Playing God

Cleveland Clinic Hospital may have created a monster.

A prosecutor in the city has accused the hospital of hastening organ donors' deaths in order to procure critical tissues for transplant. Ordinarily, organs are only taken from individuals who have been declared brain dead. A new proposal put forth by the Cleveland Hospital, and backed by many ethicists across the country, would allow doctors to remove organs from terminally ill patients just minutes after their hearts have stopped beating.

The issues involved are more than medical. There are legal concerns, for instance. Two drugs often administered to organ donors prior to their deaths now face scrutiny. Neither is intended for the benefit of the patients but rather to preserve their organs for future transplant. Some doctors allege these drugs may actually help speed death along. If this is the case, the proposal amounts to an authorization of active euthanasia-still considered manslaughter in most states.

But even if the drugs-which together are only supposed to prevent clotting and widen blood vessels-are determined to have no detrimental effects upon the patient, there are grave moral concerns at stake. As medical technology and expertise has progressed, the line between "living" and "dead" has been blurred. Doctors can sometimes restart hearts for many minutes after the y have failed. When should a doctor give up? Would a doctor put forth his best efforts to save a patient whom he knows to be an organ donor? And more importantly, is not administering these organ-preserving drugs before the patient's death an admission that his physician has already given up on him?

Some ethicists point out that these patients are gravely ill to begin with; the loss of a life that was drawing to a close is tragic, but that individual's organs could possibly save several other patients' lives. Doctors are responsible for these lives as well-ones that could survive for decades after a transplant is made.

This type of utilitarian calculus is frightening. A great deal of trust and faith is placed in the medical profession today. The idea that a doctor might be be forced to essentially play God and decide which patient lives and which patient dies extends the power of doctors beyond the field of medicine into a field no one is qualified for.

The choice many individuals have made is to simply not place doctors in that sort of position at all-they refuse to sign organ donor cards or decline a sticker on their driver's license. But while this may solve the problem for most people, those in desperate need of a transplant are ill-served by a public unwilling to donate. Regardless of the outcome in Cleveland, the case has been a public relations disaster, raising fears that doctors will begin "farming" or "harvesting" organs from the people entrusted to their care.

The solution to this problem must come from the medical community. Clear standards must be set, with guidelines acceptable both to professionals and laymen alike. Nothing less than doctors' professional integrity is at stake in this issue. "Above all, to do no harm" is the concluding phrase of the Hippocratic oath. If we can no longer implicitly trust doctors to make decisions on the basis of an individual patient's health, without regard to the supply and demand for organs, then the whole basis of medical treatment in this country falls apart.