That's gorgeous. I hope you tell your class.

As far as the actual problem goes, I wonder if making organ donation opt-out rather than opt-in would reduce the pressure to chop up Chuck because there'd be another Chuck brought in in a few minutes.

Practically, though, I suppose all this means is that well-informed rich people will opt-out and then we'll have Rich Chuck surviving and Poor Chuck being chopped up.

Can one opt-in to having your death hastened so your organs would be useful? I would assume something like if I am unconscious and going to die just kill me and take my organs.

Organ donation should be mandatory.

You only posted that because the doctor is Iranian, you bastard.

I got the link from NRO, where the post was called "this is why I didn't check the organ donation box." So yeah, that.

It seemed sort of ambiguous from the story whether Navarro might have lived at close to his previous level of well-being after the incident, or whether he was more or less a goner and the only question was whether the organs would be usable.

Cala: A lot of states are already opt-out when it comes to organ donation, but it has made no difference in actual practice. No one wants to call in a transplant team without talking to relatives first, which means in practice you always have an opt-in situation.

Oy. I was just talking to Dr. Oops, who was telling transplant war-stories. Nothing remotely related to this, but a lot touching on the desperate need for more transplantable organs. I'd guess with Cala that anything increasing the supply would make this sort of thing less likely to happen.

But what a horrendous story -- I was prepared to take it as overreaction, but irrigating a living patient's stomach with antiseptic through a feeding tube? Ew.

CJB, I was wondering about that-- it sounds like a patient asking for more sedation with a wink and a nudge might do the trick, judging from how gung-ho some of those surgeons are.

Ogged: yes.

I talked to my intro class about the trolley problem yesterday. It wasn't in my lesson plan or anything, but the students started spitting out hypotheticals on their own that were like the trolley problem, so I thought it would help to get the most refined version of the problem. Once they had that, they could see that it was less than useful line of investigation.

Organ donation should be mandatory.

Could not disagree more.

What do you mean, Rob? I think it's pretty useful in getting clear about what constraints against harm get endorsed by our intuitions.

As far as the actual problem goes, I wonder if making organ donation opt-out rather than opt-in would reduce the pressure to chop up Chuck because there'd be another Chuck brought in in a few minutes.

I don't think so. The standard vice in this area is to conduct debate in terms of laws, on the one hand, and the motives and ethical concerns of individuals, on the other. The whole necessary layer of institutional structure and organization process disappears.

Hey, I have to say this stuff. I have a book to flog.

I got the link from NRO, where the post was called "this is why I didn't check the organ donation box."

Doesn't make any practical difference. The hearts of National Review editors, being made entirely of stone, are considered poor candidates for transplantation.

You have to die in a fairly special and unique way to be eligible for organ donation. One good way to die this way is to crash your motorcycle with no helmet on. This is why helmet laws are silent killers.

8: This isn't knowledge -- more an impression -- but I'd thought from talking to Dr. Oops that they really didn't let the transplant surgeons near possible donors, or let them make treatment decisions about possible donors, until they were sufficiently dead that their interests didn't need to be considered at all anymore.

This seems perfectly reasonable to me -- like, your original doctor should be on the phone with transplant people so the organs get snapped up as soon as available without deteriorating, but you really don't want a poorly socialized and incredibly driven surgeon who wants your liver to be allowed to make any positive decisions about what should happen to you before you're dead.

It is too abstract to elicit reliable or strong intuitions. I much prefer to use real cases, or at least plausible ones, as a starting point. The real cases may have many factors that are eliciting your reaction--they aren't laboratory pure--but you can tease the different factors apart with a little effort.

Reading between the lines of the article, and knowing what I know about organ donation, there was absolutely no chance that Navarro would have survived, but his parents probably don't want to believe that, and that's why they're suing the doctor and also why the newspaper declines to go into detail about their son's condition.

Is whether he would have survived really relevant? (In some sense, obviously yes, but "he was going to die anyway" isn't how we decide these things.)

12 is a better way of getting at the problem I was raising in 6.

16: hey, what a great chance to re-create many classic unfogged threads!

15: the transplant teams' practice of dressing up like hospital employees seems a little over that line...

