[MarMema]

Sorry to hear you are having a busy day. I am writing emails to my church, the Orthodox church, to ask them to speak out about this killing.

One thing that has greatly intrigued me is the very last line in this journal article, about the parallel implicit and explicit support. Can you tell me how to go about obtaining the complete article?

[hocndoc]

Whenever you want to find a medical article, you can search "Medline" (sort of the Google for summaries of all medical information).
This article is from the September issue of Critical Care Medicine (ironic, isn't it?)
You can copy the article at a local medical library (a medical school) or order the article access for $25 at
http://www.ccmjournal.com/article.asp?ISSN=0090-3493&VOL=31&ISS=9&PAGE=2391
I"ll try to post the text in a few following excerpts.

[hocndoc]

The practice of organ transplantation has been wedded to the concept of brain death for most of its history. The bond between them has been the "dead-donor rule," which requires that patients be declared dead before the removal of any life-sustaining organs (such as the heart, the entire liver, or both kidneys) ( 1). Yet the declaration of death, necessary for application of the dead-donor rule, has recently been described as an issue that is "at once well settled and persistently unresolved" ( 2).

The "well settled" aspect is reflected in the enormously successful and largely uncontroversial organ transplantation programs that recover organs from brain-dead patients and save the lives of those dying from organ failure on a daily basis. The "persistently unresolved" features pertain to nagging concerns that the concept of brain death is incoherent in that it fails to correspond to any biological or philosophical understanding of death.

Were no alternatives available, we believe a rational utilitarian argument could be made for ignoring these persistently unresolved issues in the interests of preserving the transplantation enterprise. We believe, however, that the ethical foundations of organ recovery need not rest on the problematic determination of death. We instead propose that the ethics of organ donation be based on the ethical principles of nonmaleficence and respect for persons rather than on brain death and the dead-donor rule. These provide a straightforward, ethically transparent, and potentially practical method for guiding the practices surrounding organ donation.

The dead-donor rule depends on a coherent definition of death, yet that definition has proved elusive. Before the development of mechanical ventilation and modern intensive care, the definition of death was relatively straightforward-patients were dead when they ceased to have evidence of circulation, respiration, and neurologic functioning ( 3). Typically, all three of these functions are lost over a very short period of time, with the loss of any one of them quickly leading to the loss of the other two. With the development of mechanical ventilation and cardiac support devices, however, it became possible to have the continuation of respiration and circulation in the absence of any detectable neurologic functioning. Although patients in this state are comatose (unreceptive and unresponsive), they retain most of the characteristics of living beings (Table 1); there is even a spirited debate among anesthesiologists about whether they should receive anesthesia for organ procurement procedures ( 4-7). Development of the ability to sustain patients in this state has had two important consequences-it has created the possibility of procuring transplantable organs from patients while the organs are still being perfused by a beating heart, and it has made the question "when is a person dead?" much more complicated.

[hocndoc]

It's been a long day, so I'm not going to try to comment more on the position of the authors, other than to state, again, that they are trying to fuse utilitarianism, autonomy and beneficience with non-maleficence.
Utilitarianism always comes down to who has the greater power to define "the greatest good for the greatest number," just as beneficience devolves into who is defining "for the greatest good." Autonomy can not overcome inalienable right to life, and maleficence - or "First, do no harm" -- must be the over-riding ethic, lest we go down the path toward utilitarianism.

These are the very "hard cases" that ethics struggle with, and the perfect rationale for non-maleficence as the "trump" for protecting the right to life - on which the other rights depend.