The Ethics of Organ Donation Euthanasia

The Ethics of Organ Donation Euthanasia
June 16, 2020 No Comments Brave New World Apara Sharma

Saving Lives via Actively Ending Lives: the Ethics of Organ Donation Euthanasia

By Claire Chou

In this paper, I explore the ethical implications of organ donation euthanasia, a hypothetical procedure in which the cause of the patient’s death is their vital organs being removed in the operating room. These organs would then be available for transplantation. There is an extreme dearth of organs available for transplantation, making this a relevant topic from a utilitarian standpoint. However, organ donation euthanasia also raises questions of whether the ethical values of autonomy and non maleficence are being challenged. For example, by legalizing ODE, would we be spreading the message that terminally ill people have more value as organs than as living individuals? On the other hand, these same values (autonomy and non maleficence) can be used to support ODE. For instance, ODE facilitates a non painful death while guaranteeing one’s last wish is granted.

Table of Contents

Abstract

Imagine a patient in the terminal stage of their illness, Patient X, who has decided to cease treatment, which  will lead to their death.   Imagine patients in neighboring hospitals who need organs to greatly improve the quality of  — or even save — their lives . Patient X also wants to donate their organs.   The doctor informs them that after treatment has ceased, machines have been withdrawn and they have died, their organs may be harvested with their consent. However this method of organ procurement is not failsafe- the time it takes a patient to die may render organs not useable. Further, it is not optimal- harvesting organs from alive patients would maximize both the quantity and quality of organs retrieved.  If the doctor were to cause death by removing the patient’s organs this would drastically minimize ischemic time, meaning blood and oxygen would continue to flow through organs virtually up to the moment of retrieval. 

“Why don’t you just take them now? I’m going to die soon anyway.  I’m uncomfortable. I’ve lived a good life but I’m not really living anymore… please stop my suffering and let me help other people.”

– asks Patient X

But the procedure that would guarantee that this altruistic request was granted seems to be the polar opposite of what medicine was designed to do: to cure, to preserve, to do no harm. The procedure described here- ending a patient’s life via harvesting their organs for transplant- is organ donation euthanasia, and it is not yet legal anywhere in the world. 

Would it be ethically permissible to intentionally end a patient’s life via euthanasia to retrieve the most amount of their organs possible in the optimal condition?  In the United States, it is not legal for a physician to cause a patient’s death; ie euthanasia is illegal.  With withdrawal of life sustaining treatment, the disease is technically causing the death of the patient. With medical aid in death, the patient is causing their own death by self administering the lethal drug. With both withdrawal of life sustaining treatment and medical aid in death, one can donate organs.. However, doctors cannot currently legally harvest the patient’s organs until after the patient’s heart has stopped, a procedure known as donation after cardiac death. Having to wait to harvest organs until after cardiac death causes the organs to organs decrease in viability. Thirty percent of all natural American deaths occur in hospitals,  making this a relevant issue. (Christensen, 2019)

Demand for organ transplantation has been rising rapidly owing to the increasing incidence of end-stage failure of many vital organs including kidney, liver, and heart. In the US there are currently about 114, 000 patients on the transplant waiting list for a life saving organ.   But less than 40, 000 transplants were performed in 2019. There is a dearth of organs available for transplant. 

On average, 20 people die every day from the lack of available organs for transplant. 

-American Transplant Foundation

Organ donation euthanasia in theory would look like this: once a patient has decided to die as well as become an organ donor, they would be brought to the operating room and given anesthesia and their organs would be removed. Death would follow the removal of the heart. Unlike with the current legal donation after cardiac death, there would be no time where organs were decreasing in viability with organ donation euthanasia because blood and oxygen would continue to flow to the organs until the moment of retrieval.  Organ donation euthanasia could increase the number of potential organ donors by up to 2201 organs per year in the UK. (Wilkinson & Savulescu, 2012 ) This figure may be similar in the United States because our existing protocols are very similar. 

In this paper, I will discuss the ethical implications of organ donation euthansia if it was to be implemented in the US for those who are terminally ill (have a disease that cannot be cured and will eventually lead to death), have a prognosis of six months to live, have decided to withdraw life sustaining treatment, and will die when life sustaining treatment is withdrawn. I will also discuss organ donation euthanasia as an option for those who already qualify for medical aid in dying.  Organ donation euthanasia for patients who want to be euthansized but have any other condition, such as are terminally ill but not in the terminal stage of an illness, are disabled, or are depressed, is beyond the scope of this paper.

