What often goes unnoticed in cases for mortal harvesting is how inimical they are to the notion of human equality. Common to every proposal is the proposition that the organs inside a potential donor are more valuable than the life of the donor. For example, although Miller and Truog believe no one would be made dead by mortal harvesting who would not otherwise be made dead by withdrawing life-support, they readily
acknowledge that some patients will die by transplant surgery who would otherwise continue to live because of our imperfect ability to prognosticate death after the
withdrawal of life-support (2012, 116). They are willing to accept this risk, however, in light of the benefits that would come to organ recipients as well as the respect for the wishes of the donor to donate. What they are not willing to risk, however, is possibly damaging the organs from warm ischemia in a protocol that would begin surgery after withdrawing life-sustaining treatment and waiting for asystole to occur (Ibid., 121). Consequently, their view implies that the risk of harming the organs outweighs the risk of harming the donor, something that is at odds with the longstanding norm that protecting the donor from harm should take precedence over protecting the organs from harm. Of course, the only senses of “harm” they care about is the experience of pain or a setback to one’s interests; intending the destruction of another’s being is of no concern to them. This should not be the case.
To be sure, the value of the organs in proposals like Miller and Truog’s is derived from the value the donor and recipient places on them. Yet this just reveals that one’s life may be medically sacrificed for the sake of another, owing to the assumption that the donor’s life is not worthy of protection from being instrumentalized to the point of death. Potential donors, who are deemed “terminally ill” (Verheijde, Rady, and McGregor 2007), or “as good as dead” (Miller and Truog 2012, 144–47), or to have “no hope of meaningful recovery” (Glannon 2013), are empowered to consent to their deaths via transplant surgery while those who fall outside these categories, are not. Since we expect people to be rational, those who refrain from undergoing mortal harvesting must give some reason to do so upon pain of irrationality, which is an intellectual burden no healthy person has to bear, and is therefore unfair (see the argument of Velleman 1992 again).
The choice to refrain is not only burdened intellectually, but also morally. Given that every argument for mortal harvesting references the dire need for organs, this empowerment to die by transplant surgery quickly moves to an imperative that is all too easy to justify. One could use the framework of Peter Singer’s “Famine, Affluence, and Morality” (1972) argument to reasonably conclude that you act immorally if you are “terminal” or “hopeless” or “as good as dead” and you refrain from “organ donation euthanasia.” Formulating the argument makes this clear:
1. Suffering and death from the lack of a transplantable organ is bad.
2. If it is in your power to prevent something bad from happening, without giving up anything as equally important, it is wrong not to do so.
3. If you are “terminal” or “hopeless” or “as good as dead” and if you refrain from donating, then it is in your power to prevent suffering and death by donating a transplantable organ, without sacrificing anything nearly as important.
4. Therefore, if you are “terminal” or “hopeless” or “as good as dead” and if you refrain from donating, then it is wrong to do so.
All parties to the debate agree with the first premise. Nearly everyone agrees with the second, as it seems perfectly wasteful to forbid transplants from freshly-dead bodies (e.g. Fletcher 1968); yet, the third is precisely what is at issue. Mortal harvesting could not be justified as a matter of public policy without affirming it, and potential donors would be saddled with its moral stigma despite being permitted to refrain from sacrificing their lives. Now, a potential donor could invoke what I have argued for here, that there is
something that would be sacrificed that is just as important, that is, the inherent dignity of the individual human person. While I believe this is a good reason for a potential donor to refrain from undergoing mortal harvesting, the point is that no potential donor should have to bear the weight of rebutting this (question-begging) argument, which just assumes, as a matter of policy, that this not a good reason.
Worse yet, policy makers who would establish mortal-harvesting practices seem indifferent to the fact that a certain set of quality of life judgments along with their lethal implications would become a systematic part of the transplant enterprise. No doubt, these judgments are already tacitly involved, but it does not follow that they should be involved as a matter of policy and that this would somehow be an improvement over the status quo (being honest about an evil practice is no virtue). For if we were to adopt these proposals, then there is no reason why we should not be able to lethally experiment on the same class of people, so long as they consent to being used lethally for the sake of gaining medical knowledge. This, of course, would undo the fundamental ethical principles laid down by the Nuremburg Code, the Declaration of Helsinki, and the Belmont Report. To allow mortal harvesting is not to just “rethink” the ethics of death, dying, and organ
transplantation, but the whole bioethical enterprise itself. Are advocates of mortal harvesting prepared to go as far as their principles will take them? If not, why not?
