Academic journal article The Hastings Center Report

Personhood Redux

Academic journal article The Hastings Center Report

Personhood Redux

Article excerpt

Personhood Redux

It will come as no surprise to those who have observed or participated in the major bioethical debates of the past fifteen years that often contributors on all sides of an issue not only passionately disagree but seemingly talk past one another. Genuine debate is infrequently joined because advocates of a given proposal often resist the impulse of critics to explore both its probable and unanticipated consequences. Typically, advocates characterize their proposed change in the bioethical status quo as a commonsense accommodation to changing mores and advances in medical technology. They are not interested in "what-ifs," but want debate on their recommendation limited strictly to its "merits."

By contrast, critics usually ask two related questions. First, how momentous--now and in the foreseeable future--will the impact of the contemplated change be on the immediately affected group, be that the unborn, disabled infants, or those in a persistent vegetative state? Second, is the reasoning used applicable to others, especially to broader categories of the medically dependent and disabled? Such questions require that the assumptions underlying a given proposal be spelled out if we are to know whether the requirements for inclusion under society's protective arm have been revamped. That is, are the qualifications for "personhood" being altered, and if so, at whose expense?

Proponents typically deny any broader implications, or deny that anyone can say what they will be. Nor do they believe they should be held responsible if others build on (or distort) the change they are recommending. In addition, they may attempt to preclude further debate by asserting that, paradoxically, it is the critics' rigid adherence to such abstract principles as the sanctity of all human life that will guarantee that when the inevitable readjustment is made, the changes will be far more sweeping than they would have been had opponents simply bent a little.

The controversy over Loma Linda University Medical Center's (LLUMC) protocol for using infants born with anencephaly as organ donors is a classic example of this phenomenon. Most of the transplant surgeons and associated medical personnel at Loma Linda assure observers and critics that while the use of anencephalic babies as organ donors may seem like an abrupt change in the way we customarily treat patients, it is in fact good and ethically responsible medicine. The child's dignity, it is claimed, is preserved for two reasons: First, even though the infant is placed on a ventilator solely to maintain his organs until he qualifies as brain-dead, this procedure is limited to a maximum of seven days. Second, they are "respected as human beings because they serve a highly worthwhile purpose."

Nor on their view is the baby's humanity compromised. Indeed, in one sense it may be enhanced. While the anencephalic child will certainly die, his organs will "live on" in another child who would otherwise die. Most important, physicians involved in this controversial practice vigorously insist they are honoring "accepted" criteria for brain death. [1]

Why all the criticism? Why has the National Right to Life Committee called on LLUMC to observe a moratorium? There are three principal reasons. To begin with, if physicians await a reliable diagnosis of total brain death, in all likelihood anencephalic infants would never become a source of usable organs. [2] Several Canadian physicians associated with such transplants have recently complained that their efforts cannot succeed unless there is a change in the method of determining brain death in anencephalic infants. On the one hand, parents who initially agreed to allow their child's organs to be removed are withdrawing their consent when after several days on a ventilator their child is not brain-dead. On the other hand, physicians are acknowledging uncertainty about what will happen if anencephalics are maintained on life support and given palliative care. …

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