[FoRK] Fatal flaw: modern definition of death is wrong, costs lives

Jeff Bone <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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