4.6 Conclusion
I opened this chapter with two epigraphs, one from Joseph Fletcher (Bard and Fletcher 1968, 64) and the other from John Paul II (1995, 102) so as to contrast the implications of two very different views of human life. On the one hand, there is Fletcher’s view, which makes life’s worth wholly dependent upon the likelihood of actualizing certain psychological capacities constitutive of (neo-Lockean?) “personhood.” What degree of instantiation is required for personhood is anyone’s guess, but it is clear that one can be born an “idiot” — Fletcher’s charming term for people with Down’s Syndrome — and be kept from living. To allow for such a life, on his view, would be to incur some vague and unspecified sort of guilt. On the other hand, there is the Pope’s view, which simply identifies human animals with “persons” and ascribes “absolute equality” to every one of them. The opportunity to flourish for an eighteen-year-old man matters no more (or less) than it does for a day-old female human embryo. One might be tempted to think of these views as two unacceptable extremes, and that there should be some safe middle ground that avoids the moral implications of each. It is a reasonable thought. Certainly, a view like McMahan’s does not automatically count babies with Down’s Syndrome as being life unworthy of life.122 Nonetheless, such views place a
122 Though I have been critical of him, I must draw attention to his admirable courage in confronting
the case he describes in the following:
I recall once being consulted by a hospital’s ethics committee about a similar case. A woman in the late stages of pregnancy had been told that her fetus had been discovered to have Down’s syndrome and a heart condition that would be fatal within the first year unless it underwent a major surgery that would have a reasonably high probability of success (I think, though my recollection is dim, around 70%). The parents were opposed to abortion on religious grounds and thus said that they preferred to
burden of proof on such babies as to whether they will likely display a sufficient amount of “psychological connectedness” to merit some form of respect. This is precisely what we should expect of views that make one’s moral status depend on the instantiation of certain psychological properties that can only come in degrees. Nor can we avoid the problems of arbitrariness and injustice by positing some threshold of respect to make moral status an all-or-nothing category. Even if we could draw the line in a reasonable place, some are in and out on the basis of negligible differences with grave consequences.
The just alternative is to identify moral status with something that does not come in degrees, that is, a being’s nature, specifically a rational nature.123 On this view, our
dignity is bound up with our way of being rather than our way of becoming. If you are an individual substance with a rational nature, you have moral status; every human being is such a substance, so every one of them has moral status. Concomitant to this belief is that our dignity is ineliminable, which makes it the case that our suffering always matters no matter how terrible it may be or how insentient we may become. The deep implication of this view is that we are not merely receptacles of “value” whose claim to life wholly depends on whether we can be the subject of some good state of affairs or pleasurable
continue the pregnancy; but they also wanted to decline the surgery, allegedly because they wanted to spare the infant the suffering that would be involved. The other members of the committee — physicians, a nurse, a priest, a rabbi and a lawyer — all thought this was an acceptable solution. I pointed out that no one would think it acceptable to forgo the surgery if the infant did not have Down’s syndrome or if a similar heart condition requiring similar surgery were not diagnosed until the child was a year or two old. I suspect that it was because I had implied, especially in the presence of a lawyer, that the committee was endorsing the view that an individual could be allowed to die because of a disability that I was never again invited to serve as an ethics consultant at the hospital (2013, 275). Of course, his wisdom in highlighting this case of ableism is only meant to serve his broader point, that all
infants are equal candidates for infanticide so long as some set of relevant conditions are met — like being orphaned and a perfect tissue match for those who are in need of a healthy organ, and healthy enough to supply them.
sensation. Modern accounts of killing tend to reduce human worth to the degree of happy properties one contingently exemplifies, and leave our natural, intrinsic dignity behind. “They are,” as Timothy Chappell says, “metaphysically superficial, because these accounts focus on what’s secondary, the properties of the individual person, while
ignoring or bypassing the primary thing, the person herself” (2004, 108). Perhaps this is a consequence of our culture’s move towards secularization, which leaves behind the idea that human beings are made in the image God. Geirtz certainly thought this when he remarked at the Ciba meeting that “The concept of unconditional human worth cannot, however, be justified rationally” (1966, 144) — the implication being that it could only be accepted as a matter of blind faith. My hope is that the reader will see, that after examining the contents of this chapter, that it can be accepted rationally. Once it is accepted, we can see that killing someone for their organs is disrespectful of the worth of the one being killed.