18: Depends on what "would have survived" means. We got into this talking about the New Orleans 'euthanasia' case. If it were possible to know, for example, that the two possibilities were (1) actively kill the donor, and retrieve useful organs, or (2) allow the donor to die naturally at some time certainly within the next day, certainly without regaining consciousness, but with useless organs, there'd be a real conversation to be had. I don't think that sort of thing is knowable, and wouldn't trust the people who'd have to make that decision to make it, but I can imagine circumstances under which it would be relevant.

15: the transplant teams' practice of dressing up like hospital employees seems a little over that line...

I'm not getting this at all. Say it again?

Since Kieran is lurking around here today, allow me to express my profound admiration for and appreciation of the following sentence, which he posted on CT a few days ago:

What's annoying, though, is the way something quite trivial like this [Fred's Thompson's association with the Lockerbie bomber defense]--a mere curlicue on the ear of a minor gargoyle on a single buttress of the immense gothic Cathedral of WTF Has Happened Since 2001--could have the potential to bother a Presidential campaign, whereas the ongoing renovations to said Cathedral are more or less settled doctrine, dirty fucking hippies excepted.

From the article:

The more aggressive drive for organ donations grew out of a federal campaign known as the Breakthrough Collaborative, which the Department of Health and Human Services launched in 2003. The project was designed to boost the number of organs retrieved by the nation's 58 organ-procurement organizations, or OPOs. These private, nonprofit government-authorized entities deploy nurses, social workers and other specialists to identify potential donors, obtain consent from families, and work with doctors and nurses to recover as many organs as possible.

...

Critics also worry about how OPO representatives interact with families reeling from the impending death of a loved one. Some representatives delay identifying their role, either initially letting families assume they are part of the hospital staff or being vague, saying only that they are "end-of-life" or "grief" counselors.

"In some places, the organ-procurement folks will actually go into the room and meet the family and wear scrubs that are the same color as the hospital personnel and allow themselves to be experienced by the family as being members of the hospital staff," said Daniel O. Dugan, a bioethicist who advises hospitals in California and Illinois. "They will introduce themselves and build a kind of rapport when actually their whole agenda is organ procurement."

Some OPOs say their representatives always identify themselves immediately, but others acknowledge that practices vary.

It is relevant whether he would have survived, because a tough fact about organ donation is that you cannot harvest organs from a dead body. You have to prepare for the extraction while the body is alive.

The organs tend to be ruined when the body has been used to stop a trolley.

Right, but you're not allowed to act any differently before he dies, based on your best guess of whether he's going to or not.

That makes sense, but I'd draw a distinction between OPO representatives and actual transplant surgeons -- I can imagine setting up incentives for a nurse/social worker OPO rep. that were well balanced between procuring organs as efficiently as possible and not abusing the interests of still-living patients (and building rapport with families seems not out of line in that context).

Actually letting the literal transplant surgeons make treatment decisions seems like asking for this sort of story to happen, and I had the impression that generally literal transplant surgeons weren't allowed to get their hands on donors while they still had interests to respect.

28 to 24.

(And I should say on Dr. Oops's behalf that she hardly ever leaves men she picks up in bars kidneyless in bathtubs full of ice. Because that would be wrong.)

weren't allowed to get their hands on

Sure, because their literal hands are only there to get the organs; they aren't part of the hospital medical team. It would be bizarre if otherwise. Nonetheless, the helpful "grief counselor" or "guy in scrubs" might well be saying things to the family that affect end-of-life decisions, and this isn't much better.

You all don't deserve this, but I am going to dump these two excerpts from my book on your heads.

From Ch 3

From the mid-1980s to the mid-1990s, the South Carolina Organ Procurement Agency (SCOPA) consistently ranked in the bottom half of OPOs in terms of procurement rates. This was partly due to its geographical location, a relatively poorer area with a relatively higher black population than average. Our findings so far in this chapter make its poor performance unsurprising. Since 1997, however, this OPO increased its donation rate by 83 percent as a result of a series of changes in the management of the procurement process.50 Consistent with the ideas developed in this Chapter, SCOPA invested more money and people in the procurement process, increasing their field staff from eight to twenty one employees. But they also changed their procurement methods. The key innovation was to decouple the moment donor families were told about the brain death of the patient from the moment they were asked to consent to donation. Tasks previously assigned to a single procurement co-ordinator --- hospital liason, family support counselor, donor clinician, recovery co-ordinator and aftercare co-ordinator --- were assigned to separate employees, each with an appropriate professional background. The OPO's organizational mission had been simply to procure as many high-quality donor organs as possible. During the restructuring, SCOPA changed its name to LifePoint and added a "Family Support Service." The goal of this part of the organization was "to insure that families of dying patients ...made well-informed decisions about donation and had timely bereavement counseling and follow-up."51 A crucial aspect of the reorganization was that the person who explained to families that their loved-one was brain dead, and who spend a considerable amount of time (perhaps a whole day) helping them with this realization, was no longer the person who requested consent for donation. Within five years of its introduction, consent rates were about 85 percent, close to the proportion of the population that survey data suggests support organ donation in the first place.

