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ss triple helix - spring 2024,  a confluence of evils

a confluence of evils

the disturbing link between euthanasia and meeting the demand for organs

Trevor Stammers is a retired GP and a former lecturer, course director, and editor in bioethics.

There are times when you see a confluence of evils merging from afar, but they merge so slowly that most people remain totally unaware of them, or if they are, they simply shrug their shoulders and move on. I first wrote about my concerns over organ donation from those requesting euthanasia (ODfE) in 2017 when Belgium was at the time pioneering the practice.[1]

Canada has now overtaken Belgium, embedding the practice right from the introduction of its 'medical assistance in dying' (MAID) legislation.

A recent worldwide scoping review of ODfE found that 39.7 per cent of the papers were from Canadian experiences. Canada leads the world in harvesting organs from the euthanised.[2] One study of Canada, Belgium, the Netherlands, and Spain, found 286 donors seeking euthanasia donated organs to 837 people; nearly half the donors (136) came from Canada.[3]

Very recently, Canadian policy guidance was updated. Several new recommendations are of concern, including:'…patients who are potentially eligible for organ donation should be approached for first-person consent for donation after MAID once MAID eligibility has been confirmed'Organ donation organisations and transplantation programs should develop a policy on directed deceased donation for patients pursuing MAID, in alignment with the directed donation principles and practices that are in place for living donation in their jurisdiction.'[4]

Thus, should a person requesting euthanasia have a relative in need of an organ, such a 'directed donation' after euthanasia could easily add pressure for the donor to go ahead with their death. Meanwhile, Canada has once again postponed a decision on offering MAID solely for psychiatric distress. Experience in other countries where ODfE is already offered to those with mental disorders shows why organs from such cases are especially desirable for transplantation. These patients are often very young and have organs that may consequently last for decades. One study in the Netherlands shows that between 2012 and 2022, whilst psychiatric cases only constituted two per cent of all patients given euthanasia, they accounted for 29 per cent of all organ donors following euthanasia.[5]

Public trust is crucial to to maintaining deceased and living donations. Those wanting to take things a step further than ODfE by promoting euthanasia by the removal of vital organs (ERVO) show themselves all too aware of this when they state:

'Regardless of a possible change in the law, it is crucial to avoid that the general public is given the impression that there is a "hunt" for organs, to take vital organs from a living patient.'[6]

ERVO is the next logical step in the relentless progress of what a medical colleague calls 'organ greed'. Euthanasia by removing the heart from unconscious anaesthetised but living patients would maximise the use of organs. While ERVO would undoubtedly violate the dead-donor rule, calls to scrap that rule have existed for at least a decade.[7] Though the utilitarian cases for ODfE and even ERVO are overwhelming, from a biblical perspective, we should not 'do evil that good may result'. (Romans 3:8) Euthanasia and assisted suicide are both unjustified evils,[8] even if others may live longer as a result of receiving the organs of those whose lives have been so ended.

Accessed 13/05/2024
  1. Stammers T. 'A Last Act of Grace'? Organ Donation and Euthanasia in Belgium, from Jones D, Gastmans C, MacKellar C (eds). Part II - Euthanasia and End-of-Life Care. Cambridge: Cambridge University Press (online). 21 September 2017
  2. Silva e Silva V, et al. Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects. JBI Evidence Synthesis. Feb 2024;22;2:157-194. DOI:10.11124/JBIES-22-00143
  3. Mulder J, et al. Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021. Am J Transplant. 2022;22:2759-2780. DOI:10.1111/ajt.17198
  4. Wiebe K, et al. Deceased organ and tissue donation after medical assistance in dying: 2023 updated guidance for policy. CMAJ, Jun 2023;195;25:E870-E878.DOI:10.1503/cmaj.230108
  5. van Dijk N, et al. Organ Donation After Euthanasia in Patients Suffering From Psychiatric Disorders: 10-Years of Preliminary Experiences in the Netherlands. Transplant International. 2023 9 Feb;36:10934. DOI:10.3389/ti.2023.10934
  6. Bollen J, et al. Euthanasia through living organ donation: Ethical, legal, and medical challenges. The Journal of Heart and Lung Transplantation 2018 16 Jul;10:1016. DOI:10.1016/j.healun.2018.07.014
  7. Rodríguez-Arias D, et al. Donation After Circulatory Death: Burying the Dead Donor Rule. The American Journal of Bioethics,. 11;8:36-43. DOI:10.1080/15265161.2011.583319
  8. Thomas R. assisted suicide. CMF file. 56; 2015.
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