedeceased,as, ex hypothesi,
all
thedeceased,butalso againsttheinterests
constitutes
a violationoftheinterests
ofthedeceased.
ofbodilyintegrity
disruption
reasontorejectthe(ratherbanal) view
Because thisis absurd,we havesufficient
is itselfof intrinsic
value.11
thatbodilyintegrity
if
is
valuable(ifBI1 is true),itwould
Moreover, bodilyintegrity intrinsically
a harmand/ora thwarting
of
followthatdecompositionitselfwould constitute
theinterests
of thedeceased.12Decomposition,as we now know,is inevitable.13
of what(on thebaIt thusfollowsthatthereis no way to avoid thedestruction
nal view) is positedas havingan intrinsicvalue. The refusalto donateorgans
of thebodyhereseems simply
on thebasis of wantingto preservetheintegrity
ofthebody.Dust willindeedreturn
misguided:one cannotpreservetheintegrity
of a corpsewhenthat
to dust.It seemspointlessto insiston thebodilyintegrity
thesamecorpseonce
the
of
but
to
be
of
some
use,
ignore
integrity
corpsemight
itis in theground.
This consequenceof thebanal view,I think,revealsthatfewpersonsactuthen
ally endorsethisview.If one's aim is to preventloss of bodilyintegrity,
we are notdoingnearlyenoughto preservethecorpse.Even afterembalming,
a corpsewill normallybeginto decomposewithina week.14If we reallycared
of thecorpse,therewouldbe as muchresistance
theintegrity
aboutpreserving
for
as thereis to organdonation.Because themovement
to gravedecomposition
individuals
to
eccentric
is
limited
infinite
(likephilosophy's
veryfew,
preservation
belovedJeremy
Bentham),we havegood reasonto thinkthatthemorecommon
organdonationis a subtlerview thantheone we have
objectionsto mandatory
been considering.
2.1.2 The ClosureView
BI1, we haveseen,is nota particularly
plausibleview.A muchmoreplausible
in
the
idea thatthereare conditionsunder
is captured
view of bodilyintegrity
- butthat
- evendesirable
is permissible
whichtheviolationofbodilyintegrity
inwhichsuchviolationis imperthesearefaroutnumbered
bythecircumstances
forinstance,theviolationof bodily
missible.In thecase of organconscription,
is neitherdesirablenorpermissible.
integrity
advocatedbyphilosoThis formulation
capturesmostoftheviewscurrently
I
thisview
want
to
distinguish
phersand thelaityalike.15For clarity,though,
intofinerstrands.Thereare twotypesofreasonstypicallyofferedagainstorgan
donation:survivor-regarding
reasons,thatplace the benefitof the deceased's
lovedones,or evensocietyas a whole,at thecenterofourdecisionmaking,and
reasons,thatregardthewell-beingof thedead personas of
deceased-regarding
292
survivors
Relatedto (1), and as F. M. Kammhas pointedout,17
mayhavea
to
for
the
of
one's
desire
a
loved
"use-history"
bodyparts end with
strong
thehistoryof thatloved one. Much as we wouldnotwanta spouse's ring
to be re-usedafterthedeathof a spouse,we mightfeela strongdesireto
putall of a lovedone to rest.
3)
Finally,a generalpolicyoforganremovalmighthaveseriousconsequences
forthewaywe regardourselvesas agents.As Kammputsit,"oursenseofourforgoodorill" (221).
selvesas different
embodiedpeoplemaydiminish,
it seems to me, failsto adequatelyjustifyBI2. ArguEach of thesearguments,
in thiscontext,as theybothinvolve
ments(1) and (2) can be dealtwithtogether
theimmediatewell-beingof thoseclose to a lovedone.