The implications of these organizational changes are striking. On the narrow question of the measurement of OPO policy, they suggest that asking detailed questions about an OPO's willingness to procure donors under adverse circumstances (e.g., in the face of opposition from the families) might not be very informative. LifePoint's success was due to new strategies designed to improve procurement rates by making it easier for shocked and grieving families to understand and fully support the procurement process. But by splitting the information-provider role from the consent-request role, they ensured that the person providing them with information about brain death (and helping them manage for the day in the hospital) would not be perceived as having an ulterior motive. Thus, families are carefully managed by the organization in a way that shepherds them toward the vital moment when consent is requested, and granted.

:: And from Ch 6:

Cases like South Carolina's LifePoint show that OPOs have the ability to change their logistical methods in order to increase consent rates.26 LifePoint was was restructured in a way that separated distinct procurement tasks into separate occupational roles. ... from the family's point of view, the Support Counselor who helped and informed them and the LifePoint coordinator who requested consent might not have been from the same organization at all.

They were from the same organization, of course. Organ procurement organizations must make sure that the next-of-kin gives their informed consent, and this means in part that the donor family not be deceived. Does the OPO's careful management of the procurement process meet this standard? The process is not that different from the practice of "Cooling the Mark Out" described in a famous paper by Erving Goffman. Here, a con-artist and an associate carefully manage an interaction with their victim, or mark.27 Once the con has been concluded and the mark relieved of his money, the con-artist sends in an associate who explains what has happened, commiserates with the mark, and reconciles him to his fate --- perhaps even making him think it was his own fault. This "cooling out" period helps ensure that the mark doesn't report the crime to the police.

Now, organ procurement is not a con, but bioethicists worry that managing the consent process in this way might make us unsure whether the consent of donor families is properly informed. Sociologically, however, this aspect of successful procurement is crucial. Effective OPOs must manage the consent process by breaking it up into its component elements, controlling the way in which the donor family gets information. Goffman's case is relevant because it emphasize the way the fine structure of the interaction shapes the outcome and the feelings of the participants about what is happening, both during the procedure and especially afterward. Donor families are grieving, often in shock and sometimes confused. It is a mistake to think that, in such volatile circumstances, a decision is made after the pros and cons of the decision are dispassionately weighed in the light of one's preferences. It is in just such a case that clear information and guidance from a reliable source is needed, so that any choice is more than a reflex response one way or the other. The relationship established by the OPO, and the amount of time and personnel that they can afford to invest in it, is vital both to the needs of the families and the goal of the organization. The way the OPO manages the process is therefore inevitably strategic, but this does not make it immoral. A commitment to the principle of informed consent cannot by itself answer detailed questions about how the consent process should be managed. How much information does the donor family need to be given about the potential uses to which donated tissues might be put? Ought it be given all at once? What sort of language should it be presented in? As Onora O'Neill comments, a process that detailed everything would "bring the consent procedure into disrepute by reducing it to ticking boxes or signing paragraphs of unread fine print" and "actually diminish trust by the very ways in which it seeks to demonstrate trustworthiness."28 What separates procurement from Goffman's case, of course, is that donor families ought to be able to trust the OPOs to do the right thing, given that organ procurement is a routine event for them and they have far more knowledge about it than the donor family. However, there is nothing in either gift exchange or market exchange as such that can be relied on to automatically solve these problems of trust. Both forms of exchange have the potential to betray donors and recipients.

That oughtta kill the thread.

Can't just wait for natural death, can you, Kieran?

