September/October, 1999 Volume XIII Number 8

The age of "Already Dead"

by Cathy Ramey

TV’s X-Files antagonist, Agent Spender who’s involved in a high-level government conspiracy walks into an isolated hospital room. A burn victim lies swathed in white bandages. These barely disguise the red and black blisters on his face.
“We picked him up last night,” a young doctor tells Spender.
“The burns you’re looking at are somatic, caused by close proximity exposure, brought on by radiation . . . .”
Spender, an unlit cigarette in hand, leans over the man to inspect the burns. “What’s the prognosis?” he asks with a measure of disinterest.
“It’s just a matter of time. This kind of absorption will have a rapid effect on cellular activity . . . a massive and malignant onset of cancers,” the doctor replies.
Spender lights his cigarette and inhales deeply before asking, “Has anyone been in to see this man?”
The ember from his cigarette is close to the man in the bed whose eyes move to track both the cigarette and the conversation.
The doctor answers by suggesting that a specialist be brought in to treat the patients. Apparently there are others with burns that have blistered their flesh.
“Do you know what caused this?” the doctor asks.
Spender mumbles that he has seen the condition before. Turning on his heels to leave the room he orders, “Have the bodies destroyed.”
Looking stunned, the doctor gasps, “But sir, these men aren’t dead yet!”
“Isn’t that the prognosis?” Spender shoots back as he leaves the room.

The X-Files is a science-fiction TV show, but the scene just described illustrates an ethic that has dominated medicine in the past, is operative today in the abortion industry, has moved Oregon to legalize assisted-suicide, and which ultimately is having an impact on discussions concerning organ procurement. It is an “already dead” ethic which says, in essence, that if death is determined to be a certainty within a specified period of time, medicine and science—even society—may treat the individual as if they are “as good as dead,” or “dead already.”
In the past, this ethic underscored an assumption that each individual carried into a Nazi concentration camp with him. There was a foregone conclusion that any person entering the Auschwitz Concentration Camp was sentenced to death. Their extermination was so completely assured (since the State’s policy was to eliminate those seen as useless or undesirable), that officials and guards at the camp actually viewed them as “dead already.”
Such a view made it possible to participate in actions that might otherwise result in enormous moral and emotional conflict. Since they were “as good as dead,” it was unnecessary to worry about the ethics of punishments, questionable or downright immoral medical “treatments,” failure to treat, or research experimentation upon them as living human beings. The fact is, they were going to be dead, so they were viewed by their captors as “already dead.”
Writing of the routines at the Stutthof concentration camp, Tadeusz Skutnik suggests this view, stating:

The Jewish doctors received neither medicines nor dressings. There was not even drinking water. They were all destined for extermination, therefore treatment was unnecessary.”1

In such an environment, experiments done by physicians and researchers “reflect the Nazi image of ‘life unworthy of life,’ of creatures who, because [identified as] less than human, can be studied, altered, manipulated, mutilated, or killed...”
In the same way, abortion facility staff persons subconsciously view the Unborn child as already dead. Since the woman’s autonomous decision is to have the child killed anyway, the infant’s rights—even feelings and experience of pain—are irrelevant.
In fact, personnel will often quibble over vague definitions as to when life actually begins despite credible biological evidence that it begins at fertilization. Some go so far as to argue for a date much later than the day of birth under the theory that a child ought to be evaluated for a period of time before obtaining the rights of personhood.2
Degree of physical and cognitive development may be the litmus test for some, while projections of what the future might hold for the individual, or what service the individual might contribute in the future become determinants for others.
This idea of viewing captive Jews and Unborn humans as “already dead” by virtue of some perceived benefit to be derived from their deaths has increasingly spilled over into the treatment of other people groups.
In 1992 the Florida Supreme Court handed down a decision regarding an anencephalic baby. Her parents and the American Civil Liberties Union (ACLU) sought to have the infant declared dead at birth. Their reasoning, despite the child’s obvious lack of morbidity, was that baby Theresa Ann Campo was expected to die eventually. By declaring her dead, when in fact she was still living, the hope was that her body organs might be “harvested” for the benefit of another. Such a legal precedent, it was speculated, could result in a feast of organs made available as parents of babies born with anencephaly were pursued to donate their children’s organs even before actual death.3 A summation of the legal activity, commented on by Paul Fox, a physician-ethicist, follows:

The reasoning of the ACLU in this case was chilling. They noted “the inconsistency of permitting the termination of pregnancies up to the moment of birth” while at the same time “prohibiting the donation of organs just after birth.” [They argued] “There is absolutely no morally significant change in the fetus between the moments immediately preceding and following birth.” 4
Note the semantics involved in avoiding the reality of what is being argued as a social good. The act of killing the now born infant is euphemized so that its ban—that is to say, arguing against the intentional killing of the child—is reduced to a perceived negative, an egregious sin because it results in “prohibiting the donation of organs.”
In the same article Dr. Fox noted that the American Medical Association Council on Ethical and Judicial Affairs had, in 1993, “declared that it was ‘ethically permissible’ for anencephalic infants to be used as donors while still alive. . . ‘because of the great need for children’s organs,’ and second, because anencephalics ‘have never experienced, and will never experience, consciousness.’”5
Precisely what anencephalic infants’ experience is really not known. What is a fact is that they frequently have a functioning brain stem that may support life for hours, days, weeks, and in at least one case, for years. But to allow them their lives until natural death occurs means that their organs undergo deterioration making them unsuitable for transplant purposes. Researchers and physicians, anxious to exploit such “resources” have worked steadily to erode traditional definitions of death. These include death due to cessation of cardiac and respiratory function, and what is termed “whole brain death.” “Cortical death” is the term used to describe the absence or irretrievable loss of conscious and cognitive brain function.