First,itis notatall obviousthata viewingofthedeadprovidesthetherapeutic
effect
thatitis oftenclaimedtohave.Itis perhapsrevealingtonoticethattheviewbuta universalculturalpractice.This suggests,at
ingofthedeceasedis anything
a minimum,
thattherearemanywaysto achievehealthyclosureaftertheloss of
a lovedone,as itis unreasonableto suggestthatonlyculturesthathaveviewing
are adequatelydealingwiththefactof death.18
So, evenifitis truethatviewing
an intactcorpsecan aid in themourning
to achieve
process,allowingsurvivors
the
closure,it is nottheonlyway to findsuchclosure norevendemonstrably
best.Indeed,itmightevenbe thecase thatourattitudes
aboutviewingthebody
are in factan instanceof our inabilityto deal withthefactof death.Consider
Kamm'sremarkson thispoint:
4)
thatthelastcontactofthelivingwiththedeadshouldbe
[I]tseemsimportant
withwhatseemstobe anintact
elsemaytakeawaya continuing
body;anything
illusion
oflife.Peoplemayprefer
thattheundeniable
ofdeathandradievidence
cal changethata dismembered
surface
ordecaying
cometoexist
bodypresents
(222)
beyondsight.
293
294
Butthis
thebody,andso forth.
thewaywe thinkabouthumanbeings,personhood,
die
from
failure
is incredibly
When
several
day
organ
every
speculative.
people
thespeculativepossibilitythattheway we thinkabout
due to lack of transplant,
humanagencymightalterseemslikea distantworry.Indeed,ourcurrent
policy
morethanhelpingtreat
suggeststhatwe value ownershipof organspostmortem
thosepersonswho desperately
wanta normallifespan.I welcomesomechange
in theway we thinkof organs.
2.1.3 TheAutonomy
View
ofbodilyintegrity
The otherclass ofarguments
in supportofthepreservation
I called "deceased-regarding"
above. In essence,thesearguments
areconcerned
to respectthe wishes of the deceased. At thispoint,however,I wantto limit
myconcernsto whetheror notthecurrentpolicyof double vetoactuallydoes
exploring
respecttheautonomyof thedeceased. I do thisas a meansof further
In defending
an organ
ourcurrent
(and criticizing)
policyfororganprocurement.
1
will
I
will
do
in
3
return
to the
which
sections
through5,
conscription
policy,
of thequestion.
providinga moresustainedtreatment
questionof autonomy,
As mentionedabove, the double veto requiresthedeceased as well as the
deceased's immediatefamilygive consentto the removalof organsfromthe
deceased. On theface of it,thispolicyseems to conflictwiththeautonomyof
thepatient:ifmywishesto be an organdonorcan be overridden
by thewishes
of myfamilyto preservemybodilyintegrity,
it seemsthat,primafacie,myautonomouswishescan be trumpedby thewishesof myfamily.Thus,it appears
thatthedouble vetopolicyis notin factcompatiblewitha truerespectforthe
autonomyof thepatient.
But thisincompatibility,
it mightbe argued,is onlya primafacieone. T. M.
Wilkinsonprovidesthefollowinganalogy:20
If myparentsrefuseto allow me to
be married,theyhave indeedviolatedmyautonomy.If,however,thewomanI
intendtomarry
refusestomarry
me unlessmyparentsapprove,myautonomy
has
notbeen violated.Likewise,if a doctorwill onlyremoveorgansfroma patient
on theconditionthatboththepatientand thepatient'sfamilygiveconsent,the
doctorhas notviolatedanyone'sautonomy.
to theclaimthatthedoubleveto
This,I think,is a powerfulcounterexample
doesnotrespecttheautonomy
ofthedeceased.Butitis important
nottoexaggerate
theforceofthisargument.
Itdoes notshowthatautonomy
is neverviolatedinthe
doubleveto.It merelyshowsthatitis logicallypossibletorefrain
fromactingon
someone'srationalwisheswithouttherebyfailingto respectthosewishes.
thatthisdoes notaddresstheissueofwhether
thedoubleveto
Notice,however,
itself
is
based
on
for
if
Wilkinson's
policy
respect autonomy.Indeed,
marriage
analogyis a good one,thedoublevetowouldseemto be based moreon respect
fora surgeon'sdesirenotto cause offense.Whilethisis notobjectionableperse,
itdoes pointto a limitation
in theviewthatthedoublevetois designedtoprotect
theautonomyof a patient.Whileitmightnotnecessarilyviolatesaid autonomy,
295
296
297
3.1 A Thought
Experiment
Considerthefollowingcase.
Imaginethatyou own vast amountsof farmingland in remoteportionsof
thatitpleases you to thinkof thisland as beingunAfrica.Imagine,moreover,
inhabitedby humanbeings.Finally,imaginethatitis totallyimpossibleforyou
new aboutthisland,and
everagainto use thisland,see thisland,hearanything
so on. In fact,youhaveneverseenthisland- thoughyoucouldhave,atan earlier
time,ifyouhad been willingto engagein some ratherdangerousor uncomfortthefactthatyouownthislandgivesyoucertainprima
able procedures.