Arguments Against Legalizing Organ Donation Euthanasia

Autonomy should be limited because people do not always know what is best for themselves.  For example, people will want organ donation euthanasia instead of holding on to hope/ making peace with their quality of life. To quote David Vellman, “My worry in particular is that the word ‘dignity’ is sometimes used to dignify, so to speak, our culture’s obsession with independence,  physical strength, and youth. To my mind the dignity defined by these values– a dignity that is ultimately incompatible with being cared for at all– is a dignity that is not worth having.” (Velleman, David J, 1992). In other words, people’s egos should not prevent their survival. 

Even if the original requirement to access ODE was a prognosis of six months or less to live, if the rationale morphed to emphasize patient dignity in general rather than patient dignity in death, this law could change.  In fact in Belgium, the only requirement for euthanasia is “Condition of constant and unbearable physical or mental suffering, resulting from a serious and incurable disorder caused by illness or accidents”. This means there is no prognosis of x months left requirement, and it means that patients with psychiatric conditions can obtain euthanasia. (“The right to die in Belgium: An inside look at the world’s most liberal euthanasia law.” PBS, 2015. ) What would it say about American society if we established an avenue for vulnerable people to convert their lives into a collection of organs for others? Counter arguments might claim that this is in addition to, rather than instead of other treatment options, but simply offering organ donation euthanasia as an option spreads the message that they are more valuable as organs than as people. Although this is especially true for patients with psychiatric conditions or disabilities (the patients that could potentially be affected by the slippery slope), it is also true for patients in the terminal stage of a terminal illness (the patients that would initially be affected by ODE legalization). 

People’s motivation for organ donation euthanasia might not be that they are tired of their life, but that they think other people are tired of them.  Although this could also be the case for medical aid in death or withdrawal of life sustaining treatment, the organ donation piece adds a factor that a lonely person might want to feel like a hero.  After medical aid in death was legalized in Oregon,  the top reason people sought it was fear of being a burden and wanting to be in control.  (Oregon Public Health Division 2015. Oregon’s death with dignity act—2014, 2015.)  At the same time, this could be argued that granting this desire for control is ethical because it is conducive to autonomy. 

Existing end of life options provide patients with a sufficient amount of autonomy. For instance, palliative care and hospice are options to control pain and have a calm and peaceful and comfortable end of life.  

Further, legalizing ODE could shift the emphasis away from palliative care. In the words of D. E. Pellegrino, “Cure may be futile but care is never futile (Pellegrino 2001). With appropriate utilization of palliative care, far fewer patients would be driven by fear to request that physicians actively end their lives via physician assisted suicide/ euthanasia .” 

(The internal morality of clinical medicine: A paradigm for the ethics of the helping and healing professions. The Journal of Medicine and Philosophy 26: 559–79. doi: 10.1076/jmep.26.6.559.2998) 

Also, medical aid in death could be legalized in every state.  Because medical aid in death provides for a quick death, more organs and higher quality organs can be retrieved than with withdrawal of life sustaining treatment.  This means medical aid in death would still fulfill the autonomous wish of the patient to be a “good” organ donor. Besides, medical aid in death involves more autonomy than any type of euthanasia because the patient, rather than the doctor, is ending their own life. 

Potential coercion further threatens patient autonomy.  End of life care is expensive, especially if someone is in the hospital for an extended period of time.  In fact, about one quarter of all Medicare spending goes toward care for people during their last year of life (Jha, Asish K., 2018). Patient’s family or insurance providers could pressure them into organ donation euthanasia in order to save money. Euthanasia seems to violate non maleficence.  We have value because we are people, and euthanizing people takes away this value

An excerpt from Non Faith Based Argments Against Physician Assisted Suicide and Euthanasia reads, “Empowering physicians to assist patients with suicide is quite another matter striking at the heart not just of medical ethics but at the core of ethics itself. That is because the very idea of interpersonal ethics depends upon our mutual recognition of each other’s equal independent worth, the value we have simply because we are human.” 

Daniel P. Sulmasy, John M. Travaline, […], and E. Wesley Ely. “Non-faith-based arguments against physician-assisted suicide and euthanasia.” The Linacre Quarterly, www.ncbi.nlm.nih.gov/pmc/articles/PMC5102187/.  