Lest we be lulled into apathy by the idea that only those who have “never experienced” consciousness are vulnerable—as if that offered any level of moral validity—there are other examples.
On April 13, 1997 the TV news magazine show 60 Minutes aired a segment entitled “Not Quite Dead,” an investigation into organ harvesting which took the life of a 33 year old woman, Pamela James, of Defiance, Ohio.
Mrs. James was the victim of an intruder who entered the family home and shot her once in the head. She was taken to St. Vincent’s Hospital in Toledo, apparently assessed as a potential organ donor, and transferred to an operating room where first one and then another of her organs was harvested for transplantation. Later an autopsy demonstrated that the head injury was one from which it could have been anticipated that she would recover. The autopsy report determined that Pamela James’ actual time of death was at precisely the moment when her heart was taken from her body by the transplant team.
In an interview with 60 Minutes, Dr. Arthur Caplan, a leading medical ethicist in the United States, responded to the problem of taking organs from patients who are still alive by stating,

“If we make people wonder, ‘Well, are they just going to say, dead enough, or sort of dead, or kind of dead, close enough’ because they want organs, and that’s what’s driving the determination of death, that’s not good public policy.”6

In the same news segment, Dr. Mary Ellen Waithe, professor of bioethics at Cleveland State University, while condemning the taking of organs from living patients alarmingly suggested that the determination of death is merely a matter of legislation:

“I’m splitting hairs, [she said] because ‘as good as dead’ is not ‘dead.’ And it’s not up to physicians. It’s up to the Legislature of the state of Ohio and the separate states to determine what our legal criteria of death are.”7

Such a marriage of State and medicine is actually an unholy alliance. Moral absolutes and time-honored definitions of death and respect for the human body are discarded as the body politic molds law to suit its own preferences. Dr. Waithe’s faith in the State is no more reasonable than another’s faith in unprincipled physicians who see people as organ farms rather than patients.

Just as Jews were dehumanized into “vermin” and “gangrenous appendix,”8 and Unborn infants have been translated into developmental terms like “embryo” or “fetus,” patients who are seen as a potential source of organs for transplant can become labeled with terms that resist any reference to their human dignity. They are “vegetables,” “PVS’s,” “GOMERS” (get out of my emergency room), “living-dead,” and spoken of as if they exist in a gray state between life and death. Indeed, the very measurements used to identify human life become confusing to the average individual and there are increasing pressures to idealize death. It is a benefit which can be granted at the behest of the State and medical profession, and which is hindered only out of respect for emotionally distraught family members and a society that has not yet adopted a solidly humanistic, mechanistic view of life and the body.
There is a tone of frustration among transplant-industry promoters that the “nearly dead” cannot be treated as already dead in the same way that Unborn children have. Unborn babies have suffered no end of vulnerability to medical experimentation even while in the womb. But there are indications that at the other end of the transplant scale—on the recipient end—there are others considered burdensome and abnormal who are treated as “already dead” in passive ways.
Katie Atkinson was nine-years old just under a year ago and, medically speaking (bypassing the ethical conflicts), in need of a heart-lung transplant. But she was denied the opportunity to be placed on the waiting list.
Katie Atkinson was born with Trisomy 13, Down’s Syndrome. Her “presumed fitness to live” gave her a score too low to qualify as an organ recipient. In fact, according to science correspondent Aisling Irwin, Katie and other children and adults have been turned away because they are “elderly, poor, single, homeless, unintelligent or could not speak English.”9
But going back to those more aggressively pursued as “already dead,” it is naive to insist that nothing but respect for the dying would motivate final medical treatment. Once a person becomes persona non-gratis by virtue of shifting definitions for death, our own history indicates that all manner of research might be pursued without regard to a more traditional understanding of death or human worth.
Gene therapy researcher, Dr. French Anderson, of the University of Southern California, has petitioned the U.S. government and a national ethics committee to allow him to experiment on Unborn infants awaiting abortion. His 1998 proposal includes identifying babies with potential genetic abnormalities, injecting them in utero with a virus carrying alternate genetic material, and then autopsying them after abortion to discover how the substitute DNA might have impacted their genetic condition. Women involved in the experiments would have to agree to follow through with an abortion in order to avoid the possibility of Dr. Anderson having created survivable but serious deformities.
Anderson’s application is not unlike a long series of applications resulting in experimentation on living Unborn infants. Recall, March of Dimes advisor and abortionist, Dr. Kurt Hirschhorn, who, in 1973 sought permission to engage in “non-therapeutic research” on living Unborn babies in order to test the impact of drugs on the child. His intent was to experiment on what he referred to as “defective” Unborn infants who were going to be aborted. He said, “It is not possible to make this fetus into a child” because the intent is to kill it and the legal mechanization is in place to allow it “therefore we can consider it as nothing more than a piece of tissue.10
Suzanne Rini, in her well documented book Beyond Abortion, cites two researchers who “argued that any intrusion on the [living] fetus to be aborted could not be logically agonized over, considering its ultimate fate.”11 In other words, since the Unborn baby whose mother opts for abortion is “as good as dead,” why all the fuss over invasive or harmful experimentation?
Ethicist Joseph Fletcher, who is largely responsible for promoting “situation ethics,” comments in his book entitled Research on the Fetus:

“Common sense, in any case, does not allow that a fetus which is inviable or to be terminated can be ‘harmed’ or ‘injured’ or ‘insulted,’ since acts of battery and mayhem presuppose a living, independent individual biologically. . . . An injustice predicates a person.”12

Logically, this mindset is what contributed toward the experiments, funded by the March of Dimes and carried out in Helsinki Finland, in which Dr. Peter J. Adam aborted babies and then decapitated the still-living infants for research purposes.13

Again, traditional medical ethics has always condemned experimenting on human subjects when they cannot give consent and will not derive personal benefit from the treatment.
Already, as with fetal tissue research, transplant technology oversteps long-standing ethical barriers to treating a patient or causing them to endure procedures that cannot be shown to have personal benefit to them.
Patients with fatal injuries who are potential organ donors typically experience medical complications at the end of life for which there is no treatment available that will be of benefit. However, because every attempt is made to preserve organs and tissues, expensive, invasive, even potentially painful therapies are common. Patients who are attempting to die, despite all that medical science would do to keep them in a state of suspended animation, suffer from a variety of crisis including; cardiovascular instability, anemia, coagulopathy—a need for transfusion of fresh blood products, diabetes insipidus, and need for mechanical ventilation.
But as in times past, the focus is not on abusive treatments that a dying person might not otherwise consent to. It is the, apparently excusable, sin of mercy in which dying must hold more meaning for others than for the one who undergoes that process. Medical managers simply determine when and what “benefit” might be derived from their going. From a utilitarian standpoint, maintaining the health of the larger community is of more value than allowing the individual to die in a less contrived manner.

The X-Files Agent Spender is only a character brought to life by Hollywood. But the callous expression of surrendering human beings to be disposed of without regard to time-honored traditions and concern for the expression of grief on the part of others, even before they have died in traditionally accepted ways, is part of a post-Hippocratic medical ethic.
Now comes the debate over what is termed “Presumed Consent,” the idea that all dying persons are potential organ donors unless they have become listed on a national database to “opt out.” Those least likely to understand and exercise their option are the young and poor who enter emergency rooms with potentially lethal gunshot wounds but strong hearts, kidneys and livers.
Like Mrs. James in Toledo, Ohio, one has to ask if they too might be presumed to be “as good as dead,” therefore, “already dead” and ripe for a harvest.

1 Tadeusz Skunik, Stutthof Historical Guide, Pg. 15, Krajowa Agencja Wydawnicza, Gdnask, Poland, 1980
2 Sir Francis Crick, one of the discoverers of the DNA double-helix structure, stated “No newborn infant should be declared human until it has passed certain tests regarding its genetic endowments . . . If it fails these tests, it forfiets the right to live.” quoted by John and Paul Feinberg, Ethics for a Brave New World, Pg. 285, Crossway Books, Wheaton, IL, 1993
3 In fact, various researchers debate that such babies could prove to be a significant resource for organs at all. Anencephaly generally results in failure of at least one other major body system or organ to develop in a healthy manner. For further research, a search under “Loma Linda,” or “Baby Gabrielle” will result in an example of an anencephalic baby whose organs were “successfully” harvested before death.
4 Paul C. Fox, MD, “Babies and Body Parts,” First Things, pp. 9-17, Dec. 1994
5 Ibid.
6 CBS News, 60 Minutes, vol. XXIX, number 30, “Not Quite Dead,” April 13, 1997, Pg. 6 of transcript
7 Ibid.
8 Lifton, The Nazi Doctors, Pg. 204
9 The rationale is often based upon an ethically related decision to give organs to those most likely to remain medically compliant so as to promote continued organ health.
10 Victor Cohn, “Live fetus research debated,” The Washington Post, April 10, 1973
11 Suzanne Rini, Beyond Abortion- A chronicle of fetal experimentation, Pg. 21, Tan Publ., 1988
12 Joseph Fletcher, Research on the Fetus appendix “Fetal Research: An Ethical Appraisal,” Pg. 3/3,
13 Rini, Beyond Abortion, Pgs. 26-28

Whose body is it anyway?
Language of the transplant industry
Attitudes about donation
The age of "Already Dead"
The Wholesalers

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