The Extent to Which the Wish to Donate One’s Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis

Abstract

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual’s wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

KEYWORDS:

• Active voluntary euthanasia
• organ donation
• ethics
• Terminal illness

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 Such is frequently the trajectory of, for example, reflex sympathetic dystrophy, an aggressive and incurable tetraplegia that causes progressive physical deterioration, severe pain, and rising paralysis.

2 The support for beneficence arguments generated by the AVE as Life-Extension View closely resemble the support for autonomy arguments, which is largely based on the nature of the future suffering predicted by the individual (extreme, persistent, intractable, etc.) and how that informs his autonomous decision-making.

3 Vitalism would consider the AVE as Life-Extension View to simply offer a justification of what the view holds to be an intrinsic wrong (euthanasia) by appeal to another intrinsic wrong (taking one’s own life without assistance).

4 This makes the case stronger for PAD, and even more so for AVE, than it does for taking one’s own life without assistance. Suicide requires the capacities to do so, while PAD requires these capacities in smaller but non-zero quantities, and AVE requires neither capacity in the presence of a suitable advance decision that specifies the precise stage of the individual’s illness at which he would wish to access AVE but has lost the capacities to participate in his death or the cognitive ability to reason or communicate his wishes. Accordingly, PAD allows greater returns on investment than taking one’s life own life without assistance, while AVE allows maximal returns on investment (even in the absence of an advance directive, AVE would still allow life to continue beyond the point at which the physical ability to participate is entirely lost).

5 While the individual could be admitted to the donor hospital prior to his natural death and thereby increase the retrievability of his potentially-donatable organs, this could threaten his autonomous decision-making regarding his preferred location of death, and possibly induce additional suffering during the transfer to hospital, without (in the absence of AVE) addressing the timing problem.

6 Death is usually brought about by AVE through the administration of a pharmaceutical (such as a large dose of a barbiturate) which, rather than acting as a ‘generalised poison’ that causes severe and protracted symptoms prior to death due to widespread tissue damage and multi-organ failure, reliably brings about death secondary to suppression of the central nervous system in the absence of distressing symptoms within a 30-minute period (Wood et al. 2003, Dierickx et al. 2018).

7 In scenarios in which the individual opts neither to end his own life without assistance, nor to access VAE (if it is available), and thereby undergo a natural death at the end of Year 20, the likelihood that his organs will be successfully donated after death is lower than if he accessed AVE (since the quality of his organs would be unsuitably low for donation, the challenges to retrievability, and the challenges to matching his organs with potential recipients), but potentially higher than if he ended his own life without assistance (since his organs would be of [marginally] higher quality, while also being more readily retrievable, and the likelihood of potential recipients being preidentified and matched would be greater). However, since a natural death is not incorporated into the VAE as Life-Extension View (which considers suicide as the only plausible option for individuals who wish to avoid a natural death but to whom VAE is unavailable), this observation is not directly relevant to this paper, although it does strengthen the VAE as Donation-Enhancement View generally.

8 This effect may be compounded by organ sharing schemes, for example the UK Living Kidney Sharing Scheme, in which organs are donated in a non-directed manner by deceased or living donors into paired/pooled schemes to trigger chains of donations that would otherwise not occur. These chains generate multiple organ donations that, in the absence of the initiating donation, would not occur. Donations following AVE made in this manner would therefore trigger increases in welfare of potentially multiple recipients (NHSBT 2018).

9 And potentially to the recipients of other organs, the donation of which was only made possible by the initial organ donation after AVE that triggered a chain of donations within an organ sharing scheme that would otherwise not have occurred in the absence of organ donation after AVE.

10 This includes those donations which are only made possible by a donation after AVE that triggers a chain of donations within an organ sharing scheme that would otherwise not have occurred in the absence of organ donation after AVE (Wilkinson 2011).

Additional information

Funding

The author reported there is no funding associated with the work featured in this article.

Notes on contributors

Richard C. Armitage

Richard C. Armitage is a GP and Honorary Assistant Professor at the University of Nottingham.