March 28, 2021

Assisted Dying and Organ Donation

At Exit, we are often asked about assisted dying and organ donation. For example, is it possible to donate one’s organs after a suicide or, in the context of an assisted dying law, after the assisted death/ assisted suicide.

In general, the answer has always been no, except in countries such as the Netherlands, Belgium and, more recently, Canada. This is despite widespread organ shortages in almost all western countries.

Indeed, I was especially heartened to receive by mail in Amsterdam last month, notification from the Dutch health authorities informing me that my adopted country now had an opt-out system of organ donation.

This means that should I be hit by the proverbial bus, my organs and tissue will automatically go into the organ collection pool. I can opt out of this new scheme if I want, but I won’t.

There have always been strong public policy reasons as to why a person who is electing to die early/ voluntarily (through a VAD – voluntary assisted death) cannot donate their tissue or organs.

The most obvious of these is the perception that the person may be encouraged to ‘do the right thing’ in order to give their body parts to others. It could be seen that the person is being encouraged to suicide for the greater good.

This standpoint seeminly had enough political traction to be published in the British Medical Journal March 2020. The article by a little known researcher from Belgrade, Dr Zeljka Buturovic, argued that there were no sufficient safeguards that would ‘disentangle MaiD from organ donation decisions’.

Pro-life fanatics such as Wesley J. Smith have long scare-mongered that assisted suicide laws would create untold fortunes for the ‘organ donation industry’. As always with such extremists, the situation is black and white with no room for a nuanced, humanist approach in between. They argue the slippery slope is real; we will soon all be being put down so as organs can be sold on.

Others highly critical of allowing mutual assistance in dying and organ donation such as the outspoken American Catholic doctor, E. Wesley Ely, have suggested that this is a short route towards euthanasia via organ harvesting. That is, people are put down because their organs are removed. Rather than those organs being removed after the person’s ‘good death’ (euthanasia).

The highly politicised field of assisted dying and these sensationalised ‘ethical dilemmas’ (the church is a powerful lobby group) have been enough to scare legislators into excluding the topic of organ donation from many of the new right to die laws that are now sweeping the western world. No where in Australia or the US for example, can a person who is getting lawful help to die, elect to donate their organs.

However, as with so many areas of life, it has been the pragmatic Dutch (and Belgians) who have led the way with devising a path forward where euthanasia recipients can give life to others.

Organ donation has been possible in the Netherlands since 2011, with the first clinical guidelines devised in 2017. More recently, Canada has followed suit. In all countries that allow both practices, the ‘dead donor rule’ applies: meaning that organs are only taken after the euthanasia or assisted death has been completed. So much for the hysterics of the anti-choice lobbyists.

Practical Problems

Of course, organ donation of euthanasia/ assisted dying recipients is no straight forward affair. There are numerous practical issues which make the practice difficult.

For example, most people will need to die in a hospital if their organs are going to be successfully harvested and donated to others. Yet most people want to die at home. Fortunately, modern medicine is coming to the rescue. On 7 March 2021, Canadian Huntington’s disease sufferer, Mike Neill, made the headlines when he was able to donate his lungs. What was so special about Mike’s ‘gift of life’ is that he died at home. The media reported this donation as a ‘world first’.

The donation of a major organ such kidneys, lungs, hearts and livers after euthanasia/ assisted dying stands in stark contrast to tissue donation which can be recovered following home deaths. In this regard, the donation of eyes, heart valves, bone tendons and skin is much more straight forward.

The Benefit of Planning Ahead

Many people who elect for an early death/ assisted suicide have a deeply thought-out sense of the world and their place in it. If we were to characterise Exit Members it would be as older people who know their minds. They tend to be people who have led highly independent, autonomous lives and who are used to making their own decisions and being in control.

One benefit of planning for an assisted death followed by organ donation must be the fact that it can be planned ahead of time, and every detail discussed and thought through.  The relative time of death is always known so the services needed to make the organ donation successful can all be put in place before hand.

Planning ahead for donating one’s organs also removes the person’s family and loved ones from having to make often difficult decisions at a time of extremis. And consent can be withdrawn right up to the last moment, allowing for flexibility in individual decision-making.

Organ Donation in Switzerland

It has long been bemoaned that in the one country in the world where one does not need to be seriously ill in order to get lawful help to die, that organ donation in prohibited. Like most other countries, Switzerland is presumably concerned about the message it would send if recipients of assisted suicide were also allowed to donate their organs.

Would people be pressured into dying, just so their organs could be donated? This seems an ironic question for a country which allows the use of organs of those who die by ‘violent, unassisted suicides’. It seems the principal stumbling blocks for the Swiss lie in practical concerns.

Given that most people who are helped to die in Switzerland die at home or at an assisted suicide clinic, how might the organs get to hospital where they are needed. What about the quality of the organs? And would allowing organ donation act as a disincentive to those travelling to Switzerland for an assisted death if they knew what ‘could’ happen after they are gone.

As a country with a scarcity of organs available for transplant and a historically week culture of organ donation, it seems a hugely wasted opportunity.

Imagine what can be

At Pegasos Swiss Association, one makes the VAD application online. In the course of this application, all sorts of boxes are ticked. What music would you like us to organise for you? Do you wish to have champagne for a final toast? Where should we send your ashes? Who will be accompanying you? And so on it goes.

How sensible, common sense and convenient would it be to add the box, do you wish to donate your tissue and organs once you are gone? Tick for yes.

This would allow Pegasos’ Organ Donation Facilitator (an imaginary futurist position) to make the appropriate arrangements, thereby ensuring that your death gives life.

Alas.

Canada’s Way Forward

Organ donation seems to be a last bastion for change within the assisted dying movement. Canada is to be congratulated for going it alone in following the Benelux lead. This country is proving innovative and progressive when it comes to tweaking its end of life law to accommodate the needs of its citizenry.

As of March 2021, to qualify for help a person no longer needs to have a death that is ‘reasonably forseeable’ (a criteria which in other jurisdictions is translated as < 6 months to live and which is hugely problematic).

This expansion of qualifying criteria opens the way for people with disabilities and other conditions that have no clear prognosis but which make one’s life so miserable that a dignified death has become a preferable option.

Finally, the recent Bill C-7, via a new sunset clause, leaves the way open for people suffering from mental illness to be able to ask for help to die.

In Canada, unlike in the Netherlands and Belgium, a request to die can still not be included in an Advance Health Directive and nor can people who have ‘completed life’ or are ‘tired of life’ ask for help to die.

Finally, there is nothing in these legislative changes that take the decision-making away from the medical profession.

There is no Dutch-style Completed Life Bill which advocates that all people over 70 years of age should be able to be issued with Nembutal so that they can make their own end of life decisions should the need ever arise.

In this regard, there is no place like Holland!