I have everyone's best interests at, uh, heart.

Hey, I just nagged Dr. Oops to read your book. I'd sent it a couple of months ago, but hadn't made it clear that I 'knew' you, and she'd put it aside. But swears she'll read it now.

"Knew" is in quotes because LB means it in the Biblical sense.

It sounds like in the Navarro case, the surgeons knew he was headed for death, and they wanted him to arrive at brain-death first so that they could harvest the organs. The fact that he didn't, and they didn't, makes me suspect that there is no foul play here.

FL is taunting me. Yellow card.

Yeah. She actually made fun of me for having a psuedonymous Internet identity that involved talking to academics rather than weird sex. I pointed out that large parts of it were devoted to talking to academics about weird sex, but that apparently doesn't redeem it sufficiently.

But the extracts in 32 address a real problem -- under the circumstances of an organ donation (terribly time-pressured, and occuring at the moment of death), there's no possible way to get at what we'd call ethically obtained consent in any other context. The family is automatically going to be emotionally off balance and underinformed, because there isn't time to let them think about it dispassionately. If we're going to allow organ donation at all, we can't hold family consent to the same standards we would generally, and have to rely on other factors to protect the interests of the patient.

Remind me why we allow the family to have any say in the matter, when there's positive evidence of opt-in? I've signed an organ donation card, and as far as I'm concerned, that should be the end of that; my immediate family doesn't have authority, as far as I'm concerned, to decide otherwise.

Because they have the power to make a fuss if they think you've been killed for your organs. Your family has some right to oversight of your medical care while you're alive but incapacitated, and that right extends up to the point of death, which is plenty to mess up an organ donation.

Because the hospital doesn't want to be sued.

Even though intuitivly i think people shouldn't be killed off to harvest their organs, i can't think of any reason to justify this. but i let it slide because its so far out of mainstream.

Organ donation should be mandatory.

Could not disagree more.

How about making people who refuse to check the organ donation box ineligible to receive donated organs?

Because they have the power to make a fuss if they think you've been killed for your organs.

Which is why I want a "feel free to kill me for my organs" form to fill out.

"he was going to die anyway" isn't how we decide these things

Why not? I mean, suppose you stick "really, really soon" in that phrase, why not?

In the end, the only binding decision you make about what should be done if you are incapacitated is to decide who is your proxy decision maker. After that, everything you do, recording living wills, checking boxes on your drivers license, is really just advice given to your proxy. The check box on the drivers license really doesn't do much, because it isn't effective communication with your proxy decision maker. The best thing to do is to have a next of kin who understands what you want.

Why not? I mean, suppose you stick "really, really soon" in that phrase, why not?

I was making a descriptive, not normative, statement. Maybe we should do it that way, but we don't right now, so "he was going to die anyway" isn't now or yet, a good reason to have hastened someone's death.

we don't right now

"We" of course is more and more limited to us Americans who labor under the delusion that each of us has a right to stave off, perhaps indefinitely, death.

51: you'd push the fat guy in front the train, wouldn't you?

52: The fat man would have died eventually. Probably soon, given his unhealthy weight.

you'd push the fat guy in front the train, wouldn't you?
No, of course not. But look, imagine extension of life on the y axis and expense of extension on the x axis. The value of y approaches zero as you go to the right. I'm simply saying there exists some value of x for which the value of y is not worth x. Weirdly, some economists disagree with this proposition.

I think the claim is that: (a) y is really a % chance of Z time of life, (b) you have really bad information about y, and (c) people tend to value life highly. Which is to say that it's not self-evident in any individual case.

The funny thing is that people who believe that no cost-control measure that might effect end-of-life treatment is going to be workable in the US often seem to often be quite enthusiastic about cost-benefit measures for occupational health/safety/pollution regulations, based on an assumed economic value for a life. Which means, I think, that they don't disagree with that proposition as a matter of economics, but out of (unclearly sourced) beliefs relating to what the US public will find acceptable.

Expense of extension is changing the subject, I think.

And there's a difference between a) heroic measures (expensive and aggressive treatments and etc) to prolong a life versus just letting a person die; and b) active measures to hasten a death versus just letting a person die.

