Moral Aspect of Heart Transplants
MORAL ASPECT OF HEART TRANSPLANT
At a press conference on May 24th, Mons. Ferdinando Lambruschini, professor of Moral theology in the Lateran University, dealt with the moral problems arising from heart transplants. The following is a summary of what he said:
Heart transplants are on the increase though the results are not always successful. Public opinion is very much concerned lest the donor's heart should be removed before he is already dead. What has Catholic Moral theology to say on this very grave matter?
Catholic moral principles do not allow the direct killing of an innocent person. The heart may lawfully be removed from a person who is certainly dead. But it is never permissible to remove the heart from one who is still alive or where there are serious doubts as to his death.
To remove the heart in these circumstances would be tantamount to killing the donor, and this can never be justified even with the donor's consent. To allow even a single exception would have disastrous consequences for humanity and would open the door to innumerable abuses.
When is the Donor Dead?
How are we to determine the exact moment of death? A clinical decision of death based upon the cessation of heartbeat and breathing, which comes within the specific competence of the doctor and which is also ascertainable by empirical observation, can no longer be regarded as sufficient in the light of the progress of science and of the technique of resuscitation which is capable of reactivating the heart-beat and breathing.
When there is need of an early diagnosis of death, such as is required in the cases of the removal of unique and vital organs with a view to transplantation, recourse must be had to a whole series of tests, among which the most important is the encephalogram which confirms the absence of electrical impulses in the brain in which are found the specifically human functions of thought, consciousness and free will. But does this exclude the possibility of the return of such impulses?
The case history of resuscitation records several cases of the return of life to the brain cells hours and, even days after the encephalogram test had been made. These cases were put to Dr. Barnard who admitted that he was not aware of them.
Real and Apparent Death
Pope Pius XII in a discourse of May 14th, 1956, recognized the opportuneness of removing organs and parts of a corpse for a therapeutic purpose. He praised those who while still living consented in advance to such a removal, though he did not impose a moral obligation. The Pope was referring in particular to the cornea which can survive for some hours after the person's death. The removal of the heart, however, must be carried out very quickly for the success of the heart transplant operation. The instruments and methods of diagnosis of death which are now available to science are much more advanced.
We may observe with the Jesuit moralist, Eugene Tesson, that resuscitation can be considered in relation to three different cases. In the first case the patient is in a condition to be brought back to a conscious human life even though it may take some time to do so. In such a case the removal of the heart would be forbidden by the moral law.
In the second case the heartbeat can be reactivated, but only in a mechanical manner, without restoring life to the brain cells. In such a case there would be no moral objection to the removal of the heart.
Between these two cases a third may arise. What of a case where a human life can be prolonged for hours, days, weeks, months, and even years? These are the cases that disturb public opinion, for people are well aware of the moral problems that can arise. To meet such cases we must have recourse to the principle that human life is sacred insofar as it can be said to be really human. Certainly there is no moral obligation for a doctor to resort to extraordinary means to prolong life indefinitely when it is not known to what extent it is human. Pope Pius XII dealt with the limits of a doctor's obligations in the matter of resuscitation.
Undoubtedly a doctor is not morally bound to continue attempts at resuscitation beyond all hope of success. But before we can jump to the conclusion that it is lawful to remove the heart of a patient in these circumstances, a distinction must be made. It is one thing to abandon the use of means which afford no hope of success for the return of human life, but is quite another to proceed to the actual removal of the heart. Father Tesson (Etudes, Mars 1968, p. 325), makes two wise and moderate suggestions.
He urges doctors to do everything in their power to help the patient, as they would in the case of any other sick person in similar conditions without regard to a possible heart transplant which would benefit another patient. In the second place, he emphasizes that the heart should not be removed until the death of the donor is absolutely certain. This second exhortation of Father Tesson brings us to the very kernel of the problem, without giving us an unequivocal moral solution.
When Dr. Barnard was reminded of the experiments to bring back life to brain cells which had been regarded as dead for a period of months, he replied that he was sure that the heart removals for his transplant operations took place after the death of the donors, and he added that he acted in accordance with his conscience.
The first statement pertains to the strictly medical field, and we leave that to be judged by science. The second belongs to the moral order, and does not seem to us convincing. We must all act according to our conscience; but conscience must not be confused with arbitrariness.
The "Certain Conscience"
According to moral theology the personal norm of moral, human, free, conscious and responsible behaviour is not just conscience, but a conscience that is certain, that is to say, it must guarantee a sufficient margin of security to exclude the opposite.
In the matter of heart transplants, can one be said to act with certainty of conscience when he knows that there are qualified schools of medical thought, for example, German and Russian, who question with arguments that are serious, valid and probable the insufficiency of the criteria employed to determine the death of the donors?
To determine the moment of death, the American National Academy of Sciences recommended that it should be left to the unanimous decision of a group of clinicians, cardiologists, and brain specialists not directly concerned with the operation. A decision of this kind would provide ethical guarantees more readily acceptable to Catholic morality than the simple conviction that one is acting according to his conscience. It is quite true, insofar as we know, that two teams of this kind were present at the two heart transplants carried out in South Africa; but both teams were headed by Dr. Barnard, and consequently were not independent according to the proposal put forward by the American Academy. The adoption of the American proposals would provide an objective basis for moral assurance regarding the death of the donor.
Weekly Edition in English
6 June 1968, page 7
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