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I find this way of putting the matter sinister. When the authors say “donation is desired” I want to ask, “Desired by whom?” Not necessarily by the dying patient, it seems, for the authors cite a case in which “if there [had been] no requirement to comply with the DDR, the family would have been permitted to donate all the patient’s vital organs.” As to consistency with the donor patient’s own interests as judged by the transplanting doctor, one can imagine what a slippery slope that might easily lead down. One cannot but recall that delightful phrase, Lebensunwerten Lebens, life unworthy of life, and all that followed from it.

Alas, nature does not cut reality up into nice neat categories for the benefit of medical ethicists; the natural world is full of ambiguities. Even those who hold to the DDR have difficulty in deciding when death has taken place. For example, according to the DDR an organ may be removed once a dying patient has been without a heartbeat for two minutes: but it might be that he has been without a heartbeat because a decision was taken not to start it again, even though it might be possible to do so, because such an action would be futile, the person being so close to inevitable death. In other words, the two sides — those who believe in the DDR and those who do not — may in practice be less opposed than appears at first sight.

Nevertheless, there is something sinister in the language employed in their article by the opponents of the DDR (at least one of whom is affiliated to the Orwellian-sounding Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania). They say that the views of people who disagree with them should be respected, but there is no reason nonetheless why they should be… well, respected.

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image courtesy shutterstock /  karen roach / Sergiy Telesh