- Hardcover: 208 pages
- Publisher: Oxford University Press; 1 edition (October 28, 2011)
- Language: English
- ISBN-10: 019973917X
- ISBN-13: 978-0199739172
- Product Dimensions: 9.4 x 1 x 6.3 inches
- Shipping Weight: 14.9 ounces (View shipping rates and policies)
- Average Customer Review: 2 customer reviews
- Amazon Best Sellers Rank: #2,915,739 in Books (See Top 100 in Books)
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Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life 1st Edition
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Although the authors draw extensively from their argumentation in published articles, this is their first full-length presentation... Their argument should be taken seriously by academic bioethicists." -- DOODY'S
"This slender, 174-page book is engaging and will have broad interest to all professionals and academicians whose work touches on issues surrounding the withdrawal of lifesustaining treatment, vital organ transplantation, or both. I highly recommend Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life and consider it one of the best bioethics texts I have read in the last year." -- Andrew R. Barnosky, DO, MPH, JAMA
The core metaphysical conclusion of the book is that "the human being dies when the body ceases to function as an organism, which is marked by the irreversible cessation of circulation and respiration" (p. 78). In support of this claim, the authors draw on a rich acquaintance with clinical practice, the relevant neuroscience, and the scientific and political history of the notion of brain death, offering a highly informed case for the view that the elimination of brain function does not destroy the ability of the rest of the organism to function in an integrated fashion." -- The Hastings Center Report
"This book is amodel of quality scholarship in bioethics. The central arguments are detailed, carefully constructed, empirically well grounded, and are presented in cogent, clear prose with an economy of style, all of which are helpful to the reader in readily identifying loci of agreement and disagreement." -- Benjamin E. Hippen, Metrolina Nephrology Associates, The American Journal of Bioethics
"An extensive, relevant bibliography supports the text. Summing up: Recommended. Upper-division undergraduates and above." - J.N. Muzio, emeritus, CUNY Kingsborough Community College, CHOICE
"This book is very well developed in the challenges posed to the current way of thinking about clinical death and how these challenges relate to the current organ... Students and clinicians who work with patients in intensive care unit settings will benefit in many ways from the content in this book. Expanding one's mind beyond the status quo always results in meaningful knowledge and personal growth, whether one accepts the precepts or not." -- Lisa Anderson, DrPH, MA, MSN, Clinical Ethics Consult Service, University of Illinois Medical Center
"Whether one agrees with Miller and Truog's viewpoints and proposals, there is no denying that this is a stimulating and thoroughly engaging book...although the book's focus is on issues at the end of life, it also carries implications for other areas over which the discourse of medical ethics casts a critical eye. For that reason, it is likely to appeal to practitioners,
teachers and students of medicine and medical ethics." -- Kartina A. Choong, University of Central Lancashire, Medical Law Review
About the Author
Franklin G. Miller, Ph.D. is retired from the senior faculty in the Department of Bioethics, National Institutes of Health and currently Professor of Medical Ethics in Medicine at Weill Cornell Medical College. Dr. Miller has published a book of his selected essays, The Ethical Challenges of Human Research, edited six books, and published numerous articles in medical and bioethics journals on the ethics of clinical research, death and dying, professional integrity, pragmatism and bioethics, and the placebo effect. Dr. Miller is a fellow of the Hastings Center and Associate Editor of Perspectives in Biology and Medicine.
Robert D. Truog, MD. is the Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics and Director of the Center for Bioethics, both at Harvard Medical School. He has practiced pediatric intensive care medicine at Boston Children's Hospital for more than 25 years.
Top customer reviews
 If it is true that doctors should not cause the death of their patients for any reason, then withdrawing life-sustaining treatment at patient request is impermissible.
 But it’s not.
 Therefore, it is false that doctors should not cause the death of their patients for any reason.
The problem with this assumption is that “causes death” and its cognates is ambiguous. Surely there is a sense in which withdrawing life-support is causally related to the *timing* of one’s death, but it is dubious to suppose that it is the proximate cause, or *the* cause of death. If it were, then a lifeguard who ceases performing CPR and mouth-to-mouth resuscitation is the primary cause of death for the one whom she rescues but cannot revive no matter how hard she tries. True, her ceasing contributes to the time of the victim’s death, yet it is still plausible to suppose that the primary cause of death is the irreparable damage caused by nearly drowning, not the cessation of efforts that keep oxygenated blood circulating. But on Miller and Truog’s analysis, it is not plausible to say this, which we should take to be a problem for their view.
