The Corner

Removing Life Support Not Euthanasia

Stopping life support so natural death can come is a normal part of health care. We all have the right to refuse medical interventions even if it is likely to lead to death. As the great late bioethicist Paul Ramsey put it when he led the movement in to obtain that right, not forcing tubes and drugs into an unwilling person is to treat the “patient as a person.”

Moreover, in the 1976 Karen Ann Quinlan case, New Jersey’s Supreme Court ruled that removing a respirator at the request of an unconscious patient’s parents is not killing. It is notable that after her respirator was removed, Quinlan lived another ten years.

As they always do, the euthanasia movement attempted to harness the right to refuse treatment and morph it into a right to be made dead. That gambit was refused unanimously by the U.S. Supreme Court in 1997 (Vacco v Quill). There are factual and moral distinctions between dying after refusing life support–such patients don’t always die and the death is natural–and giving a patient poison to make her dead.

Now, Dave Adox, a New Jersey man dying of ALS wants to remove his ventilator so that he can die. That’s his right.

But he wants to do it in a hospital so he can donate his organs. Hospital lawyers are saying no, worried that it might be construed as an assisted suicide. From the MedCity News story:

University Hospital has declined several requests for comment, but Bach said the hospital’s attorneys were concerned about liability.

“The legal issue is: What is euthanasia?” Bach explained. “Are you killing a patient by taking him off a respirator that’s keeping him alive?”

But that’s a long settled question under the law. It isn’t.

The lawyers are clearly squeamish because of the organ donation request. That is the real concern, not that the death would be euthanasia.

They have a point. Adox’s case represents an expansion of what is known as “donation after cardiac death” (DCD) protocol, during which life support is removed, and then three minutes after death cardiac arrest, death is declared and the organs are procured.

Such protocols are controversial for several reasons too lengthy to get into here. But if performed properly, they are definitely legal.

When that protocol was first developed, bioethicists promised it would be strictly limited to people with catastrophic brain damage. Of course, such public policy promises are made to be broken, the assurances given merely to convince a wary public to go along. That is why bioethicists promising strict guidelines should never be believed.

The principle should be judged, not the promised strict limitations that soon evaporate. 

This case represents just such an expansion. But the principle is sound.

I see no reason to preclude Adox from being an organ donor. His disease is at a very advanced stage when refusing life-extending treatment is common and uncontroversial. He has a right to refuse treatment. He is not being killed for organs.

But if he doesn’t die after the ventilator is removed, no action should be taken to make his heart stop.  That would cross the crucial line into killing for organs–as happens in Belgium and the Netherlands–which would violate the law and crucial moral principles that vital organ donors be dead before their gift of life is received. 

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