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Editorial

Abbot Peter Novecosky, OSB

03/22/2017

Abbot Peter NovecoskyOrgan donation dilemma

Another wrinkle has been added to the quagmire the legalization of assisted suicide in Canada has initiated.

It is the close connection between the need for donated organs and the retrieval of organs from people who choose to end their lives.

In Canada in 2014, more than 4,500 people were waiting for an organ, and 278 died waiting, according to the National Post.

The March 20 online edition reported that doctors have already harvested organs from dozens of Canadians who underwent medically assisted death, a practice supporters say expands the pool of desperately needed organs. Ethicists, however, worry this could make it harder for euthanasia patients to voice a last-minute change of heart.

In Ontario, 26 people who died by lethal injection have donated tissue or organs since the federal law decriminalizing medical assistance in dying, or MAID, came into effect last June, according to information obtained by the Post. This was out of a total of 338 who died by medical assistance.

A major ethical concern is that the need for an organ transplant may override the freedom of people who have chosen assisted suicide to change their mind.

Ethicists say organ donation could put pressure on those who qualify for assisted suicide to choose death, that the terminally ill “may feel they would better serve society by dying and saving other people’s lives,” Dr. Marie-Chantal Fortin, a transplant nephrologist at the Centre hospitalier de l’Université de Montreal, and ethicist Julie Allard write in the journal, Clinical Ethics.

Others are asking, what if people agree to donate, but then change their mind about hastening death? Would they feel compelled to follow through with the act, knowing the chosen recipients are waiting for their organs?

Jennifer Chandler, a professor in the centre for health law, policy and ethics at the University of Ottawa, said, “Imagine a situation where the work up is done — people have gone out and done the medical tests and found the recipients and set everything up. And then you change your mind.

“One wonders if perhaps that might create pressure to continue with the MAID,” she said. “It would be very important in these scenarios to make it very clear to people that they can change their mind at any time — that someone shouldn’t stick with MAID just because they feel an obligation, having set the process in motion.”

At present, it is after people are declared “brain dead” or suffer cardiac death that their organs are allowed to be harvested. Patients are removed from life supports which have kept their hearts and lungs functioning. In the latter case, once the heart stops beating — and after a five to 10 minute “no-touch” period — organ procurement can begin.

However, death can take several hours and vital organs like the heart and lungs deteriorate. With assisted dying, organs can be harvested much sooner, making it more ideal to harvest healthy body parts.

Belgium and the Netherlands already allow organ harvesting after euthanasia.

While church teaching encourages organ donation, an ethical dilemma is raised for a patient to accept organs from someone who chose an assisted death. While typically the cause of death isn’t disclosed, including cases of suicide, unless there’s a valid medical reason to do so, a patient’s ethical dilemma would be much more serious if the donor had wanted to change his or her mind about dying, but it was ignored.

This is just another crack in the new legal situation in Canada.