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

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 ...

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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.
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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)

Meet the Author

Franklin G. Miller, Ph.D. is a member of the senior faculty in the Department of Bioethics, National Institutes of Health NIH. Dr. Miller has edited five books and written numerous published articles in medical and bioethics journals on the ethics of clinical research, ethical issues concerning death and dying, professional integrity, pragmatism and bioethics, and the placebo effect. Dr. Miller is a fellow of the Hastings Center and a Faculty Affiliate at the Kennedy Institute of Ethics.

Robert D. Truog, MD, is Professor of Medical Ethics, Anaesthesia and Pediatrics at Harvard Medical School. He has practiced pediatric intensive care medicine at Boston Children's Hospital for more than 20 years, and he has published more than 200 articles in bioethics and related disciplines.

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Table of Contents

Preface
1. Withdrawing Life-Sustaining Treatment: Allowing to Die or Causing Death?
2. Active Euthanasia
3. Death and the Brain
4. Challenges to a Circulatory-Respiratory Criterion for Death
5. Donation after Circulatory Determination of Death
6. Vital Organ Donation without the Dead Donor Rule
7. Legal Fictions Approach to Organ Donation
8. Epilogue

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