According to the American Medical Association (AMA) killing one patient to benefit another is acceptable medical practice. Specifically, they justify the killing of anencephalic neonates [newborns with most of their scalp, skull and brain missing] for the benefit of other children needing organs. "It is ethically acceptable to transplant the organs of anencephalic neonates even before the neonates die," says the AMA's Council on Ethical and Judicial Affairs (CEJA).2 Reversing their 12008 opinion3, they claim consistency "with the majority view among experts in medicine and ethics." This strips ethics of its meaning (ethics is from ethos that at its root means a place of permanence). What the CEJA has done is change its morality. Their justification for doing so was that their reversal "is consistent with the majority view among experts in medicine and ethics."
The CEJA felt compelled to change their opinion for three reasons. First, because there is a shortage of organs for transplantation in infants and young children who "usually can benefit from organ transplants only if the organs are taken from children of similar size." This argument is "compelling" because "many children will be saved from death, and many other children will realize a substantial improvement in their quality of life." Second, "parents may find much of their psychological distress alleviated by the good that results from donating theirchild's organs . . ." Finally, the CEJA implies there is a different worth for anencephalic newborns. ("They never have thoughts, feelings, sensations, desires, or emotions. There is no purposeful action, social interaction, memory, pain, or suffering.") In summary, the CEJA believes the life of such a child may be taken because other children have needs and can be benefited by the killing of anencephalics; parents may only find value in their child if the child is sacrificed for another; and the severe devaluing handicap resulting from the absence of the above-listed abilities.
Although they claim that their reversed opinion does not violate the "value of the respect for life," it does exactly that. Using doublespeak they argue, "Respect for the essential worth of life is an absolute value in the sense that it exists irrespective of a person's quality of life. However, it is not an absolute value in the sense of overriding all other values." Is it absolute or not? The AMA places the value of life relative to other values, which they feel to be higher in nature. This ethical schizophrenia is highlighted by an earlier Council statement, "The intentional termination of life of one human being by another . . . is contrary to public policy, medical tradition, and the most fundamental measures of human value and worth."4
It is documented that parents can have a warm, positive bonding experience with their babies who have anencephaly. Though such documentation is anecdotal, it is more unbiased than the CEJA postulating that there may be some psychological benefit to parents if they will agree to sacrifice their babies to provide improved quality or length of life for another child.
It is a tragedy that many infants and children (40% to 70%5) in need of a transplant die awaiting a donor organ. We need to do all we can through scientific research and public education to provide for these children in a manner that maintains respect for all life, not just the more functional life or life with more predictable longevity.
Responding to the AMA decision, Rabbi Lester Frazin of Sacramento said, "Experimenting or harvesting organs from living human beings is reminiscent of Nazi Germany experimentation."6 The goal of Nazi eugenics was purification of society, establishing a right and a duty to kill for the good of society as a whole. Similarly, the CEJA report states "there is a compelling social interest in permitting the use of organ transplantation" with organs from newborns with anencephaly [emphasis added].
The philosophical prelude that prepared the German medical profession for the Holocaust was introduced in 1920 in "Permitting the Destruction of Unworthy Life."7 This paper argues that there is life that has no value to the bearer of the life or society because it: Never possessed or completely lost purpose; is the "fearsome counter image of true humanity"; arouses horror in nearly everyone. These were "lives no longer worth living." They were Untermenschen. Beginning with the killing of those with congenital or acquired idiocy, Nazi social purification eventually included bedwetters, amputees and millions of Jews. The AMA argues this cascade would not occur today.
The implications of the AMA's position regarding infants with anencephaly are enormous for the mentally disabled, elderly and severely injured. A recent paper from an organ transplant center seeks to expand those who are recognized as brain dead so that their organs would be available for transplants. It stated, "A redefinition of brain death applying only to human beings born without a brain [anencephalics] would make more donor hearts available."8 Similar redefinitions could easily classify those with significant mental disability as brain dead.
"Killing one patient to benefit another is a line that society should not cross," said pediatrician Eugene Diamond. Yet the AMA is leading its profession across this line. Will we as a society endorse this? No human being, however disabled, exists for the medical benefit of another, any more than for his pleasure or convenience. Anencephalic infants are human beings entitled to respect like all human beings and no one should have the right to take their lives for any reason.
Are these precious babies our new Untermenschen? Are their lives not worth living? Do they no longer merit the legal, moral and ethical protection of society? They are society's ultimate helpless children deserving our utmost compassion and protection.
2. Council on Ethical and Judicial Affairs, American Medical Association: The use of anencephalic neonates as organ donors. JAMA, 1995; 273: 1614 --1618
3. Council on Ethical and Judicial Affairs, American Medical Association: Anencephalic infants as organ donors. In: Code of Medical Ethics: Reports. Vol. I. Chicago, American Medical Association, 1992, 49-52
4. Quoted in Kinsella TD, Singer PA, Siegler M: Legalized active euthanasia: An Aesculapian tragedy. Bull Am Coll Surg, 12009; 74: 6 -- 9,56
5. Friedman JA: Taking the camel by the nose: The anencephalic as a source for pediatric organ transplants. Columbia Law Rev, 1990; 90: 917 --978
6. Public Policy Division, Focus on the Family: AMA okays organ harvesting from live anencephalic babies. Family Issues Alert, 1995; 3: 1,2
7. Binding K, Hoche A: Permitting the destruction of unworthy life. Issues in Law & Medicine, 1992; 8: 231--265
8. Diaz JH: The anencephalic organ donor: a challenge to existing moral and statutory laws. Crit Care Med, 1993; 21: 1781 --1786.
Copyright © 2002. This article can be found on the Center for Bioethics and Culture website (link closed). Reprinted with permission.