This article also explains that if interests , such as the interest to be euthanized, take precedence over people, then the severely demented can be euthanized once they no longer have interests, even without their consent.  Also, people often argue that they need assisted suicide to preserve their dignity, but people have intrinsic dignity because they are human, so the idea of preserving dignity is redundant.  As the article details, euthanasia is suicide, in the sense that, “Many persons who raise the question of suicide are really testing the waters and asking us if we care enough to try to stop them.”  When we do not stop them, we are confirming their deepest fears. With organ donation euthanasia, we are taking in a step further that not only is someone not wanted, they are wanted dead for their organs. 

Some of the immediate and longterm consequences of organ donation euthanasia are negative. For example, a patient is not surrounded by their family in their final moments because the patient is in the operating room,  nor are they conscious. Next, choosing organ donation euthanasia might be an overwhelming decision for  a surrogate decision maker to have to make for their loved one. Additionally, cases of directed donation could cause tension in families. Directed donation is a request made by a donor or donor family to transplant a specific recipient. For example if a grandmother was terminally ill and incompetent and a younger and more popular uncle needed a kidney, the family might feel more pressure to euthanize the grandmother.  Lastly, people’s trust in doctors might decrease if it was deemed ethically permissible to end lives to end suffering and to increase organs, and killing became part of a doctor’s job. 

Arguments For Legalizing Organ Donation Euthanasia

Patient autonomy could be maximized through advanced directives and other strict procedures. As a result, patients who wanted organ donation euthanasia would be able to elect to have it and patients who did not elect it (e.g., in an advance directive) would not receive it.  The procedure would look like this: advance directives such as the POLST (Physician Orders for Stopping Life-Sustaining Treatment) form would include an option for organ donation euthansia in the event of irreversible loss of function or terminal illness.

They would ask, “Would you like to be an organ donor? If so, in the event that you have been fatally wounded would you like to donate your organs through organ donation euthanasia? In the event that you become terminally ill and likely permanently unresponsive would you like to donate your organs through organ donation euthanasia?”

– Questions in the Physician Orders for Stopping Life-Sustaining Treatment form

Of course, not all patients have advanced directive, so that would not be the only way to access organ donation euthanasia. After a patient has already decided to withdraw life sustaining treatment which will cause death/ has been approved for medical aid in death, they will be asked if they want to be an organ donor. It is important that they are asked about organ donation after they have already made the decision to die that way the doctor is not suggesting that they should die in order to donate their organs. The doctor would then ask the patient if they would prefer ODE or donation after cardiac death.  In the case of incompetent patients with legally valid advanced directives, the advanced directives will be valued over the family’s current wishes.  

In cases when a patient is incompetent, a family member may be the patient’s healthcare proxy by operation of law. Ideally, the patient would have previously communicated their end of life preferences with their family beforehand, and the family would be expected to implement these wishes by directing the health care provider accordingly. However, when explicit conversations about end of life have not occured between the patient and their proxy, the proxy  must execute substituted judgement about what the patient would have wanted. At present, this means what they would have wanted as far as decisions such as withdrawal of life sustaining treatment and organ donation, but if organ donation euthanasia were leganalized it should (in my opinion) also include it. 

Currently, if a family member decides to withdraw life sustaining treatment from a terminally ill  incompetent adult patient,  the patient’s doctor’s may advocate for the court to become involved to confirm that it is in the patient’s best interest. In situations when there is no reasonable likelihood of recovery, courts will be likely to accept the proxy’s decision. If organ donation euthanasia was legalized, it can be assumed that if a family member decided to choose organ donation euthanasia as an end of life option for a patient it might require the courts to get involved if their doctor advocated for it.  The courts would act as a safeguard because they check to make sure there is truly no hope of the patient’s recovery. Since organ donation euthanasia has the same outcome (death of the patient) out withdrawal of life sustaining treatment, in my opinion courts should use the same criteria to evaluate patients whose proxies had requested organ donation euthanasia for them. 

Patient Autonomy in Organ Donation Euthanasia

Organ donation euthanasia maximizes patient autonomy by nearly guaraenteeing that their last wish will be granted, which all other forms of death plus organ donation cannot one hundred percent guarantee. In 2006, a 25 year old man named  Ruben Navarro with a progressive neurodegenerative disorder was on life support in an intensive care unit in California. He had also suffered an out-of-hospital cardiac and respiratory arrest and was believed to have sustained significant hypoxic brain injury, and doctors planned to remove him from the breathing machine and allow him to die. His mother had agreed to Ruben donating his organs after his death. Although a transplant team was present when Navarro died, he died eight hours after withdrawal of life support machines, and therefore did not meet the criteria for organ donation. He was not able to donate any of his organs. 

