Update
Anencephalic Neonates as Live Organ Donors:
AMA and CEJA
by Theodore D. Masek
by Theodore D. Masek
In December of 1994, at the interim meeting of the AMA House of Delegates,
the Council on Ethical and Judicial Affairs (CEJA) submitted an updated
opinion (1) concerning the use of anencephalic neonates as live
organ donors. To understand the AMA policy on this controversial topic,
it is necessary to understand the interaction of CEJA and the policy making
arm of the AMA, the House of Delegates.
CEJA is one of several councils used by the House and Board of Trustees
to produce reports concerning issues in medicine. This council has several
unique characteristics that allow it to function autonomously. Its members
are elected for a single term by the House of Delegates, upon nomination
by the AMA president. On election, members of CEJA are required to resign
all other positions in the AMA.
The AMA bylaw 6.4021 states that one of the functions of CEJA is "To
interpret the Principles of Medical Ethics of the American Medical Association."
(2) When acting in this role CEJA can either offer a report or
an opinion to the semi-annual meeting of the House of Delegates. Reports
of CEJA which respond to requests from the House or which make recommendations
to the House may be adopted, not adopted, or referred, as may be appropriate.
Reports may not be substantially amended by the House. Opinions of the
Council are also reported to the House. The members of the House may discuss
an ethical Opinion fully in Reference Committee and on the floor of theHouse.
After concluding its discussions, the House files the Opinion unchanged.
It is appropriate for the House to adopt a nonbinding resolution requesting
CEJA to reconsider or withdraw the Opinion. CEJA responds to such requests
in due course, after reconsidering the issues presented. No action of
the House can prevent the publication of CEJA's opinion in the Principles
of Medical Ethics. In other words, the opinions concerning ethical
issues cannot be modified by the politics of the House. On the other hand,
there are no rules that prevent the House from adopting policy in direct
conflict with the published opinions of the Council.
In the past the main physician influence on CEJA concerning ethical issues
came in the form of discussions of the informational reports at reference
committees during the annual and interim meetings of the House of Delegates.
This testimony was taken only after the opinion had been produced and,
as stated above, could not be modified. The obvious analogy would be if
the Supreme Court gave its opinion and then heard the arguments from the
parties involved.
This was the situation in December of 1994 when the Council issued its
opinion to exclude anencephalic human infants from the dead donor rule.
The report eloquently delineates the arguments against using live human
donors for organ transplants. It goes on to exclude this category of persons
"because of the fact that the infant has never experienced, and will
never experience, consciousness." (3)
The informational report received a contentious reception by many physicians
when discussed in reference committee. The House of Delegates was swayed
by the utilitarian argument of the Council and voted to file the report.
Because many physicians felt that this and several other issues were not
given a full debate, and that opposing legitimate ethical arguments were
not considered, the Council made a historical decision. The Council agreed
to hold a forum at the next meeting to hear from physicians on reconsideration
of this issue and other ethical issues that were to be considered by CEJA
in the future.
On June l9, 1995 at the annual meeting of the House of Delegates, this
new forum was held. The entire council heard testimony concerning ethical
issues. The lion's share of the forum was taken up with a discussion of
the ethical issues of live organ donors and whether or not an anencephalic
infant could be excluded from the protection of the dead donor rule. Of
the testimony given that day, only one physician rose to support CEJA's
opinion. The Council heard testimony from expert physician witnesses and
moving testimony from mothers of anencephalic infants who had survived
the neonatal period and died a dignified death at home. The message given
at the hearing was that certain actions offend us because they threaten
our unambiguous status as human beings.
In his book Ethics after Babel: The Languages of Morals and Their Discontents,
Jeffrey Stout discusses his concept of "Moral Abomination."
(4) His metaphor of cannibalism seems to apply. We find it repulsive
to eat human flesh even in situations when no other moral wrong occurs.
For instance, if in extreme circumstances a dead comrade is eaten, most
feel guilt and remorse. And yet because the comrade may have died of natural
causes, no life was taken. A life may well have been saved (that of the
cannibal) by taking the comrade's flesh for food. So the balance of utility
is favorable. It is not clear that anyone's rights were violated. The
fact remains, however, that we define ourselves as human in part by what
we do not eat. Our humanity is also defined by the fact that we do not
sacrifice living donors for organ procurement.
CEJA will now reconsider the anencephalic issue. Unless it can find a
compelling moral argument on why these infants should be excluded from
the realm of humanity, it would seem only prudent to maintain the principle
of the dead donor rule for all.
References
1 Council on Ethical and Judicial Affairs. "The Use of Anencephalic Neonates as Organ Donors," House of Delegates Proceedings: 48th Interim Meeting, Chicago: American Medical Association,1994, 211 16.
2 Constitution and Bylaws of the American Medical Association, Chicago: American Medical Association, 1993, 36.
3 Council on Ethical and Judicial Affairs. "The Use of Anencephalic Neonates as Organ Donors." Journal of the American Medical Association, (1995): 1614-18.
4 Stout, Jeffrey. Ethics after Babel: The Languages of Morals and Their Discontents. Boston: Beacon Press, 1988, 145-62.
Return to top of page
Can Evil Ever End?
by David R. Larson
Loma Linda University
"Always be ready to make your defense to anyone who demands from
you an accounting for the hope that is in you; yet do it with gentleness
and reverence." (1 Peter 3:15, NRSV)
A recent year was especially difficult for a young physician who is a
friend of mine. His father, a family doctor who served a rural community
and church for the better part of five decades, died in September of that
year. His mother, as much of a saint as his father, succumbed not long
thereafter to a malignancy. Just before she died, an intoxicated driver
crashed a speeding vehicle into the van in which my friend's two sisters
and their husbands were traveling after visiting her in the hospital.