It is currently not acceptable to actively hasten a person's death in order to harvest his organs. I would like to keep it that way. Something to do with wanting to treat human beings as ends not means, along with some anxieties about differentials in wealth and power (the possibility of creating classes of expendable persons and etc).

Expense of extension is changing the subject

Not if you consider lost lives owing to organ failure as a component of expense.

wanting to treat human beings as ends not means

Yes, except of course there's not a really bright line dividing the time when human beings are human beings from the time when they're just rapidly decaying bodies. And of course that's the division between the time they're ends and the time they're means. If you want to say that even a body should never become a mere means, then ok.

52, 54: slol is a Utilitarian, not a Benthamite.

Utilitarian: one who believes that the morally right action is the one with the best consequences, so far as the distribution of happiness is concerned; a creature generally believed to be endowed with the propensity to ignore their own drowning children in order to push buttons which will cause mild sexual gratification in a warehouse full of rabbits.

Benthamite: someone who really would ignore their own drowning child in order to push the rabbit-gratification button.

The funny thing is that people who believe that no cost-control measure that might effect end-of-life treatment is going to be workable in the US often seem to often be quite enthusiastic about cost-benefit measures for occupational health/safety/pollution regulations, based on an assumed economic value for a life. Which means, I think, that they don't disagree with that proposition as a matter of economics, but out of (unclearly sourced) beliefs relating to what the US public will find acceptable.

Right. The people who are into cost-benefit measures for health/safety/pollution (like me) don't think that cost-benefit measures for end-of-life treatment are bad ideas, just unpopular.

61: I'm not sure anybody thinks cost-benefit measures are necessarily a bad idea. But the meat of the matter will be the measuring of cost and benefit, and there are obvious sets of people who will not be in well-positioned to argue their set of values for measuring.

Yeah. The discourse gets confusing because the 'impossibility' of cost-benefit analysis with respect to end of life care gets appealed to as a reason that socialized medicine wouldn't work in the US (Megan McArdle just has a post like this), and the distinction between "we can't possibly do it here because the US public is made up of unpersuadeable nitwits" and "we can't possibly do it here because it would be wrong" gets deemphasized.

I absolutely love the trolley problem. The look on the face of someone who's never heard it before is priceless.

I like the variation on the trolley problem from the Wikipedia article, attributed without reference to a "Dr. Robert Jacobson":

"What happens if, on one of the trolley tracks, the President of the United States has been tied by terrorists, and on the other trolley tracks, five average citizens are also tied up. As in the original Trolley Problem, who should you save?"

Answering that doesn't tax my utilitarian scruples in the slightest.

I think that part of the issue is that our society excels at creating weird bureaucracies that make bad decisions-- who's responsible for Verizon's CDMA choice, or the quality of the BMV experience?

The trolley problems differ from real life in that an individual is actively deciding, rather than setting up a set of rules to be manipulated by accountants and marketing types. The rules exist in part to absolve individuals of blame.

While medical decisions are in a way like any other decision, any loss of agency introduced by a bureaucracy is a huge difference. The extent of loss of agency will not be perceived the same way by people who ususally lose and by people who usually win; that is, people who are used to playing the system are more comfortable with one more system. People who get played want to stay off the field.

the claim is that: (a) y is really a % chance of Z time of life, (b) you have really bad information about y, and (c) people tend to value life highly

Yes, okay: but then we need to have a discussion about how to make decisions in the face of imperfect information. A lot of people, on this subject at least, sound like Dick Cheney-esque one-percenters -- i.e., they'd give away the whole store to prevent something that has a one percent chance of occurring.

Also, you know, *I*'m not a utilitarian. I.e., lovely as you all are, I'd happily save a child of mine at the expense of saving any two of you. No offense. But I think *we* could probably, as a society, stand to reason in a slightly more utilitarian fashion about these kinds of problems that tax our shared resources.

65: Is there some way to get the trolley to back up over someone to make sure they're dead?

Are we going to have the trolley problem discussion after all? ok here's my take: unrealistic thought experiments are necessary for situations where you are trying to figure out the limits of the possible. They are very useful in metaphysics and philosophy of language, for instance. They definitely have a role to play in ethics as well. I'm teaching Thomson's A Defense of Abortion right now, which is surely the mother of all unrealistic thought experiments. But when the focus is on a theory that can be applied in real life, the important intuitions are really the ones elicted by real life situations.