David Adox was a 42 year old man with ALS who needed a ventilator to breathe and couldn’t move any part of his body except his eyes. He decided it was time to die when he began to struggle with his eyes, his only way to communicate.  He wanted to come off of his ventilator and donate his organs at University Hospital in Newark.  However the hospital rejected this request because it would require them to administer some drugs to help with the organ retrieval, and they were afraid it looked too much like medical aid in death, a procedure that was illegal in NJ at the time, even though it is unlikely these drugs would have accelerated Adox’s death. After being turned away from six other hospitals who had the same concern, Adox was able to donate his organs at Mt. Sinai Hospital in New York, a state where medical aid in death was also not legal. It is important to recognize though that the procedure that Adox went through– was not medical aid in death. In this instance, a man was almost denied a generous dying wish because of hospitals’ fear of breaking a law. A parallel can be seen with the dead donor rule. Many people can be denied their dying wish or not able to fully execute it because of medicines fear of breaking the Dead Donor Rule which violates autonomy. 

Human life involves many decisions about deeply personal milestones such as birth, marriage, sex, faith, etc. Death is another one.  Yes, we do not let people choose how to live their lives indefinitely; people may not work as slaves or do heroin legally, or commit actions that hurt themselves too drastically. However organ donation euthansia- a painless procedure that helps other people- is only being proposed in cases where death is imminent. Organ donation euthansia is not hurting the patient any more, which means it is ethically permissible as an option for the patient to have.  Laws should facilitate altruistic potentials. Technicalities (of death) should not prevent people from doing good on their deathbeds.  

Hippocratic Oath and the Legality of Organ Conscription

In general, doctors act upon the principle of nonmaleficence – “Do no harm.” 

“I will never give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” 

The Hippocratic Oath

 Still, although organ donation euthanasia is it at odds with tradition, euthanasia is not inherently harmful because it is not bringing about any suffering or death that would not otherwise have occured.  Inflicting death could be viewed as the ultimate moral harm, but in this context we are talking about a painless– due to the full panel of anesthesia– death instead of what could be a painful one, and a death that is going to occur no matter what.

A newer version of the Hippocratic Oath can be interpretted to support euthanasia. The Declaration of Geneva, a revised version of the Hippocratic Oath developed in the wake of the medical crimes committed in Nazi-occupied Europe, was adopted by the General Assembly of the World Medical Association at Geneva in 1948. It was mostly recently amended in 2017.  It is a declaration of a physician‘s dedication to the humanitarian goals of medicine.

The Declaration of Geneva does not take an explicit stance on euthanasia, but its clause “THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration” seems to be most relevant to euthanasia. 

Well-being does not just entail mortality. Well-being entails how much one is enjoying their life, how much one’s life reflects their values, etc.  Opponents of euthansia worry that euthansia represents a judgement that a patient is worthless. On the contrary, it is a patient’s judgment that a treatment is worthless. If the patient thinks continued suffering is inconsistent with their assessment of what makes life worth living there should be a framework for them to obtain a peaceful and painless death. 

Euthanasia literally translates (in Greek) to “Good death”. If the burden of suffering and hopelessness becomes too heavy to bear, a doctor granting a patient’s request for death can be a merciful act.  In a sense, the above is already taking place in the United States whenever life sustaining treatment is withdrawn.  What is keeping someone alive (the treatment)? So when the treatment is withdrawn, what has caused the death? Therefore the hasUS states has already, without realizing it, decided it is ethically and legally permissible to end life. Still, one could argue that the US is merely allowing life to end, but even then this supports the principle that sometimes a doctor can and should help someone die.  Further, organ donation euthanasia might be a more desirable way to die than withdrawal of life sustaining treatment because withdrawal of life sustaining treatment (in a hospital setting) is not accompanied with a full palette of sedatives, ie organ dontion  allievaites more physical discomfort for the donor as well. 

