Three years after assisted death became legal in Canada, the medical community is debating a provocative question: should organs be removed from consenting euthanasia patients while they’re still alive?
Some say changing the rules would allow people choosing an assisted death to donate as many organs as possible — in the most optimal condition possible — because blood and oxygen would continue to flow through vital organs until the moment of retrieval.
Under this scenario, people granted an assisted death would, with their full knowledge and consent, be transported to an operating room, put to sleep under general anaesthesia and their organs removed, including the heart and lungs. Death would follow removal of the beating heart. Under so-called “euthanasia by organ donation,” the act of organ donation itself — not a lethal injection or a doctor-prescribed, life-ending dose of barbiturates — would be the mode of death.
Organ donation after euthanasia is already occurring, legally, in Canada. About 30 people who have died by “medical assistance in dying,” or MAID, since the law decriminalizing the act was passed in 2016 have consented to donate kidneys or other organs. In Ontario, 168 more have donated tissues such as corneas, skin, veins, tendons and ligaments — tissues that don’t require the same conditions as organs to survive and can be taken up to 24 hours after death.
However, under the long-standing “dead donor rule,” organs can’t be procured until donors are declared dead — typically, five minutes after the heart has stopped beating — and the organ retrieval itself can’t lead to the death of the donor.
The rule is intended to maintain a “firewall” between the team removing a person from life support — and determining death — and the transplant surgeons waiting to retrieve precious, desperately needed organs.
The idea provokes a visceral kind of horror for some. “Death by donation would, at present, be considered homicide to end a life by taking organs,” Dr. E. Wesley Ely, a professor of medicine at Vanderbilt University School of Medicine wrote in USA Today.
Remember when doctors adhered to the Hippocratic Oath?
Do no harm; don’t perform euthanasia or abortion:
I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.
I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.
We’ve strayed so far…