65: A better example might be one where you could send the trolley down a completely empty track or send it down a track with both the current president of the US and five innocent civilians.

Isn't this the drug combination that the Katrina doctor (Anna Pou) was using? FWIW, I think this shoots the idea of the Louisiana AG that this combination is a "lethal cocktail". Sounds like to me they need better lethal cocktails.

We've talked about this before, but I'd argue that one of the problems about things like the trolley problem is that they're insufficiently abstracted -- that part of the intuitive response to them is to elements that were supposed to have been abstracted out but still remain. Like, I understand that most people will flip the switch to the track with one person on it rather than five, but won't either Chop Chuck or push the fat man in front of the trolley. And I'd argue that a difference there is partially due to the fact that stopping a trolley by pushing a fat man in front of it really doesn't sound like it would work -- it might kill him, but wouldn't stop the trolley. Same with Chopping Chuck -- people getting transplants are sick and might die anyway, so it's hard to regard the tradeoff as really five lives for one, whatever the problem says.

70: With or without his current constitutionally-designated successor? It may make a difference to my answer.

decisions with imperfect information

Absolutely, and with socially complex differences between individuals.

Trolley drivers in Prague have a reputation for drunken viciousness, but trolleys are basically a very pleasant way to get around. They make city driving difficult, though. They cannot do abrupt stops, and build up a lot of speed downhill.

72: It's generally a mistake to think of the trolley problem as the professor saying 'this is how it is decided.' They're useful mostly for pulling different intuitions or clarifying very abstract points without people getting hung up on the details. And then someone says 'wait, what about those details...' and then you talk about the details.

I'd happily save a child of mine at the expense of saving any two of you. No offense. But I think *we* could probably, as a society, stand to reason in a slightly more utilitarian fashion about these kinds of problems that tax our shared resources.

None taken. But it's only once you actually save two of us at the cost of a child of yours that I'd feel we'd found someone that we might theoretically be able to trust to make such decisions bureaucratically in the face of imperfect information. We already know that the best way to get disease research funded is to find a powerful Congressperson affected by said disease. The models are bad enough that any specific rules that are promulgated are likely to be a function of political power rather than some simple application of a well-understood rule of nature.

I'd feel we'd found someone

And here's where we're arguing incommensurable points. I don't want to find someone to make the decision bureaucratically, I want to find some way to make the decision bureaucratically. I know, I'm a crazy procedural liberal, or Popperian, or whatever.

I have a hard time understanding what a procedural process that stands alone without a decisionmaker looks like. Even though I like procedural processes, in the main. But healthcare strikes me as an area where people will get screwed for very bad reasons. The obvious place to look for potential problems, I'd think, would be the initial response to AIDS. In particular, I'd be curious about the public's response. My self-recollection is that I tended toward the "heartless evil bastard" side of things.

72:

Like, I understand that most people will flip the switch to the track with one person on it rather than five, but won't either Chop Chuck or push the fat man in front of the trolley.

My old college professor used to respond to this difference by saying, "Okay, but suppose that, instead of pushing the fat man over the side, there's a switch or lever that will open up a trap door beneath the fat man and cause him to drop onto the tracks below. You know, a switch or lever identical in appearance and design to the switch or level which operates the track switching device in the prior hypothetical."

Pretty funny stuff.

Oh, and this:

72:

I'd argue that a difference there is partially due to the fact that stopping a trolley by pushing a fat man in front of it really doesn't sound like it would work -- it might kill him, but wouldn't stop the trolley.

I've always thought that this is part of the thought experiment -- you have to accept the premise that you know to a moral certainty that the fat man's death will stop the trolley and save the track workers.

Right?

That was my point -- I'd bet that the differing intuition comes from on some level not believing the premise of the thought experiment.

I don't want to find someone to make the decision bureaucratically, I want to find some way to make the decision bureaucratically.

In terms of how much the state will provide for long-term care of the chronically ill, or in terms of whether, and under want conditions, the state (or we the people or whatever) have a claim on anyone's organs?

If it's the former, I'm with you. If the latter, I'm not with you at all.

I'm struck by how, in these accounts of the hospital scenario (the doctors and organ procurers and various other experts versus the distraught family members who cannot be expected to make rational decisions), the family's experience of the death stands in the way of the medicalized understanding of what death should mean. White-coated men of science set against weeping wailing women or something.