From a consequentialist standpoint, organ donation euthanasia is a Pareto improvement, meaning one party improves while the other is neither helped nor harmed. The donor is not harmed because they had elected to die and donate their organs anyway.  At the same time, more and better quality organs would be available for transplant. Organ donation euthanasia could increase the number of potential organ donations by up to 2201 transplantable organs per year in the UK; we can assume a roughly similar figure in the US (Wilkinson & Savulescu, 2012). In addition to an increase in the sheer number of organs available, the organs would also be of better quality because of a shortened ischemic time (time where the organ is in a body with no blood flow). This means the organ would be more likely to perform optimally and with fewer complications in a recipient. 

Opponents of organ donation euthanasia may argue that there are sufficient ways to bring more organs into circulation. I will now evaluate many of these options to show why they are not as beneficial, either to the general population or to the donor, as organ donation euthanasia. 

One proposed measure is organ donation conscription in which some/ all people are required to donate their organs. This could be seen as one’s duty to the nation, like military service.

In the US, this would have to overcome the law that it is illegal, in fact a felony,  to “abuse” or “desecrate” a corpse. Also, this is a violation of personal rights and therefore “unAmerican.” There is a complete lack of autonomy with this system. 

Currently, organ procurement in the US and in the UK requires would-be donors to register their consent to posthumous use of their bodily organs.  An opt out system, in which cadaveric organs are used unless the deceased registered an objection, could potentially increase the number of organs in circulation. This type of system is practiced in Spain, Croatia, and Belgium.  Research shows that opt out policies tend to increase organ donation rates because people tend to conform to the status quo. Also, it is more convenient to donate organs if one is automatically registered. However, the utilitarian benefit of an opt-out system is not predicted to be as great as with organ donation euthansia. Dominic Wilkinson and Julian Savulescu in their paper Should We Allow Organ Donation Euthanasia? Alternatives For Maximizing the Number and Quality of Organs for Transplantation predicted a change to an opt-out system in the UK to potentially increase the number of transplantable organs by 666 per year whereas a change to organ donation euthansia could potentially increase the number of transplantable organs by over three times that amount.  Supporters of the opt out system assert that autonomy is preserved because people still have a choice to opt out. 

Opponents of opt-out systems criticize them for relying on the principle of “presumed consent”, and they believe consent must be an action rather than lack of an action.

I agree, and think autonomy is better preserved through organ donation euthanasia than the opt-out system because patients are operated on as a result of them actively making a decision, not because they didn’t act.  In the Western world, particularly in the United States, autonomy, independence, and individualism are valued very highly, and organ donation euthansia protects these values better than the opt-out system does. 

Instead of organ donation euthanasia, some critics support organ donation after euthanasia, meaning a patient is euthanized (via an injection or pill etc administered by their doctor) and then their organs are harvested.  This would entail legalizing euthanasia and donation after euthanasia in the United States. With organ donation after euthanasia, there is more of a distinction between dying and donating organs as opposed to dying in order to donate organ.  However there would be less organs available for organ donation than with ODE because of a longer ischedmic time.  Additionally, this could be possibly more traumatic for a patient’s family. First they would say goodbye to the patient before euthanasia, and then again to the patient’s body before organ harvesting. Organ donation euthanasia is just one goodbye. There are beneficial consequences for each stakeholder of organ donation euthanasia. For the patient, it may seem that the euthanasia cuts their lives shorter, but this is time those who elect ODE feel would be otherwise spent dying, not truly living. The family of the patient will not have to watch their loved one die. Also, they will know their loved one would die without any struggle and knowing that they are doing a charitable deed would grant them peace of mind. Lastly, the recipients of organs, will receive an organ and have their lives saved and/or quality of life much improved.

Religious Perspectives on Organ Donation Euthanasia

If something is ethically permissible, it may or may not be permissible in a religion and vice versa. This is because religions are their own unique schools of thought with their own sets of values that determine how they view issues. I considered Christian and Jewish faiths because they are the most predominant organized religions in the United States, with 71% of Americans identifying as Chirstians and 2% of Americans identifying as Jewish Pewform. (https://www.pewforum.org/religious-landscape-study/).. 

Christianity tends to support organ donation or at least view it as an individual’s choice.  Christian, Anglican, Catholic and Protestant scholars seem to agree that organ donation is an act of selflessness and endorse transplantation.  Church of Jesus Christ of Latter-day Saints (Mormon Church) and Quakers do not object formally but believe that organ donation and transplantation should be left to the individual’s decision.  Jehovah’s Witnesses view decision as the individual’s choice as long as no blood is transplanted. 