Certainly,
to determine
the
facierights.But thequestionis this:are theserightssufficient
basis for
use of theland in question?Is yourownershipof theland a sufficient
itis
limits
to
what
or
there
are
to
the
will
what
land,
happen
ultimately
deciding
withinyourrights(morally)to do?
Suppose a tribebeginsto use yourland forforagingand thelike.Whileyou
wouldpreferforthetribenotto be there(so you could imagineyourland with
itis byno meansclearthatthemerepresenceofthispreferease as uninhabited),
fortheremovalof thetribe.To complicatethings,
ence is sufficient
justification
clean waterin thatarea is to be foundon your
source
of
the
that
only
imagine
land- land,thereaderwill recall,whichyou will neverbe able to visit,to use,
or to hearanynewsabout.Supposethat,ifthetribeis forcedoffyourland,their
298
299
and ExpansionoftheThought
3.2 Implication
Experiment
300
301
to scattered
burialwouldbe feared),butsuchfearwouldlikelybe insufficient
to
an
moral
identity.
actuallydestroy agent's
Second,therearecases whereevenourmostcherichedbeliefsareover-ridden
bypolicy(as in epidemics,wherepublichealthconcernstrumptherightto reliSo itisn'tclearthatthemerepresenceofthesestrongbeliefsis
giouspractice).32
forexemption,
whenlifeis at risk.More argument
would
sufficient
particularly
thatis notimmediately
be requiredto establishthis- argument
apparent.
Even if we acknowledgetheimportanceof strongreligiousbelief,though,
thisneed notentailthatthepersonwithsaid beliefswill be exemptfromconto a solutionof theorganshortage.It simplyis notclearthata person
tributing
maintainthattheymusthaveall oftheirownorgansafterdeath.
can consistently
Considerthefactthatmanysuchpersonswouldwillinglytakeinfusionsofblood
or accepttransplanted
organs.If thisis so, thenthereshouldbe no inprinciple
removal
of at leastsomeorgans.
to
the
objection
thathe be buriedwithall organs,
If one insisted,on pain of irrationality,
will
to thecause. Irnotcontribute
thisneed notentailthatourimaginedagent
as usual, comes at a price.Allowingcertainexceptionsmightwell
rationality,
to theorgancause in otherways. Someone who
be conditionalon contributing
insistedon beingburiedwithall ofherorgansmightbe grantedsucha right,for
instance,onlyon conditionthatshe contribute
organswhilelivingthatwould
for
bone marrow,as well as liver
There
is
need
lifetime.
her
rejuvenateduring
to
portions,thatcould be metin thisway,thusallowinga personto contribute
at death.While I am
theorganshortagewhilealso protecting
bodilyintegrity
ofthissortofpolicy,itdoes demonstrate
unsureaboutthefeasibility
(alongwith
theotherreasonsgiven)thatevenrespectfortheautonomyof an agentneednot
organdonation.
produceexceptionsto a generalpolicyof mandatory
4. Two More Objections
Thereare (at least) twoadditionalobjectionsto myviewthatare worthconsidering.These objectionsare as follows:
theuse of mandatory
forjustifying
organ
1) theview advocatedis sufficient
donationsfromlivingpersonsas well as fromthedeceased,thustheview
is unacceptable.
whatwe
This view ignoresourcustomary
abilityto do withourproperty
after
to
be
able
to
is
wantafterdeath.It customary
bequeathproperty death
The bodyis simply
and
of
a will,thegiving inheritance, so forth.
through
is
view
this
To
one morepiece of property. reject
equivalentto rejecting
is
view
thus
wills.
The
therightsof personsto have
unacceptable.
in turn.