His sisters were wounded, one of them badly enough to attend his mother's
funeral on crutches. One of his brothers-in-law lost his life instantly.
So there was another funeral.
Can the evil of unnecessary pain and suffering ever end?
Clarifying Evil
Six basic and overlapping features of everyday life that are evil in the eyes of some will never end if my understanding of the Biblical view of things is valid. One of these is dependency. Another is finitude. Embodiment is here to stay as well. Relatedness is yet another basic feature of everyday life that won't disappear. Neither will temporality. The ability to determine in part the direction and shape of one's own life that we call freedom is also permanent, though its form and degree will continue to vary greatly.One way to test the validity of this view is to compare it to alternative points of view. If these most basic features of everyday life are evil as such, how possible and desirable could life of any sort be without them? What would we have if we actually did escape them?
This question elicits two similar answers. The longer reply is that we then would have the non-exclusive identity of undifferentiated unity that is possible only by wholly overcoming intranscendent experience the dichotomies between subject and object, one and many, and potential and actual. The shorter response is that we then would have nothing, or more accurately: "no-thing."
I'm prepared to take my chances on the basic features of everyday life from which, according to my understanding of the Hebrew and Christian Scriptures, it is impossible to escape. To my mind, to be"some-thing" in these ways instead of "no-thing" is not evil. It is good. And splendidly so.
Overcoming Evil
As evidenced by its creation stories, the Bible exudes ontological optimism. This delight in the inherent goodness of ordinary existence is a foundation for reasonable and realistic hope. If the most basic aspects of everyday life are necessarily evil, either in themselves or in what they must always produce, evil cannot be overcome. If that were the case, we would be wise to invest less in attempts to eradicate evil from private and public life and more in efforts to escape it in psychologically soothing ways. This is what some sages recommend.And yet, regardless of what they say, most people around the world function as though the Bible is more optimistic view of things is true. Some do find it possible to order the whole of their lives on more pessimistic premises. But this is difficult for the vast majority, even though a number do give it an honest try. From a Biblical perspective, this difficulty is an omen of futility, not hypocrisy. Almost like attempts to fall upward, lives arranged on such negative outlooks are difficult because they run counter to the way things really are. As our experience confirms on a deep and daily basis, the most basic features of everyday life are good, not bad. For this reason, it makes sense to hold with the ancient Scriptures that in principle it is possible for the evil of unnecessary pain and suffering to be overcome. This is one basis for hope.
At least two lines of additional evidence converge to make it reasonable to be hopeful. Both are especially evident to Christian eyes in the life, death and resurrection of Jesus the Christ. But both are manifest elsewhere as well. One of these is that actual evil is self-destructive. Just as the one who betrayed Jesus ended his own life, evil annihilates itself. This reality provides little comfort in the short run, particularly when those who cause the evil of unnecessary pain and suffering prosper. But such prosperity eventually and invariably collapses. An exception to this rule has yet to be established. This is a second basis for hope.
"False prophecy wrongly claims that God will not let us destroy ourselves. This is a delusion."
A third basis for hope is that goodness out-lasts and out-performs evil, just as the cause of Christ has out-lived and out-matched the rule of the Roman empire that unjustly executed him without even noticing what it had done. As the crucifixion of Jesus demonstrates, the power of good is so subtle and so gentle that it is often mistaken for the weakness that is its opposite. But good ultimately triumphs over evil because in God's steadfast love its resourcefulness and resiliency are so much greater. Those who cause evil are often in a hurry, and rightly so. Their time is short. Those, like Jesus, who embody goodness, can afford to temper their urgency with patience. Time is on their side, as is the way things truly are.
Living From The Future
Although Biblical faith is optimistic about the possibility and probability of overcoming actual evil, it refuses to specify when and how this will occur. This depends in part on us. God invites, inspires, encourages and nudges. But God does not coerce. It is vain to yearn for a time when God will unilaterally banish all actual evil and make good solely sovereign without the voluntary consent of those who thereby are governed. We know this has not happened in the past. We have no reason to believe it will happen in the future. As far as we can tell, God does not do things that way.Our choices do matter. False prophecy wrongly claims that God will not let us destroy ourselves. This is a delusion. We can destroy ourselves. And God will not stop us from doing so. We must face this truth and we must face it squarely. We dodge it at our own peril.
The human race could annihilate itself. But there is no reason why it must. Instead of ignoring God's invitations and admonitions,we could heed them. Instead of continuing trends that are leading us to the brink of individual and communal destruction, we could reverse them, or at least divert and deflect them. Instead of living in ways that make ourselves and others ill, we could arrange things so that we enjoy increasing health and prosperity. All this and more is possible.
To live from the future and not merely for it: this is our challenge. When we live only for the future, we are wistful. We accept things as they are even as we yearn for a better world. When we also live from the future, we are faithful. We make genuine attempts to shape our beliefs, values, policies, practices and rituals with an eye to that new and better world, a world of which it truly can be said that "God will dwell with them, and they shall be his people." (Revelation 21:3 RSV)
It can be perplexing and difficult to live in this age by what can be the better views and values of the next. And at times it can feel as though such attempts are pointless. They aren't. Among humans, nothing is more pertinent, nothing more powerful.
"Look at the proud!
Their spirit is not right in them,
but the righteous live by their faith."
(Habakkuk 2:4 NRSV)
Return to top of page.
Go to On-line Ethics Library.
- All contents copyright © 1997 Loma Linda University. All rights reserved
- Revised January 28, 1997
- Send comments and questions to webmaster@univ.llu.edu
- URL: