Thread by me.
CALGARY, Alberta, September 15, 2010 (LifeSiteNews.com) - A group of doctors have called on the medical community to cease harvesting organs from patients whose hearts have stopped pulsating, saying that doctors are misleading families to believe that the patient has died when in fact their loved one is still alive.
The story was featured Wednesday on the cover of Canada's National Post.
“A longstanding tenet of ethical organ donation [is] that the nonliving donor must be irreversibly dead at the time of donation,” explain the eight paediatric intensive care specialists, writing in Pediatric Critical Care Medicine.
The doctors say that the public’s “underlying assumption” when they agree to donate organs is that “they are giving permission to have their organs removed after they are dead.”
But the authors observe that “death” has been redefined in the last few decades to meet the demand for more organs. They say organs were originally taken from “cadaveric donors who died in the conventional way, irreversibly losing all electrical and mechanical activity from the heart (circulation) and all brain function, despite medical efforts to save them.”
But “this method of organ procurement created a problem for organ transplantation.” “If the patient died in the conventional way then, at the time of irreversibility, so did most organs.”
The notion of “brain death” was created in 1981 in order to harvest more organs, they say. Then in 1991 the Pittsburgh Protocol was developed to allow doctors to harvest the organs of adults after a person’s heart has stopped for a certain period.
The Protocol involves removing the person from life support for 30 to 60 minutes. If the patient’s heart continues to beat after that time, they are returned to the ICU, but if it stops for a prescribed period (around 2 minutes, though ranging from 75 seconds to 10 minutes depending on the jurisdiction), the organs are harvested.
“No efforts are made to assess the patient’s brain function at the time of organ removal,” the authors explain. “The claim is that circulation has irreversibly stopped after 2 mins of observation.”
But this ignores the many reports of the “Lazarus phenomenon,” where a patient’s heart starts again 5 to 10 minutes after CPR is performed. Such instances suggest that “the heart function and circulation may not be irreversibly stopped in DCD [‘Donation after Cardiac Death’] patients at the time of organ procurement.”
The authors also point out that doctors’ desire to prolong lives through organ transplants can “foster physician and institutional bias” for the cardiac death criteria.
While opposing the notion of "cardiac death", the authors accept organ harvesting following "brain death". Opponents of "brain death" point out that organs can only be harvested when the organ's functioning continues, meaning that the donor is still showing signs of life. They say that if the person is truly dead, the unpaired vital organs cannot be transplanted. In particular, "brain death" has allowed heart transplants, but the heart is only useful if it is still beating in the donor.
Akin to the "Lazarus phenomenon" noted by the authors, there have been numerous instances of patients recovering following a declaration of "brain death".
The National Post interviewed Dr. Ari Joffe, the sole Canadian author of the controversial document, from Stollery Children’s Hospital in Calgary. “I think that we’re being less than entirely honest about when the patient is truly dead,” he said. “We’re not trying to deny the parent the choice to donate … The point we’re making is ‘what if they’re almost dead and we’re not sure if they’re dead, and it’s not at the point of irreversibility yet?’”
Thread by me.
It seems indisputable to me that the medical elites and many in bioethics wish to wipe people with Down syndrome off the face of the earth using the killing tool of eugenic abortion–or if that doesn’t work, infanticide or medical neglect. This has led to a counter movement to value our brothers and sisters with Down into the human community. For example, as I reported here, the late Senator Ted Kennedy and Senator Sam Brownback passed a law through Congress, signed by President Bush, requiring that genetic counseling for mothers whose fetuses have tested positive for Down, dwarfism, and other genetic anomolies, not be directed to any particular outcome. The senators believed the law was necessary because studies showed that women were often pushed toward the abortion option.
Another method of push back is for women to refuse testing altogether. Their thinking is that they are going to love their baby come what may–gee, unconditional love, what a concept!–and they worry about being tested because of the pressure they will come under to abort.
One such mother has written a story in the NYT about her decision not to receive such testing, even though she already gave birth to one child with Down and the chances are greatly increased that she will do so again. From “Why Prenatal Testing Harms as Much as it Helps,” by Amy Julia Becker:
For this pregnancy, I have had two ultrasounds, and I have agreed to a fetal echocardiogram. But I declined the blood tests that screen for chromosomal abnormalities. I declined the amniocentesis. I didn’t return my insurance company’s calls when they wanted to assign a nurse to guide me through this pregnancy. I’m not opposed to having information about our baby ahead of time. I want to know everything we could know in order to care for this child well. If there is a physical problem, if I need to deliver with specialists on hand, if our baby is at high risk of complications, I want to know about it, and the tests we have chosen should provide that information. And although I declined, I’m not opposed to prenatal testing. There are benefits to knowledge. According to Dr. Brian Skotko of Harvard Medical School, studies have demonstrated the helpfulness of prenatal diagnosis. Women who know ahead of time that their babies have Down syndrome are able to celebrate their arrival into the world, and often these women feel better prepared for the challenges they might face as a parent.
That’s what happened with Sarah Palin. She says knowing ahead of time helped her prepare to welcome Trig with open arms (which, as I have written, is one reason why I think she generates so much hate from certain quarters). But pre natal testing, which could be so beneficial, clearly has a darker side–the targeting of those deemed deficient:
On the other hand, the way these tests are administered, the way information is provided to women and the way our culture talks about and conceives of individuals with chromosomal abnormalities contribute to my concern that prenatal testing more often serves to devalue all human life and to offer parents and doctors an illusion of control. When a friend of mine, who has a daughter with Down syndrome, declined amniocentesis for her next pregnancy, her doctor shrugged and said, “Well, if it happens again, don’t blame me.” Another friend, upon receiving the results of her amniocentesis, was asked, “When would you like to schedule the procedure to terminate?” Peter and I have participated in a program through the Robert Wood Johnson Medical School in which medical students meet families with a child with a disability. These doctors in training have told me that before they met Penny, they thought Down syndrome was the worst possible thing that could happen to a child. A medical-school professor at the University of North Carolina offered validation to their report when he said to his class, ‘‘In my opinion, the moral thing for older women to do is to have amniocentesis, as soon during pregnancy as is safe for the fetus, test whether placental cells have a third chromosome 21, and abort the fetus if it does.’’
That last bit reminded me of a speech I once gave at a medical school about the urgency of seeing all human beings as possessing equal moral worth in the medical system. Afterwards, a soon to be doctor said to me, “I do genetic counseling. What should I do when a fetus has tested positive for Down?” his implication being that there only is one right decision. I suggested that perhaps he should bring in families of people with Down to help explain to the woman or couple what life is really like for families with such children. He looked at me as if I were from Mars.
Becker concludes:
Even as maternal age increases, the incidence of children born with Down syndrome is decreasing. Studies show that 85 percent to 90 percent of women with a prenatal diagnosis of Down syndrome choose to terminate their pregnancies. We declined prenatal testing not because we assume this baby in my womb has the typical 46 chromosomes. We declined prenatal testing because we would welcome another child with Down syndrome.
We hear so often, as in AIDS, about how prejudicial attitudes of medical professionals hurt patients. That problem is clearly true with regard to Down and other genetic conditions that can be diagnosed prenatally. Because women know that they would be expected to abort, they are instead of opting out of beneficial testing. That’s not their fault. It’s that of the medical professional–and of a culture that too often rejects human exceptionalism. We all have a lot of work to do cleaning up our prejudicial act.
“Physicians are finally starting to acknowledge that the organ transplant industry is not nearly as altruistic as it claims.”
A step in the right direction.
BTTT for the whole thread and wagglebee’s post 38.