I already saw this on Law and Order. He did it to advance his career.

White-coated men of science set against weeping wailing women or something.

Something like that. My own instinct is that I would never donate my organs, but I can't articulate my reasons, let alone defend them. (My friend the Sympathetic Oncologist lectured me sternly about this a couple of months ago, just before saying that they wouldn't take my organs anyway, given my medical history.) But there is very little room (other than as something to be managed) in the medical process (machinery?) for the notion of grieving over a body, or the sacredness of even a dead body. Of course, "life" is used to trump what are cast as selfish or atavistic impulses to hold on to a body or to keep it whole.

I think by "whole" I mean something like "not scattered."

No factory seconds in the kidney biz.

Nonny nonny. We don't want your kidney anyway. So there.

Essential link to the definitive discussion of the trolley problem:
http://fafblog.blogspot.com/2004/07/serious-philosophical-discussion-on.html

FAF.: But Giblets does the end always justify the means? For example say there is a man stuck in the opening of a mine shaft.
GIBS.: How would a man get stuck in a mine shaft? Mine shafts are huge.
FAF.: Well lets say he's a big fat man stuck in a mine shaft an there are like a dozen other people trapped in there because the fat man he is just so fat.
GIBS.: This is an improbably fat man we are talkin about.
FAF.: Anyway the question is should we blow up the fat man if there is no other way to get him out of the mine shaft to free the trapped an starving people inside when we know that blowin up the fat man is cruel murder?
GIBS.: Ha! I'd like to see you try! The explosives'll just make the mine shaft collapse an squish everyone inside.
FAF.: Giiiiblets, you're ruinin my moral dileeeema.
GIBS.: The real solution is to keep the starvin people inside the shaft alive by eatin the fat man. Problem solved.

or the sacredness of even a dead body

I'm glad the peer pressure seems to have stuck.

"but his parents probably don't want to believe that, and that's why they're suing the doctor"

The complaints were made by other meds in the room, not the parents.

"knowing what I know about organ donation, there was absolutely no chance that Navarro would have survived"

How can you make that statement?

In this case, a judgement was made by other meds, whose incentive was different than the transplant surgeon. I trust their judgement.

There are criteria for death. What would the criteria be for almost dead?

The complaints were made by other meds in the room, not the parents.

The article says the complaints were made by nurses. It's not the job of nurses to make medical judgment calls. I don't think it's wise to trust the judgment of nurses over that of doctors.

"there was absolutely no chance that Navarro would have survived"
How can you make that statement?

Navarro was only breathing with the help of a respirator after suffering a seizure and cardiac arrest. The hospital (not Dr. Roozrokh) decided to take the respirator off and allow natural death to occur. That's why it's so strange to me that Roozrokh is chosen as the scapegoat here. Before Roozrokh entered the room with Navarro, the decision had been made that Navarro's artificial life support would be terminated. None of the doctors were there to help him get well, just to wait for him to die. Roozrokh made the decision to give painkillers and sedatives to a dying man. That's not murder.

I got the link from NRO, where the post was called "this is why I didn't check the organ donation box."

Obviously they failed to notice that the patient's surname was Navarro.

Anyway, I am appalled that Ogged would instinctively not donate his organs; what a freak you are, Ogged. And I don't agree, actually, with the apparent standard wisdom that hastening someone's death for their organs is a heinous thing to do: it really depends. I can think of a few scenarios (certain severe brain damage, slow death from pneumonia, that kind of thing) where you know, eh: give me an od of morphine and save someone else's life already.

Also re. informed consent--I seriously doubt that *any* next of kin in an organ harvesting situation, if they haven't already had this talk with their loved one, is *ever* going to make a decision free of emotion and regrets and possible "what ifs." I'm not sure what we want with truly informed consent here.

It's not the job of nurses to make medical judgment calls. I don't think it's wise to trust the judgment of nurses over that of doctors.

Oh, on the contrary. I think it's *often* wise to do so, especially when the nurses are reporting something unusual.

That said, re. the respirator thing, I agree that it sounds to me like eh, whatever. But blithely waving away the reports of people present, who have medical training and expertise, just because they're lower on the food chain, is a bad idea.