Wanted, Dead Or Alive (Letter to the Editor) (Report‪)‬

To the Editor: In "Rethinking the Ethics of Vital Organ Donation" (Nov Dec 2008), Franklin Miller and Robert Truog offer a provocative argument for overturning status quo justification for medical decision-making at the end of life. They do this in the name of providing a more "honest" justification for the procurement of vital organs for transplant. They correctly point out that incoherencies and practical difficulties involved in diagnosing death have led to an unsatisfactory justification of current practices in organ donation. But their proposed solution ignores equally troublesome issues in obtaining informed consent from patients and surrogates. Miller and Truog argue that when a patient dies after life-sustaining treatment is withdrawn, the withdrawal is the cause of death, and therefore, the physician who orders it has caused the death. This contrasts with the status quo view that withdrawing life-sustaining treatment allows death to occur, but that death itself is caused by the underlying illness. On Miller and Truog's view, the key element distinguishing a justified causing of death by removal of life-sustaining treatment from criminal homicide is that the patient or surrogate consents to removing life-sustaining treatment. This allows them to argue that causing death by removing vital organs can also be justified by patient or surrogate consent, freeing organ procurement practices from the need to be justified by suspect neurological or cardiovascular criteria for death.