Euthanasia increases organ donations in Canada amid ethical concerns

Ottawa, Canada, Jan 7, 2020 / 10:00 am

Increasing numbers of people killed by euthanasia are supplying a "boon" for organ transplant surgeries in Canada, according to an Ottawa newspaper. But politicians and ethicists told CNA the practice was "rather horrifying" and raises questions of "coercion."

A Jan. 6 article titled "Medically assisted deaths prove a growing boon to organ donation in Ontario" in the Ottawa Citizen, explained that while the number of people in need of a transplant in Ontario has remained relatively static, fewer and fewer people are registering in advance as donors, with assisted deaths providing a positive answer. 

"This relatively new source of organs and tissues is significant in that Ontario's waiting list for organs typically hovers around 1,600 without any great headway made to eliminate that number," Bruce Deachman reported.

From January until November of 2019, there were 18 organ and 95 tissue donations from patients who died by euthanasia. These numbers, which do not include the month of December, represent an increase of 14% over all of 2018, and 109% compared to all of 2017. 

According to the Trillium Gift of Life Network, which runs organ and tissue donation in the province of Ontario, these donations were 5% of the province's overall number of organ and tissue donations. This was more than double the percentage of euthanasia-related donations in 2017. 

"Medical assistance in dying," as it is legally referred to in the country, has been legal in Canada since 2016. Canadians who have a "grievous and irremediable medical condition" are able to elect to end their lives. This is defined as a "serious and incurable illness, disease or disability" that results in "an advanced state of irreversible decline in capability," and causes "enduring physical or psychological suffering that is intolerable" and cannot be treated in an "acceptable" manner. 

A person's death has to become "reasonably foreseeable" in order to be approved for euthanasia, but their condition does not necessarily have to be considered terminal.

In Ontario, Trillium "proactively" solicits patients to discuss organ donation once they have elected to be killed. It is provincial law that Trillium be made aware once a person has been approved to end their life. 

Ronnie Gavsie, the CEO of Trillium, defended this as "the right thing to do for those on the [organ donation] wait list." 

"And, as part of high-quality end-of life care, we make sure that all patients and families are provided with the information they need and the opportunity to make a decision on whether they wish to make a donation," Gavsie told the Ottawa Citizen. "That just follows the logical protocol under the law and the humane approach for those who are undergoing medical assistance in dying." 

In Quebec, it recently was approved for Transplant Quebec to raise the possibility of organ donation after a person's request to die by euthanasia is approved by doctors. 

Conservative MP Michael Cooper told CNA that while he is not necessarily opposed to someone donating their organs after dying by euthanasia, he said the practice raises questions regarding consent, and opens up the possibility of coercion. 

"The concern that I have is that it muddies the waters in terms of the patient making a decision freely, without any degree of coercion or influence from anyone," said Cooper. He added that with the current setup of physician-assisted death in Canada, there is a chance that it is administered to a patient who is not able to properly consent or who may not want to die. 

Organ donation "should not be part of the conversation" when a patient makes a decision regarding physician-assisted dying, said Cooper, and that he feels as though the decision to donate one's organs should be "completely separate" from the decision to pursue euthanasia. 

Dr. Moira McQueen, a moral theologian and the executive director of the Canadian Catholic Bioethics Institute, told CNA said such practices appear "rather horrifying." 

McQueen cited the scenario of a patient who opts to begin the euthasia process at home and be transferred to a hospital for organ donation as one that sparks "even more ethical and legal problems." In this case, a patient would essentially be sedated at home and then transported to a hospital for the final dose of lethal medication and then have their organs removed. 

"That situation makes it clearer that the focus is truly on 'harvesting'," said McQueen. "The donor's dignity is compromised and the 'separation' of teams that is supposed to be the warrant of independence of the teams is completely blurred." 

While the Church does not have ethical issues with the use of organ donations from consenting donors who died natural deaths, or from unconscious donors whose relatives have elected to donate their organs, McQueen said there are serious ethical questions about the transplant use of organs retrieved after euthanasia. 

"There's no Church teaching on it that says specifically, you can't. There is definitely something that talks about the dignity of the body, and I would think, as a Catholic, most of us would say 'oh no, you can't use these organs because the person has died a sinful death, died a wrong death by asking for euthanasia," she said.

The ethical questions regarding this situation have not been resolved, she explained, and that she could see both sides of the issue. McQueen told CNA that she feels the conversations regarding organ donation and euthanasia need to be completely separate. If this were the case, following the death of the patient, the organs could be considered "neutral." 

"I think there could be a possibility that [the organs] could be used, despite the fact now that we are talking about people who have asked for euthanasia," she said, but could only be considered if the medical team administering euthanasia was entirely and wholly separate from the medical team that handled the organ retreival. 

"I think the Church will eventually deal with all these implications, but right now everyone is watching these events unfold and it's tricky to separate what's morally wrong," she said. 

Given that a person who is approved for euthanasia may not be terminally ill, McQueen said it is not out of the realm of possibility that a primary physician "might well suggest organ donation as, if not an incentive, a kind of 'consolation' for the person's own loss of life."

"These scenarios are all too real, and many people will be all too willing to 'justify' their decisions by turning something which even to them cannot be an unqualified good into something quite noble," she said.

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