Abstract
Here I consider some of the ethical and philosophical issues at the intersection of medical assistance in dying (MAiD) and deceased organ donation (DOD). Three possible objections about inherent aspects of the practice of DOD after MAiD are considered, and rejected. The bulk of the chapter examines recent calls to keep decisions about DOD and MAiD separate, and to clarifying the nature of the ethical concerns underlying effort to protect patients from undue pressure and coercion. Several insights are revealed as a result of this analysis, including that there is good reason to think that sometimes it may be morally justifiable to allow an eligible patient to pursue MAiD because they wish to donate their organs after death. Noting that more research is needed, I close with several recommendations for policy and practice.
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Notes
- 1.
At the time of writing, confirmed cases of DOD after MAiD have been reported from at least Ontario, Quebec, British Columbia and New Brunswick. Other provinces are advertising the possibility of DOD after MAiD, e.g. Nova Scotia: https://www.nshealth.ca/legacy-life/donation-information-0.
- 2.
This means that a second independent medical professional would still need to confirm the patient’s eligibility for MAiD. Interestingly, in their report for Canadian Blood Services, Downar et al. (2019) hold the view that proceeding after only 1 assessment is not enough: “Discussions concerning donation should happen only after […] patients have been found eligible for MAiD by 2 independent assessments” (E607).
- 3.
Thank you to Kiley Perrier for bringing my attention to this important nuance.
- 4.
It is not clear that this concern is more pronounced in the context of death by donation, and so I will take Somerville’s concern to apply equally to deceased organ donation after medical assistance in dying.
- 5.
Another way to respond to this concern is to claim a morally relevant difference between acts and omissions.
- 6.
There may be a morally relevant difference between this case and a patient, who is eligible for MAiD, having conversations about organ donation prior to making a decision about whether to request MAiD. The difference will depend on who the conversation involves (e.g. friends, family physician, TGLN coordinator, etc.) and the degree to which the decision is informal or formal (e.g. telling a friend of one’s decision to donate is less formal than telling the TGLN coordinator that you would like to do so).
- 7.
There is an interesting empirical question about whether it is even possible to separate the donation question from the MAiD decision. Buturovic (2021) argues that doing so is practically unrealistic. They conclude that: “Psychologically unrealistic assumptions about a sequential process that allows for a clear separation between the two allows advocates of organ donation in MAiD patients to proceed unchallenged” (706).
- 8.
Shaw (2015) goes so far as to suggest that “any jurisdiction where assisted dying is legal could solve its organ scarcity problem by investing in facilitation of organ donation after assisted suicide and/or euthanasia” (187). While I do not share Shaw’s optimism about the degree to which organ donation after MAiD could solve the issue of scarcity, they are correct to highlight the potential increased supply.
- 9.
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Tonkens, R. (2023). Organ Donation After Medical Assistance in Dying. In: Kotalik, J., Shannon, D.W. (eds) Medical Assistance in Dying (MAID) in Canada . The International Library of Bioethics, vol 104. Springer, Cham. https://doi.org/10.1007/978-3-031-30002-8_9
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