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Feedback archive Feedback 2009

Peter Singer: ‘Christians condone murder to harvest donor organs’. Is he right?

Published: 3 January 2009(GMT+10)

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Hippo

Don N, a longtime CMI supporter, wrote as follows:

After reading a book (Writings on an ethical life) by the infamous Prof. Peter Singer I have been somewhat concerned about transplants.

Singer justified infanticide partly on the basis that Christians have no problem harvesting organs from live people. He explains how Prof. Barnard when pioneering transplants shifted from obtaining organs from the dead to the “brain dead” after a committee had come up with this definition which was subsequently ratified by virtually every country. He explained that “brain dead” was a convenient definition for Barnard to help make his work successful. Singer also took to task Christians because they readily changed in spite of the fact that hearts still beat, blood pressure increases as the operation progresses etc. He says that we place to one side “made in the image of God” when convenient and in effect murder the donor to harvest the organs. While I am repulsed by various beliefs of Singer I am not aware of any answer to this (for me at least) vexing question. Do you have any answers?
Yours in Christ

Don

Dr Carl Wieland replies:

Dear Don

Nice to hear from you! I think, without having read his work on this, that Singer may be being a bit sneaky by accusing Christians who accept transplanted organs of condoning ‘murder’ in the case of brain death, and hence not sticking consistently to their stance on humans made in God’s image. It is very much part of the incremental strategy used by misotheists to try to change society in their direction, and it has been seen with the homosexual and abortion issues as well.

What follows is not meant to be the ‘last word’ and not meant to be anything other than a very fallible attempt to wrestle with what are hugely difficult and in some ways almost unanswerable questions. Nevertheless, I think the above statement re Singer can be justified.

I would look at it keeping this list of points in mind:

  1. Organ transplantation per se, to save life or heal disease is condoned/permissible biblically—partly under an implication of the Dominion Mandate in Genesis, but much more so by way of Christ’s example in healing the sick, etc. Temporarily and locally reversing the effects of the curse is often called ‘blessed’ in the Word. Note that some transplants can be made without the death of the donor, e.g. kidneys.
  2. Point 1 above needs to be qualified by adding: “Provided that it involves no breach of any other commandment in Scripture”.
  3. The commandments make it clear that taking of innocent life (murder) is wrong, and there is nothing in this circumstance (such as “hierarchy of biblical principles”) that would override that.
  4. Killing a person in order to harvest their organs to help another is therefore obviously forbidden, even where that person is gravely ill. (cf. What about abortion to save the mother’s life? Which discusses the ethical principle of double effect)

However, point 4 then begs the question that is at stake all along, namely, is brain death real death? In other words, the turning off of “life support” for a brain-dead person is either murder by biblical definition or it is not — whether or not the intention is to harvest the organs.

We can transplant the heart, and the person is much the same. But the same cannot be said for the brain.

So back to the real question, quite independent of organ transplantation — is brain death real death? I.e. irreversible under any circumstances? Or is it the beating of the heart that is the issue? What is the biblical definition of death, or more importantly, of killing a person? Remember that the heart can keep beating via its own mechanisms, via a purely mechanical process in a frog, e.g., when the head is cut off, and the lungs have ceased operating on their own. Unless the lungs are artificially oxygenated, ie. mechanical ventilation, that process of heart beating will soon come to an end (in such a brain-dead person with no lung activity), because the cells of the heart are no longer receiving oxygenated blood.

But if someone is on a mechanical ventilator, and the brain is dead, and the only thing keeping the heart beating is that mechanical ventilator, is that person alive? A strong case can be made for saying ‘no’.

There seems to me to be a (reasonable) assumption in Christian discussions of death of a human being, biblically, that the point at which the ‘persona’ is irreversibly absent from the body is the same point at which there is also no longer any transcendent component present. If you like, the ‘soul has left the body never to return’ in simple language (cf. Genesis 35:18, 1 Kings 17:21–22, Matthew 10:28, as well as Brain chemistry and the fate of the personality after death) and without getting into vexed discussions on soul/spirit or bipartite vs tripartite views, etc.)

Photo iStockphoto

Hippo

So what is the seat of the persona, if you like? Is it the heart/circulatory system? I suggest not. We can transplant the heart, and the person is much the same. But the same cannot be said for the brain. Conversely, heart stoppage is clearly not the final indicator of death, since a heart can often be restarted, e.g. by a defibrillator or CPR. But this must be performed extremely quickly before there is irreversible brain death, and this supports the point in contention that brain death is the final indicator. Indeed, replacing heart death with brain death as the criterion has saved many lives.

In short, it appears to me that a strong argument can be made for the fact that once the brain is truly dead, then the fact that blood is being kept mechanically coursing round the body does not alter the fact of death. It may be that for expediency in ensuring that a potential donor organ is kept oxygenated for longer (and is thus more likely to be successful as a transplant), the artificial oxygenation/ventilation system is kept going longer than would otherwise be the case. (Otherwise the organs would be destroyed by ‘warm ischemia’, i.e. rapid deterioration of still-living cells in organs of dead people after blood flow ceases.)

That would not be, in my view, the same as ‘killing a person to ensure donor organs are fresh’, and would be ethically OK – provided that the criteria for brain death are indeed correct indicators of actual brain death – which is a clinical/scientific question in its own right. So I’m not downplaying the complexity of the issue or the difficulties in making such determinations, I’m just highlighting that it’s not quite the way Singer puts it, if I have understood your email correctly.

My colleague, Dr Jonathan Sarfati, points out, too, that Singer is actually wrong about the origins of the notion of brain death. Wesley Smith, in his informative book The Culture of Death (2000), which strongly argues against euthanasia, organ harvesting and eugenics, points out that ‘brain death’ (coma dépasse) was coined by French physicians in 1959. Dr Christiaan Barnard’s first heart transplant (South Africa) was in 1967 and he used the already existing brain death criterion. But he still waited till the medical machines were removed and cardiac arrest occurred naturally.

Singer is actually wrong about the origins of the notion of brain death.

Many years ago, while I was working as a medical doctor in major hospitals, my experience was that such decisions were made on the best medical/scientific evidence available, were made with care and compassion, and were made on the same criteria by both secular and very strongly Christian professionals. They were made on the basis of sincere belief, to the best of their professional and scientific understanding, that the individual, in the sense of the ‘person’, was truly, absolutely, irreversibly dead (whether or not their organs were still capable of functioning – as in the heart still capable of beating spontaneously under its own steam).

While recognizing that all are fallible, and that sinful man can abuse any system or set of criteria, there was no evidence, at that time at least, that people were having their life support systems prematurely switched off in order to facilitate organ transplantation—if anything, the opposite occurred, i.e. ‘life support’ systems (badly named in this instance, because they were not continuing the life of the person, just the ‘life’ in the ‘biological function’ sense of organs other than the brain) were kept going well beyond the point at which they benefited the (now-dead) patient, for purposes of buying time for the organs to be used in a subsequent transplant.

Some related articles are:

I hope this helps.

Sincerely yours in Christ,

Carl


Nick P from the USA emailed in as soon as the article was published saying:

Dear CMI,

My comment is in unison with Dr. Wieland’s statements. There was an important study done on this subject that was just recently published: "Why the Concept of Brain Death is Valid as a Definition of Death: Statement by Neurologists and Others and Response to Objections," produced by The Pontifical Academy of Sciences in 2008. First I will say that it was only by happenstance that I came across this article: I almost never read about (much less research on) medical topics [ironically though (!), my only response in the past to a CMI article was on the topic of vaccines, which also involved referencing some literature that came from Catholic institutions]. This article caught my attention, and I quickly realized that there is a critical distinction to make (one that I was not previously aware of): Brain DEATH is a completely different matter from other brain related conditions (problems), such as Persistent Vegetative State or Comas. Not being a medical person, I was previously unaware of these definitions, and so when I heard of "brain death," this was immediately associated in my mind with very tough topics such as making hard decisions about when (or when not) to pull a loved one off of life support (due to comas, persistent vegetative state, etc). *Those questions remain hard questions (which many of us will or have had to face)*, but this is A TOTALLY DIFFERENT TOPIC from brain *death*. Therefore, there really should be no controversy on this topic, as long as one is aware of (and assents to) the crucial distinction made above. I have the article in PDF, or you can download it from: (http://www.vatican.va/roman_curia/pontifical_academies/
acdscien/2008/excerpt_signs_of_death_4l_2.pdf, or referenced at http://www.vatican.va/latest/latest_en.htm). The following is an excerpt:

‘“Coma”, the “Persistent Vegetative State”, and the “Minimally Conscious State” are not Brain Death’

The inclusion of the term ‘death’ in brain death may constitute a central problem, but the neurological community (with a few exceptions) acknowledges that something essential distinguishes brain death from all other types of severe brain dysfunction that encompass alterations of consciousness (for example, coma, vegetative state, and minimally conscious state). If the criteria for brain death are not met, the barrier between life and death is not crossed, no matter how severe and irreversible a brain injury may be.

The concept of brain death does not seek to promote the notion that there is more than one form of death. Rather, this specific terminology relates to a particular state, within a sequence of events, that constitutes the death of an individual. Thus brain death means the irreversible cessation of all the vital activity of the brain (the cerebral hemispheres and the brain stem). This involves an irreversible loss of function of the brain cells and their total, or near total, destruction. The brain is dead and the functioning of the other organs is maintained directly and indirectly by artificial means. This state results solely and specifically from the use of modern medical techniques and, with only rare exceptions, it can only be maintained for a limited time. …

As an aside … of course Peter Singer knows all of this. It boggles the mind that someone could be so untruthful


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