According to Wesley Smith, my article about the ethics of organ donation “will curl your toes.” But readers might be surprised to find that my article has nothing in common with “ivory-tower discussions” that defend euthanasia or the use of puberty blockers, other than defending a conclusion with which Smith disagrees.
My thesis is that the principles used to support the rule against removing vital organs from living donors (i.e., the dead donor rule) prohibit actions that seem unobjectionable. For example, the principle that physicians may not seriously and permanently harm one patient to benefit another person would prohibit kidney transplants from living donors. (Contrary to Smith, I discuss kidney transplants to argue that one version of the do-no-harm principle is too strict, not to argue that the permissibility of removing a kidney entails the permissibility of removing a liver; up here in the ivory tower, we distinguish presenting a counterexample from making an argument by analogy.) Interested readers can find a more detailed summary of my article, which Smith fairly describes as long and complicated, here. (For similar arguments, see essays by Christopher Kaczor, Christopher Tollefsen, and Joseph Vukov, as well as Tollefsen’s essay on NRO.)
Someone could show that I am mistaken by identifying an ethical principle or definition of intentions that supports the dead donor rule, but Smith relies on assertion and disparagement instead of argument (e.g., asserting that I misapply the principle of double effect, which I have defended at length). My article discusses several fictional cases, including an example about jumping on a grenade, which Smith dismisses as too extraordinary to be the basis of public policy. I agree — which is why I explicitly say in my article that I do not make any policy recommendations.
States and hospitals might have good reasons to adopt the dead donor rule as a policy to prevent patients from feeling pressured to donate vital organs, but policies should not depend on falsehoods. If those of us who agree that all humans have an equal moral status (including unborn children at the beginning of life and permanently unconscious patients at the end of life) take shortcuts by appealing to unsound principles or by avoiding rational arguments, we will make it easier for those who disagree, including the utilitarian bioethicists with whom Smith mistakenly associates me, to dismiss our views as rationally unfounded.