Asymmetrical Information

Had you put your contacts in by the time you watched the story?

Exactly. It's not like I'm really going to need those organs anymore. All they are is extra biomass in the grave.

So if shedding some spare biomass before heading to the mortuary, even a few hours early, is going to help someone else out, then just give me enough time to say the I-love-yous and end it a few hours early. If I'm comatose, then there's no use giving me the extra hours, as I can't talk.

I am the harvest, and both the Reaper Man and the transplant team are the farmers.

The more clean, moral certainty you have, the less you have to weigh messy tradeoffs - the less you have to think.

the less you have to think

Zen Master Moral Certainty!

Administering drugs to hasten an end to harvest organs can be very, very bad. Not sure what the best method would be, but do something that won't harm the organs - maybe just vivisect with sufficient painkillers - provided that this is truly a case where you're dead within a 48 hour window.

I agree in principle.

In practice, I'm slightly nervous about anyone having a financial stake in my early demise, and the capacity to bring it about. Doctors are people too, and I don't trust them any more than the average Joe on the street.

Yeah, I guess I'm generally in agreement. But then I read one of those stories about the person who unexpectedly wakes up from a deep 25-year coma.

Man, imagine what fun after waking up from a 25-year coma! Learning about everything all at once instead of gradually over the years. Everything would seem like magic!

does the hippocratic oath ring any bells? i quote

"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

To please no one will I prescribe a deadly drug nor give advice which may cause his death."

No Enderbury, waking up from a twenty-five year coma is not fun. It's not nearly as glamorous as movies make it out to be. For one thing, you'll have to learn how to poop again because your ass-muscles will have atrophied during the twenty-five years of non-use.

In the fairytale "Sleeping Beauty," if Sleeping Beauty slept for a decade, she's not going to be a beauty anymore when she wakes up.

If the hippocratic oath is a problem, why not bring in some of the prison guards or veternarians from the recent capital punishment thread?

It's well and good if someone has given prior consent for such a procedure, I suppose, although I confess I haven't given it a lot of thought. But this case seems a different breed altogether, since, at least based on the news report, it seems as if the physician just assumed this power for himself.

From this post, it sounds as though Jane was reasonably supportive of the physician. (I apologize if I'm misreading.) Recently, she posted that people thought she had shifted to the left, and here would be, to me, an example of why people might believe that. A clear-cut violation of personal autonomy (it doesn't get any more personal than life and death) seemingly excused on the basis of some sort of social benefit. Frankly, it couldn't sound more collectivist if we put out a five year plan putting production quotas on the local organ commissars.

In short, living will, yes! Physicians (with a massive financial incentive) given license to kill for the greater social good? I'll pass. (Ooops, I forgot. Someone else got to make that choice for me. Oh well.)

Maniakes - I'm not sure if surgeons take the Hippocratic oath, but I know that they don't take the original. In addition to the obvious references to Apollo, it includes the phrase "I will not cut, not even for stone" (i.e. to remove stones) In other words, no surgery.

Incidentally, there's at least once incidence where Hippocrates helps induce a miscarriage. Abortions, on the other hand, were either poisonous or lethal. Chinese women of that day induced them by sipping mercury, for instance. And that was one of the nicer abortifactants.

Jane, I think you're off the mark here. Most of us might agree that *generally speaking* the two hours of are not worth the cost of not harvesting the organs and the corollary that a doctor induced death costs less than the benefit gained from the harvested organ. But then again, there are people who would not. It's presumptous, at the very least, to usurp the will of the patient in favor of your own interpersonal calculus. Perhaps it's against this person's religion to allow manslaughter, or perhaps this person wants to die a natural death for all sorts of intangible reasons. Who is given the power to make this judgment? If it's one day more of life, is it still a clear judgment? If it's a year and the organ will save a small child, should we kill the patient to harvest organs for the child? This is not even to warn of a slippery slope, which is somewhat beside the point, but to illustrate the utter arbitrarity of your "social utility" judgment.

I read the link and besides the title (which I found ... humorous) you learn absolutely nothing about the actual case. Everything is still "under investigation." We don't know if the doctor did it with the patient's consent. Nor do we know if the doctor administrating the lethal dose gets any tangible benefit from harvesting the organs.