I will deal witheach of thesearguments
2)
302
someoftheimportant
differences
betweenusing
Now,I thinkthiscase highlights
theorgansof theliving,on theone hand,and usingtheorgansof thedead, on
theother.Most intuitions,
in thiscase, go againsttheviolinist(and noticethat
theviolinistis a personin needof a donatedorgan).Despitethepredicament
of
theviolinist(organ-recipient-to-be),
an agenthas no directdutyto give up her
303
- something
organs.To do so, we all recognize,wouldbe an actofmoralheroism
butcertainly
nothingrequiredof theaveragemoralagent.
saintly,
But our intuitionsshift,I think,whenwe imaginetheviolinistattachedto
dead. The burdencreatedbytheviolinistforthedonor
someonewho is recently
is simplynotthesame in thetwocases. Thus,evenif thedead are obligatedto
donatetheirorgans,it simplydoes notfollowthatthelivingare. Now, importhelivingmightbe so obligated,butI do notthinkthispositionfollows
tantly,
on these
thusfarconsidered,nordo I thinkthatourintuitions
fromthearguments
whether
ornotthe
cases areidentical.My taskhere,however,is notto determine
livingmustgiveup theirorgansto thosein need. It is merelyto ask whetheror
or
notthispositionis entailedbythepositiondefendedhere,and hencewhether
notit mightbe seen as an untenableconsequenceof myview.ThoughI am not
surethepositionis, in fact,untenable,thereis good reasonto thinkthatitis not
a directconsequenceof theview defendedhere.
- one thatis substanThereis an additionalcase thatmustherebe considered
the
from
thanthecase of takingorgans
alreadyliving.The case in
tiallytrickier
questioninvolvesthecomatose:is it acceptableto removeorgansfrompersons
who arecomatosein orderto save others?If so, one mightcontend,theposition
thanitinitiallyseemed.Takingorgansfrom
advocatedhereis evenless intuitive
thecomatoseis veryclose to outright
killingthem.
the
note
that
First,let me
questionof whetheror nottakingorgansfromthe
theterm"comatose."Obvicomatoseis permissible
hingeson howwe understand
ously,someonewho is comatose,butwho has a reasonablychanceof emerging
fromthisstate,shouldnotbe subjectedto mandatory
organdonation.This is so,
I think,
forthesamereasonthatthenon-comatose
livingshouldnotbe subjected
to thispolicy.Whateverthepreferred
explanationforthewrongnessof killing,
to
seems
thisexplanation
applyequallywell to livingpersonsand to thosewho
comatose.
arerecentlyand retrievably
Whenthecase shiftstocovertheirretrievably
comatose,myabovearguments
toremoveorgansafterlifesupport
seemto supporttheviewthatitis permissible
has beenremoved
(whendeathoccurs).Ofcourse,thisdoes nottouchthequestion
not
whether
or
of
My owntemptaneedingorgansis a reasontoendlife-support.
a
euthanize
tionis to arguethatit is permissibleto
livingbodyforitsorgans,if
in a comatosestate.This hunch,
we knowinfact thatthepersonis irretrievably
Whatwill decidethisissue,itseemsto me,
ofcourse,cannotpass forargument.
availablein theeuthanasiadebate.If one accepts,as
will be thebestarguments
I do, thatsomeonewho will notrecoverfroma vegetativeor comatosestatecan
be allowedto die (say,in orderto save resources,to respecttheperson,or anyof
to denythatsavingotherlives is nota
severalotherreasons),it seems difficult
reasonforeuthanizing.
Thus,theorgandraftwouldapplytothosewho
legitimate
be euthanized.Again,though,whatis crucialin thiscase seemsto
canjustifiably
Ifeuthanasiaisjustifiedinthesecases, so too
be thateuthanasiaitselfis justified.
304
I do notpretendthatthis
will organprocurement
(giventheabove arguments).
settlestheissueofacquiringorgansfromthecomatose,butitdoes (I hope) point
outwhatwillsettlethisquestion:namely,thequestionofthemoralpermissibility
of euthanasia(activeor passive) in thecase of theirretrievably
comatose.
42 TheBodyas Property
The secondobjectionpositstherightto property
as a rightwhichcoversour
will.
of thisright,theobjection
to
do
with
our
bodies
what
we
Because
ability
we
bodies
muchas we handleother
should
be
to
handle
our
runs,
permitted
pieces of property.
I havetworesponsestothisobjection.First,evenifwe acceptthatthebodyis
a piece ofproperty,
whatever
itdoesn'tfollowthatwe can do withthisproperty
we want.Indeed,even ifparts of thebody are property,
thisdoes notfollow.