Jewish faith has traditionally taken a skeptical view regarding transplantation and deceased donation.  It places great importance on avoiding any unnecessary interference on  the body after death, but many Jewish scholars feel that these concerns are overridden by the imperative to save lives (pikuach nefesh).  (Oliver, Michael, and Alexander Woywodt. “Organ donation, Transplantation and religion.” Oxford University Press)

Both religions begin with a strong predisposition to favour preservation of life, but it is nuanced.  They both feel people have dignity because are in the image of God. Still, they have rejected, “vitalism” which holds that biological life is to be preserved at all costs and with all available technologies.  Life support can be foregone if continuation of life violates dignity of person.  Exceptions to this is found with  Orthodox Judaism, which emphasizes sanctity of life, which translates into a stronger commitment to life extending measures.

Christianity and Judaism see suicide as sinful. They view it as wrong and against one’s nature and personal dignity. Some see physician assisting in suicide as moral accomplice in evil.  However, some faith communities in Protestant Christiantiy and Reform Judaism have argued for medical aid in dying, stressing the dignity of individuals should allow them to be free decision makers.  

Most Christians are against euthansia. They see life as a gift from God.  All life is God- given; therefore, no human being can take the life of any innocent person, even if that person wants to die.   Human beings are valuable because they are made in God’s image, meaning people have a unique capacity that enables them to see what is good and to want to see what is good.  Life should be preserved in order for people to continue to do this.  To propose euthanasia for an individual is to judge that the current life of the individual is not worthwhile.  This judgement is not compatible with recognizing the inherent worth and dignity of a person because they are made in the image of God. The most vigorous Christian opposition to euthanasia stems from the Roman Catholic Church.

Pope John Paul II describes euthansia as an example of “culture of death” in Western societies. “Manifestation of social views that have abandoned the protection of life and lent support to liberalized abortion, capital punishment, and incessant warfare”. 

Still, although few in number, there are individual Jewish and Christian theologists for whom euthansia does not equal a violation but rather a culmination of religious values such as compassion, mercy, and love.  (Campbell, Courtney. “Euthanasia and Religion.” UNESCO Courier.)

In Judaism, euthanasia and medical aid in death and all other “types of suicide” are almost unanimously condemned because taking a human’s life away. In any situation other than martyrdom, the human life is to be treated as an end in itself.  The life must not be terminated for the patient’s convenience/ usefulness, even when the patient is suffering. 

Jewish law strongly condemns any act that ends life and treats the killing of a person whom the doctors say will die in any event to be an act of murder.  Individual autonomy is prioritized below the sanctity of human life.

Human life is seen as something that only God can end for “only He who gives life may take it away.

(Campbell, Courtney. “Euthanasia and Religion.” UNESCO Courier.)

Conclusion

I support organ donation euthanasia if there are appropriate safeguards for medical professionals. They should not be able to be sued for organ donation euthanasia that a competent patient consented to or their surrogate did.  I also think the medical professional should not perform the procedure on their own dying patient, and instead refer them to a third party team/ doctor.  I think having a separate doctor is better for marketing purposes, ie for getting organ donation euthanasia legalized and for increasing the number of people who would consent to it. 

Separate between treating patients and taking organs, so people wouldn’t think their doctor wasn’t “out to get them”. It would alleviate the emotional burden of the doctor who has been treating a patient to have to not have to kill them. Lastly, even though it is ethical and the patient has requested it, the doctor has their own autonomy not to support the decision. Rather than have the patient feel betrayed at the end of life if their doctor disapproved and consequently were to refer them to another doctor, it would be better to have it be standardized, and always be two separate doctors. 

When we think of euthanasia, we think of something we do to our pets to save money or to alleviate their suffering, or to dangerous criminals. It requires a shift of mind to see euthanasia as something merciful that can be done for adults who request it as well. However I believe this shift of mind is both possible and positive for the greater good. 

Increasing the number of organs in supply sets context for organ donation euthansia, but autonomy is the determining factor that makes it ethical.   Every day, people are buried with organs that they might have donated had there been a legal framework for a simple surgery that would allow them to do so. If one’s last wish is to save lives, there can be a legal framework that allows them to do so while mitigating the number of people who are coerced into it via measures such as patient/ surrogate decision maker consent and mandatory psychiatric evaluation.  

The most dignity in death can be facilitated by allowing for the most choice, ie providing the choice for organ donation euthanasia.  

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