Until someone can answer those two questions, any discussion about this case will only be conjecture.

If you believe that, then make sure your family knows. But it's not within the doctor's rights to do that to a person who has not expressed consent, nor should it be. Actively hastening the death of a patient on your own initiative, no matter what the reason, is completely outside the bounds of what a doctor should ever do.

I know that many people will say "we can stop the slippery slope with sticky stairs." In other words, we just want to take this one reasonable step: trade off a couple hours of one man's life for decades of another's.

But on what logical grounds can you then prevent a trade off of one year of a man's life versus two years of someone else's? Given that you subscribe to a quasi-utilitarian view that only the consequences matter (and not "the means" or acts versus omissions) what is the different between killing a healthy old person with, say, five years to live and giving those organs to young children?

Consider taxes. Society has already decided to forcibly take a large slice of your life for purposes you might not agree with. Consider how many hours you might not need to work...

http://www.signonsandiego.com/news/state/20070228-1753-ca-transplantprobe.html

According to this account, "[The deceased] lived in a home for mentally and physically challenged adults in the year prior to his death." If true, that would seem to render the issue of consent nugatory.

How often would this situation come up?

If my wife or one of my siblings (whom I have medical POA on)were about to die and the doctor told me that if he put them on a heart/lung machine for 24 hours, it would be possible they could save X number of lives, I would allow that. So, I guess it makes sense to go the other way, I suppose.

I will have to think about it. And I will have this discussion with all that I hold POA over.

As for me, I hearby give my consent. I think it more likely that they keep you alive longer/do ill advised surgeries than they should so they can get extra money from you that way.

It also seems like either scenario would be extremely rare.

After much careful consideration for the past three minutes, yeah, go ahead if you have patient consent.

Patients can't give consent to be killed. They can refuse to consent to life saving measures, and they can consent to palliative care measures that, as a side effect, hasten death, but they can not consent to be killed.

There was a good episode of "House" a couple months back, with John Larroquette. It had an awakening coma patient who commits suicide so that his son can have his organs. In passing, the doctors mention that aspirin helps preserve the organs and hanging does little damage to them, then they go away for 20 minutes. I can live with that.

On another note...

There is a utilitarian argument that works against the slippery-slope end-state of taking organs from one person and giving them to another just to get more man-years of life. Life isn't the only metric of utility. Psychological well-being is also important. The fear that we will be killed to harvest our organs so that another could make better use of them would be a large utility decrease. It would outweigh a few years of life for a few luck individuals who recieve organs.

Jane's going over to the dark side. We need an intervention, these liberals she's cooking with are a bad influence.

According to Kant, using someone for some other end is immoral.
From an economics POV, leaving the organs in there rather than putting them in someone who has a chance to live x longer than the donor is immoral.

But why limit it to drugs? Why doesn't the doctor just whip out a scalpel and slit the guy's throat? Death is faster, there is no chance of contamination from drugs.

Or even better, just run a standard operating table and take the organs out before the guy's dead. Please, use painkillers, but no need to take precautions to keep the donor alive.

If doctors are going to be in the business of hastening the occurrance of death, then dispense with the injections and get to the point.

From what I understand of organ harvesting, most of it is done at the end, not after it, if you catch my drift. The doctors need that tissue to be alive, so they wait for brain death, not physical death. Hence the popularity of young people with aneurysms among transplant teams.

By the way, if you want to spare your family the absurdly high cost of a funeral, then make arrangements to have your body donated to a local medical school. Just make sure you confirm that they will take you. My dad made such arrangements with Georgetown Medical School, but after he died we were told they wouldn't take him because he'd had leukemia. They only wanted healthy dead people. We ended up having to make last-minute arrangements with some dead body clearinghouse for all the medical schools in the state.

In the fairytale "Sleeping Beauty," if Sleeping Beauty slept for a decade, she's not going to be a beauty anymore when she wakes up.

And the fairy godmothers. Those aren't real, either. You can try taking it up with Perrault, but it will require more than a kiss to wake him out of sleep.

What about triage?

Does that not involve abandoning people to their deaths, so you can work on other patients?