The paper in the oh-so-prestigious New England Journal of Medicine is “Voluntary Euthanasia — Implications for Organ Donation” by Ian M. Ball, Robert Sibbald, and Robert D. Truog, a couple of docs and somebody else. We shall see that this paper at least proves knowing the knee bone is connected to the thalamus, or whatever, does not train one especially well to make ethics decisions.

Now doctors don’t kill patients, except by accident or neglect. Executioners kill people by design, on purpose, and with no legal culpability. When a person who was formally a doctor on purpose or by design kills somebody (and is not in the military engaged in war and such like), he is no longer a doctor but an executioner. You can never again have the same trust you had in this individual that he has your best interest in mind when you suspect he might be smiling at you because he likes the shape of your liver.

Doctors, as I know by many, many years association with them, really do think well of themselves. Because they are, mostly, engaged in enhancing and saving lives, this excess ego can be forgiven them. Unless it causes them to start believing their own press.

We can look to doctors regarding the ethics and morality of organ donation in the same way we look to physicists about the capabilities of nuclear weapons. The physicist can tell us what will happen, and of the nature of the effects, but the physicist is in no way especially competent to say when and under what circumstance such weapons should be used. Physicists are not moralists. Neither physicians, though they do gain some practical experience in the area.

This means we cannot leave physicians to themselves to decide what is best and what worst and what is anathema about killing somebody to take their organs. For the least proof of this we see that few or no doctors yet (to my knowledge) have embraced the term executioner, even as they advocate the active killing of patients.

Secondly, they never say killing and always employ a euphemism. Euphemism, except for comedic effect, always indicate somebody is hiding something. The euphemism (in this paper and elsewhere) “voluntary euthanasia” is interesting. Why the “voluntary”? Why its emphasis? (These are rhetorical questions.)

If you’re in the market for used spleens, you can’t be thrilled when a spleen holder dies at home, far from a hospital and its facilities for spleen removal. Bodies left to linger for even small amounts of time are like fish left in the sun. First thing you can do, then, if your hunger for used spleens is to encourage people to come to (warm, quiet) hospitals to die. Dying, it seems, requires expertise (just like births). The authors of this paper do not say “Do not die at home”, but the bias for a hospital death is there.

The dead donor rule — a traditional ethical principle guiding organ procurement — states that vital organs may not be retrieved before the patient’s death and that the procurement of organs may not cause the patient’s death. This principle assures patients and the public that physicians will be bound to the interests of their patients before the interests of potential organ recipients.

The dead donor rule doesn’t do that for me, because of the suspicion a doctor turned executioner will hasten the patient’s death. Assisted suicide is the euphemism. Our authors aren’t keen on the rule, either, because of the possibility of spoilage (my emphasis) done by the killing method.

Although some patients may want to be sure that organ procurement won’t begin before they are declared dead, others may want not only a rapid, peaceful, and painless death, but also the option of donating as many organs as possible and in the best condition possible. Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases, it may be ethically preferable to procure the patient’s organs in the same way that organs are procured from brain-dead patients (with the use of general anesthesia to ensure the patient’s comfort).

Whose goals? Drug ’em up and start cuttin’. What can’t be used is easily disposed of.

Patients who want a rapid, painless, and peaceful death while optimizing the number of organs they can donate are best cared for in an operative setting, where they can be fully anesthetized and where optimal organ procurement is supported.

There’s the death-in-hospital preference, even for patients the doctors kill.

The authors also recognize the idea of “non-therapeutic practices” has to be jettisoned. Pumping chemicals into a body you’re about to go shopping in is not by definition therapeutic.

Well, once you’ve given up on the idea physicians should do no harm, abandoning the rest of traditional medical ethics is far less painful.

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