Much of theargument
forthisclaim has been givenin theprecedingpages. To
reiterate:
we cannotleave ourproperty
in places wheresaid property
endangers
thelivesof others,forexample.Likewise,ifmyabove arguments
work,thereis
in thinking
thatmyrightto do specific
somethingquitemorallyreprehensible
with
another's
more
basic
things
myproperty
trumps
rightto life.
But thereis an even strangerresponseto be made here.As Cecile Fabre
has recentlyargued,iforgansare felicitously
consideredas amongthe scarce
resourcesof the world,principlesof distributive
justice would demandtheir
availabilityto thosein need.34WhileI am skepticalthatbodies,or partsof boditturnsoutthatthisneednotbe demonstrated
ies, can be construedas property,
in orderto showthatproperty
arenotadequateto rejectan organ
considerations
A
has
conscription
policy. powerfulargument been advanced(by Cecile Fabre)
to theeffectthat,/bodypartsare construedas thingsthatcan be property
(as
at the
resources),thenjusticewill commitus to a policyof organre-distribution
timeof death.Thus,evenifmyuncommonintuition
aboutbodies and property
is misguided,an argument
fromproperty
rightscannotstand:evenifbodies and
we havegood reasonto advocatea policyofmandatory
bodypartsare property,
donation.
organ
This leaves open thequestionof whetheror nottheinterests
of thedead in
regardto the dispersalof theirgoods oughtto be respected.It mightwell be
thecase thattherightto inheritone's family'swealthcan be overridden
by the
needsothershave forbasic medicaltreatment,
food
and
adequate
clothing,and
so on. This is an important
it
but
is
fromthe
different
question,
importantly
of
or
not
whether
we
have
the
to
determine
with
what
to
do
(each
question
right
partof) our bodies once we are deceased. Thus, the second objectionagainst
myview fails.
305
5. Conclusion
In thispaper,I havearguedthattheconsentofthedeceasedshouldnotbe
in orderto use theorgansof thedeceasedin life-saving
operations.
required
toconsider
theinterests
ofthedead,I
WhileI agreethatwe havean obligation
ofthedeadshouldcontrol
thelivesofthe
do notaccepttheviewthattherights
will
is
in
matters
that
determine
who
who
amongtheliving
living particularly
andthedead.35
Hartwick
College
NOTES
1. See T. M. Wilkinson,"IndividualandFamilyConsentto OrganandTissueDonation:Is theCurrentPositionCoherent?"JournalofMedical Ethics,vol. 31 (2005), pp.
587-590.
ofOrgansFollowing
CardiacDeath:
2. H-370.975EthicalIssuesintheProcurement
havebeenadopted:ThePittsProtocol:Thefollowing
ThePittsburgh
guidelines
who
fortransplantation
from
inwhichorgansareremoved
patients
burgh
protocol,
be
treatment
havehadlife-sustaining
withdrawn,
may ethicallyacceptableand
the
shouldbe pursuedas a pilotproject.The pilotprojectshould(1) determine
thenumber
andusability
to thepublic,and(2) identify
protocol'sacceptability
thisapproach.The protocolcurrently
of organsthatmaybe procuredthrough
consent.
ofinterest
andensuring
conflicts
forlimiting
has provisions
voluntary
in caringforpotential
ofinterest
It is criticalthatthehealthcareteam'sconflict
as theprotocol
donorsattheendoflifebe minimized,
currently
provides,
through
ofproviders
theseparation
caringforthepatientat theendof life
maintaining
In addition
totheprovisions
fororgantransplantation.
andproviders
responsible
arerecadditional
intheprotocol,
thefollowing
contained
safeguards
currently
ofinterest,
theprotocolshould
ommended:
(a) To protect
againstundueconflicts
tothepossibility
ofthehealthcareteamtobe sensitive
warnmembers
explicitly
treatment
decisions
thatorgandonationdecisionsmayinfluence
life-sustaining
ifthereis somereasonto
whenthedecisionsaremadeby surrogates.
