Patient Care

When assisted suicide/euthanasia is legalized, people who are eligible to be killed because they are seriously ill may become objectified by their societies. For example, they may be thought of as so many organ farms to be harvested after their lives are ended.

Such objectification of the sick can be infectious. In California, there is a new research program called Last Gift that seeks people with “life-shortening” conditions who also have HIV to be experimented on — not to find cures or ways to extend their lives, but to better understand the virus. From the Last Gift research subject solicitation:

UC San Diego is looking for altruistic people with HIV, who have been diagnosed with a life-shortening disease and reside in San Diego County. The Last Gift tissue donation research study aims to understand the behavior of HIV in the human body — giving scientists the rare opportunity to learn where the virus hides in an individual and inspire medical advancements for generations to come.

I think it is worth noticing that Anthony Fauci’s old outfit, the National Institute of Allergy and Infectious Diseases, is a funder of the program.

There is a move afoot among bioethicists to allow written directives by dementia patients, signed before the patients have become incompetent, to force caregivers to withhold spoon-feeding and liquids from those patients. Now, one of the country’s most notable and oft-quoted bioethicists, Arthur Caplan, has taken a position in favor of such a policy, in an article in the online publication Medscape.

First, Caplan discusses the potential withholding of feeding tubes (artificial hydration and nutrition, or AHN, in medical parlance), which is unquestionably legal because AHN is a medical treatment that involves surgery and medically prepared nutrients and — like other treatments, ranging from surgery to chemotherapy — can be ordered through advance directives to be withheld or withdrawn. Right or wrong, that’s a done deal. (He brings up the Terri Schiavo case, about which he and I significantly disagree, but let’s not relitigate that here.)

Then, however, Caplan takes the next step — which is currently on the cutting edge of bioethical discourse. From “Artificial Hydration and Nutrition in Dementia: Ethicist Weighs In”:

Is feeding by spoon the same as medical intervention with artificial forms of hydration and nutrition? I believe it is. I believe that when you say “no more food and nutrition,” it isn’t just the equipment. I’ll put it simply: It’s who’s on the end of the spoon. If nurses or doctors are feeding, it’s medical. It’s professional care, and you should be able to say no to that.

The “dead donor rule” is the cement that binds the public’s trust in organ transplant medicine. Under the DDR (other than in living donations, such as of one kidney) organs cannot be procured unless donors, in the words of the Munchkins, are not merely dead but really most sincerely dead.

There are two means of declaring death. Let’s call the first “heart death,” that is an irreversible cessation of all cardio/pulmonary function. The other is popularly known as “brain death,” (death declared by neurological criteria) in which function in the whole brain and each of its constituent parts have irreversibly ceased. The key word in both means of declaring death is “irreversible.”

But something appears to have gone badly off the rails in the field of procuring organs after heart death. A long New York Times expose found cases of patients who were clearly alive when organ procurement began. At the same time, a very disturbing report by the Department of Health and Human Services contained similar findings.

First, the NYT. From “A Push for More Organ Transplants Is Putting Donors at Risk”:

Last spring at a small Alabama hospital, a team of transplant surgeons prepared to cut into Misty Hawkins.…Days earlier, she had been a vibrant 42-year-old with a playful sense of humor and a love for the Thunder Beach Motorcycle Rally. But after Ms. Hawkins choked while eating and fell into a coma, her mother decided to take her off life support and donate her organs. She was removed from a ventilator and, after 103 minutes, declared dead.

A surgeon made an incision in her chest and sawed through her breastbone. That’s when the doctors discovered her heart was beating. She appeared to be breathing. They were slicing into Ms. Hawkins while she was alive.

The horror! Why are such awful things happening?

Twenty years ago today, Terri Schiavo’s feeding tube was withdrawn with court approval, commencing a cruel deprivation of sustenance that resulted in her death by dehydration 13 days later. For those who may not remember, the case became the most hotly contested bioethics issue since Roe v. Wade as Terri’s husband Michael fought in courts and in the media with her parents and siblings over his desire to remove all Terri’s food and fluids. In the end, he won — and Terri died. Now, two bioethicists on the influential Hastings Center blog decry the case as wrongly brought. They get some facts wrong and omit crucial information — like that Michael was living with another woman with whom he fathered Read More ›