The other argument goes like this:
 If it is wrong to kill the donor, then it is impermissible to retrieve organs from brain-dead donors or from non-heart-beating-donors.
 But it is permissible to do so in both cases.
 Therefore, it is not wrong to kill the donor.
The soundness of this argument depends on the claim, defended in two separate and very interesting chapters, that brain-dead bodies are not dead bodies, and that the cardiac function in the accepted donation-after-cardiac-death protocols is not irreversible, something that is assumed to be necessary for death (resurrection is assumed to be impossible). Let’s suppose this is right. Why think premise  is true? Answer: neither the consenting “brain-dead” donor nor the consenting non-heart-beating donor are harmed by transplant surgery, which of course causes their death (though they advise that they should be given general anesthesia to make sure they feel no pain). What makes killing wrong, then, is explained in terms of the harm done to the one killed, or the disrespect to one's autonomy if there is no valid consent (or both). The the life of an innocent person must be protected unless (1) the innocent will die imminently in any case, and (2) the innocent is willing to die; that killing someone who meets these two conditions might benefit others, as it probably would in organ donation, only serves to bolster the case for killing via transplant surgery. But this view is no good; it would still be wrong to hang today an innocent though willing person (unfortunately) on death row scheduled to die tomorrow so as to appease a murderous mob who would kill a hundred more today if the hanging were to occur tomorrow. The innocence of the victim seems to make a difference in this case despite the fact it satisfies Miller and Truog’s criteria. Why not in organ donation? Perhaps intuitions will vary one this, but more needs to be said for why innocence doesn’t matter in the context of vital organ donation, especially from those like Miller and Truog who reject utilitarianism as a sound moral theory.
Miller and Truog’s positive case for causing death in the context of vital organ donation is conditioned on a prior decision by the potential donor to withdraw life-sustaining treatment. As they see it, no one would be made dead by the process of procuring vital organs who would not otherwise be made dead by withdrawing life-sustaining treatment, provided that withdrawing life-sustaining treatment causes death (p. 116). But as we’ve seen, that is a controversial proviso. They readily acknowledge that some patients will die by transplant surgery who might otherwise continue to live because of our imperfect ability to prognosticate death after the withdrawal of life-sustaining treatment. The example of Karen Ann Quinlan is a good example. They are willing to accept this risk, however, in light of the benefits that would come to the organ recipient as well as the respect for the wishes of the donor to end her life. What they are not willing to risk is possibly damaging the organs from warm ischemia in a protocol that would begin surgery *after* withdrawing life-sustaining treatment and at the time of asystole (p. 121). On their view, the risk of harming the organs outweighs the risk of harming of the donor, something that is incompatible with the intuition that protecting the donor from harm should take precedence over protecting the organs from harm. This wretched asymmetry of value in favor of the organs over the the life of the donor is common to all proposals that reject the DDR, and Miller and Truog’s is no exception.
What about healthy people? Can they consent to their own deaths in some act of “organ donation euthanasia”? No says Miller and Truog. To be sure, they concede that no wrong would be done to a healthy donor if she were to give valid consent to her death by organ donation (p. 129). But in their view, the surgery team would still act wrongly if they followed through, because doing so would violate a widely accepted standard of professional integrity, that killing a healthy person conflicts with the goals of medicine. But the goals of medicine turn out to be relative to their culture context. Says Miller and Truog:
“Suppose further that the request to donate was made by a patient living in a country, such as the Netherlands and Belgium, that legally permits euthanasia by lethal injection. In this particular context, the logic of our ethical framework for vital organ donation would permit organ procurement in this case, and no valid considerations of professional integrity would preclude it (p. 131).”
Thus “professional integrity” appears to be a wax nose that can be shaped by the mores of the culture and not anything objectively moral. Medical ethics, however, should reach for something more firm than the shifting sands of moral relativism: safeguarding the health of the patient and not destroying it no matter how little of it may be left should be a universal goal.
The short of it, then, is that this is a good book to read if you want to get the skinny on how revisionists would reshape ethics at the end of life. The authors are forthright, honest, and provide a nice bibliography of the relevant literature. But, as I see it, the main arguments in favor of their policy recommendations need more work.