Fatal flaw: modern definition of death is wrong, costs lives
<jbone at place.org> on
Wed Mar 19 11:48:48 PDT 2008
WHEN IS A person dead -- or dead enough?
The question has long influenced decisions about when it's appropriate
to end medical treatment for people who are hopelessly ill. However, a
quieter debate has simmered for years about how the concept of death
informs the practice of organ transplantation. Transplant surgeons
rely on strict definitions of death to reassure would-be donors. Wary
of the macabre suggestion that they are willing to exploit the dying
for their organs, surgeons abide by a code known as the "dead donor
rule," which forbids removing body parts from the living.
Yet a few outspoken medical ethicists say the dead donor rule is
broken all the time -- and, perhaps even more surprising, that the
rule itself should be abandoned. The dead donor rule, they argue,
prevents some terminally ill patients from donating organs, even if
they want to. And, they say, it has become clear that doctors will
never be able to devise a coherent definition of death. Even the
concept of "brain death," the diagnosis of most deceased organ donors,
falls apart on closer examination. Why not, they ask, simply admit
that some people donate vital organs when they are, in some important
way, still alive?
"It's completely ethical to remove organs from patients we diagnose as
brain dead," says Dr. Robert Truog, director of clinical ethics at
Harvard Medical School and a physician at Children's Hospital Boston.
"It's just ethical for reasons other than that we think they're dead,
because I don't think they are."
Truog is one of a handful of vocal critics who believe the medical
community is misleading the public -- and deluding itself -- with an
arbitrary definition of death. The debate, which is being fought
largely in academic journals, has important implications for the
modern enterprise of transplantation, which prolonged the life of more
than 28,000 Americans last year. Truog and other critics believe that
changing the rules -- and the bright-line concept of death that
underlies them -- could mean saving more of the 6,500 Americans who
die every year waiting for an organ.
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