Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life

Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life

by Franklin G. Miller, Robert D. Truog
     
 

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In Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Miller and Truog challenge fundamental doctrines of established medical ethics. They argue that the routine practice of stopping life support technology in hospitals causes the death of patients and that donors of vital organs (hearts, lungs, liver, and both kidneys)

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Overview

In Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Miller and Truog challenge fundamental doctrines of established medical ethics. They argue that the routine practice of stopping life support technology in hospitals causes the death of patients and that donors of vital organs (hearts, lungs, liver, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. These practices are ethically legitimate but are not compatible with traditional rules of medical ethics that doctors must not intentionally cause the death of their patients and that vital organs can be obtained for transplantation only from dead donors.
In this book Miller and Truog undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. They expose the misconception that stopping life support merely allows patients to die from their medical conditions, and they dispute the accuracy of determining death of hospitalized patients on the basis of a diagnosis of "brain death" prior to vital organ donation. After detailing the factual and conceptual errors surrounding current practices of determining death for the purpose of organ donation, the authors develop a novel ethical account of procuring vital organs. In the context of reasonable plans to withdraw life support, still-living patients are not harmed or wronged by organ donation prior to their death, provided that valid consent has been obtained for stopping treatment and for organ donation.
Recognizing practical difficulties in facing the truth regarding organ donation, the authors also develop a pragmatic alternative account based on the concept of transparent legal fictions. In sum, Miller and Truog argue that in order to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics.

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Editorial Reviews

Doody's Review Service
Reviewer: Gina M Fullam, BS (Saint Louis University)
Description: The authors of this book present and apply what they call a common-sense ethic to end-of-life issues: withdrawal of life-sustaining treatment, physician-assisted suicide, euthanasia, and vital organ donation.
Purpose: The stated purpose is to dispel the intellectual incoherency and dishonesty of the current discussion and policy on death and vital organ donation, while creating an ethical space for physician-assisted suicide, euthanasia, and live donor vital organ donation. The project is controversial both in its conception and argumentation.
Audience: The audience is unclear. At various points, the authors issue direction to academic bioethicists. However, they presumably direct historical overviews and other background material throughout the book to the general public. In addition, the authors state that their presentation is "bias-free." This statement, as well as their tone and starting assumptions, suggest their intended audience is one that already agrees with them or one that is unfamiliar with the viewpoints with which they take issue and thus is easily persuaded. While the authors are certainly qualified to write this book, their one-sided presentation, combined with lack of clear audience, make suspect their intention of, and success in, producing a bias-free publication. Importantly, they are perhaps insufficiently sensitive toward public trust or distrust of palliative care and organ donation.
Features: The authors first examine the practices of, and justification for, withdrawal of life-sustaining treatment, physician-assisted suicide, and euthanasia. They then apply the arguments they develop in the early chapters to organ donation, and offer both an ideal and a pragmatic way forward in end-of-life discussion and policy. The crux of their argument is that the time has come to abandon the traditional norm against clinicians intentionally causing the deaths of their patients, and thus the dead donor rule for vital organ donation. They aim to demonstrate that this shift in norms has in fact already occurred, despite language and policies suggesting otherwise. Unfortunately, the presentation of many unsupported assumptions undermines their argument. Moreover, they do not accurately characterize or adequately respond to certain objections.
Assessment: Although the authors draw extensively from their argumentation in published articles, this is their first full-length presentation. Despite notable shortcomings, their argument should be taken seriously by academic bioethicists. At the very least, their challenge can help those who disagree with them to be more precise in their own arguments.
From the Publisher

Although the authors draw extensively from their argumentation in published articles, this is their first full-length presentation... Their argument should be taken seriously by academic bioethicists." -- DOODY'S

"This slender, 174-page book is engaging and will have broad interest to all professionals and academicians whose work touches on issues surrounding the withdrawal of lifesustaining treatment, vital organ transplantation, or both. I highly recommend Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life and consider it one of the best bioethics texts I have read in the last year." -- Andrew R. Barnosky, DO, MPH, JAMA

The core metaphysical conclusion of the book is that "the human being dies when the body ceases to function as an organism, which is marked by the irreversible cessation of circulation and respiration" (p. 78). In support of this claim, the authors draw on a rich acquaintance with clinical practice, the relevant neuroscience, and the scientific and political history of the notion of brain death, offering a highly informed case for the view that the elimination of brain function does not destroy the ability of the rest of the organism to function in an integrated fashion." -- The Hastings Center Report

"This book is amodel of quality scholarship in bioethics. The central arguments are detailed, carefully constructed, empirically well grounded, and are presented in cogent, clear prose with an economy of style, all of which are helpful to the reader in readily identifying loci of agreement and disagreement." -- Benjamin E. Hippen, Metrolina Nephrology Associates, The American Journal of Bioethics

"An extensive, relevant bibliography supports the text. Summing up: Recommended. Upper-division undergraduates and above." - J.N. Muzio, emeritus, CUNY Kingsborough Community College, CHOICE

"This book is very well developed in the challenges posed to the current way of thinking about clinical death and how these challenges relate to the current organ... Students and clinicians who work with patients in intensive care unit settings will benefit in many ways from the content in this book. Expanding one's mind beyond the status quo always results in meaningful knowledge and personal growth, whether one accepts the precepts or not." -- Lisa Anderson, DrPH, MA, MSN, Clinical Ethics Consult Service, University of Illinois Medical Center

"Whether one agrees with Miller and Truog's viewpoints and proposals, there is no denying that this is a stimulating and thoroughly engaging book...although the book's focus is on issues at the end of life, it also carries implications for other areas over which the discourse of medical ethics casts a critical eye. For that reason, it is likely to appeal to practitioners,
teachers and students of medicine and medical ethics." -- Kartina A. Choong, University of Central Lancashire, Medical Law Review

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Product Details

ISBN-13:
9780199739172
Publisher:
Oxford University Press, USA
Publication date:
10/28/2011
Pages:
208
Product dimensions:
6.20(w) x 9.40(h) x 0.90(d)

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