Further,
shouldbe required,
thenthehealthcareteammembers
suspectundueinfluence,
of
toobtaina fullethicsconsultation,
notmerelyencouraged,
(b) Therecipients
ofthesource
underthePittsburgh
protocolshouldbe informed
organsprocured
defectsinthequalityoftheorgans,so that
oftheorgansas wellas anypotential
whether
to accepttheorgansor waitfor
theymaydecidewiththeirphysicians
shouldbe developedtoensurethat
moresuitableones,(c) Clearclinicalcriteria
whoseorgansare reasonably
candidates,
likelyto be suitable
onlyappropriate
areconsidered
fortransplantation,
eligibletodonateorgansunderthePittsburgh
CSA Rep.4, 1-02).http://www.amaprotocol.(CEJARep.4 - 1-94;Reaffirmed:
assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-370.975.
2, 2007.
HTM, lastaccessedon January
This has been amendedas follows:
306
PUBLIC AFFAIRSQUARTERLY
E-2.157OrganDonationAfter
CardiacDeath:Giventheincreasing
needfordonor
organs,protocolsfordonationaftercardiacdeath(DCD) havebeendeveloped.
Controlled
whohaveagreedtobe takenoffoflifesupport
DCD allowspatients
ortheirsurrogate
decisionmakerstheopportunity
todonatethepatients'organs
in or
once deathhas beendeclared.In thesecases,lifesupport
is discontinued
neartheoperating
roomso thatorganscan be removedpromptly
afterdeathis
DCD also maybe considered
frompatients
whosuffer
pronounced.
unexpected
cardiacdeath(uncontrolled
thattheybecannulated
andperfused
DCD). Itrequires
withcold preservation
fluid(in situpreservation)
withinminutes
afterdeathto
maintain
theviability
oforgans.Bothofthesemethods
be
may ethically
permistocertainsafeguards.
sible,withattention
detailsoftheDCD process,such
(1) Hospitalpoliciesshouldspecifyimportant
as therequired
timedelaybeforedeathcan be pronounced
aftercardiacarrest.
itis criticalto avoidperceivedoractualconflicts
ofinterest
(2) In all instances,
in thehealthcareteamwithrespectto caringforthepatientversusfacilitating
careat theendof life
organdonation.The healthcareprofessionals
providing
shouldbe distinct
fromthoseparticipating
on thetransplant
team.No member
ofthetransplant
lifesupport
teammayhaveanyroleinthedecisiontowithdraw
orintheprocessleadingtopronouncement
ofdeath.
canshouldbe inplacetoensurethatonlyappropriate
(3) Clearclinicalcriteria
are
didates,whoseorgansarereasonably
likelytobe suitablefortransplantation,
considered
eligibletodonateorgansundertheseprotocols.
afterremovaloflifesupshouldcontinue
(4) PalliativecareforDCD candidates
portuntildeathis declared.
lifesupport
shouldbe madeby
DCD, thedecisiontowithdraw
(5) In controlled
thepatient
orthepatient's
decisionmakerbeforeanymention
oforgan
surrogate
donation(unlessthepatientor surrogate
broachesthesubject).
spontaneously
Thisis meantto ensurethatwithdrawal
oflifesupport
is notinfluenced
bythe
oforgandonation.
prospect
Theinformed
consentforcontrolled
DCD shouldincludespecificdiscussionof
interventions
aimedatorganpreservation,
theopportunity
toimprove
pre-mortem
forsuccessful
thantobenefit
rather
thepatient.
Interventions
that
transplantation,
arelikelytohastendeathmustnotbe used.
DCD, priorconsentof thedecedentor consentof
(6) In cases of uncontrolled
thedecedent'ssurrogate
decisionmakeris ethically
Perfusion
without
required.
consentto organdonationviolatesrequirements
ofinformed
consentformedical procedures
andis notpermissible.
(I, III, V) IssuedJune1996basedon the
"EthicalIssuesin theProcurement
ofOrgansFollowingCardiacDeath:
reports
The Pittsburgh
Protocol"and"EthicalIssuesin OrganProcurement
Following
CardiacDeath:In SituPreservation
of CadavericOrgans,"adoptedDecember
1994.UpdatedNovember2005 based on thereport"OrganProcurement
FollowingCardiacDeath,Amendment"
adoptedJune2005. http://www.ama-assn.
org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-2.157.HTM,
lastaccessedJanuary
2, 2007.
3. Thereare important
whendeathshouldbe said to occur.As
questionsurrounding
thecontroversy
is notimmediately
relevantto mycurrent
I will
sortingthrough
inquiry,
nothereaddresstheissue. For an arrayof positions,see The DefinitionofDeath: Con-
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