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Should prisoners on Death Row be accepted as Organ Donors?

Isobel, a Year 10 pupil at WHS, assesses the ethics and logistics of accepting death row prisoners as organ donors.

Disclaimer: This piece is based on the US death row and does not highlight my own views on capital punishment.

From a Utilitarian standpoint, there may appear to be a simple answer to this question: organ donation should be permitted because there is a global shortage of transplantable organs and those in dire health condition are unable to receive the medical care they need. However, as more research is done numerable practical and ethical barriers arise. One country that already utilises organs from death row inmates is China. Reports state that more than 5,000 prisoners are executed in China annually, and organs are harvested for transplantation from suitable prisoners. These prisoners are executed via a temporal gun shot wound and are declared dead secondary to execution. They are not declared brain dead which causes many ethical headaches because the physicians removing the organs are then put in the position of executioner. This brief case study begins to highlight some of the major opposing arguments to organ donation from death row prisoners.

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The numerous practical barriers surrounding organ procurement from death row prisoners begin to pile up after closer inspection. The first issue is the low yield of transplantable donor organs from these prisoners due to the potential high likelihood of alcohol or drug abuse. Whilst this is a potential stereotype, these factors can drastically impact the quality of the organs being donated.

For example, alcoholism is the leading cause of liver disease in the US because heavy drinking can cause irreversible cirrhosis. Approximately 10-20% of heavy drinkers develop this disease and it is the ninth leading cause of death in the US, killing around 35,000 people a year. Prisoners in long term facilities will not live on nutrition rich diets, will most likely be malnourished because of the (often) poor-quality food they have consumed and will not get the adequate exercise to build up strong organs such as hearts and lungs. These reasons could also impact the quality of their organs for transplantation.

The second practical barrier preventing condemmed prisoners from being organ donors is the logistics on the day of execution. The surgeon performing the operation cannot kill the patient by removing their organs as it breaches the Hippocratic oath of ‘do no harm’. The patient must already be dead or pronounced brain dead before they are put under general anaesthesia because when the transplant team cross clamps the aorta, resulting in a cardiectomy and takes the patient of the ventilator, they are then declared dead. Many physicians’ groups, including the American Medical Association, have prohibited physician participation in state executions on ethical grounds.

Looking through a utilitarian lense the death of an organ donor means dozens of lives saved and the donation is there simply to help those suffering from end stage organ disease, not for any other ulterior motives. The two documents that set out the rules around organ donation in the US are the National Transplant Act of 1984 and the Uniform Anatomical Gift Act. Neither of these documents explicitly prohibits organ donation by death row inmates which means there is no law preventing it from happening. The National Transplant Act states that organ donation cannot be made for ‘valuable considerations’, including exchange of money, material benefit, or a shortened sentence.  This would not be an issue for death row inmates as they have already been condemmed until the end of their life and they have little access to the wider society.

Christian Longo went public with his idea to donate organs as a condemmed prisoner and joined the organisation G.A.V.E (Gifts of Anatomical Value from Everyone). He came up with the idea himself so there is no fear of coercion and he approached the New York times with his story on a voluntary basis. There have been 14 other publicised instances of death row inmates and their lawyers attempting to seek their respective opportunities to donate their organs. They were denied on the grounds of current knowledge on the matter. As popularity surrounding capital punishment begins to dim the public’s sympathy for those stationed on death row is increasing. The conversation surrounding a prisoner’s ability to choose to have one good action in the world before their execution is becoming ever louder.

When a person in incarcerated many of their free rights no longer apply. This can make the ethical arguments considered in organ donation heightened or just too confusing to comprehend.  Two seemingly opposite arguments: fear of coercion, (insinuates the death row inmates are not being adequately protected) and the intention to preserve the morality of capital punishment (death row inmates rights are given too much protection) begin to represent this.

There is a fine line between coercion and free choice when it is made in a heavily pressurised situation like a prison. The emotional stress on the donor can be intense because of the need to make right. Also, the patient who is accepting the donor should be notified that the organs they are receiving came a person on death row. Those who oppose capital punishment are then forced to choose between their life or their personal morals. Many say that the idea of capital punishment is to achieve retribution and deterrence in society. The action of donation is not consistent with either of these aims. Making a hero of the person at the end of their life could have detrimental impact on the family and friends of the victim to the prisoner’s crime. For many, the death of the perpetrator of their pain can bring closure and end to the cycles of grief. To see them be glorified in their last days could have the opposite effect.

https://pixabay.com

It is important to consider the impact that organ donation from death row prisoners will have on the overall practice. The number of potential organs recovered from condemned prisoners would be small. The conceivable stigma that would be attached to organ donation from its coupling with execution could lead to decreases in donation rates. This may especially be true within certain minority groups.

Any notion that groups of people were receiving increased numbers of death sentences to provide organs for the rest of society would clearly make it difficult to attempt to obtain consent for altruistic donation from these groups.

Overall, the bad outweighs the good so although it may seem like an easy solution to a difficult problem, donation from death row inmates would cause more problems than it could hope to solve.

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Is nihilism really hopeless?

Nietzsche

Anya, Year 13, explores what characterises nihilism and investigates the worth of nihilism; it is hopeless or actually positive?

Nihilism, according to the Oxford Dictionary, is the rejection of all religious and moral principles in the belief that life is meaningless, which, strictly speaking, does sound quite despairing. Yet, however hopeless the Oxford Dictionary would have us think it is, nihilism can allow (perhaps surprisingly) room for personal, moral and spiritual growth.

Nihilism undoubtedly stems from pessimism. Indeed, Nietzsche, the German philosopher and scholar who is often associated with it, called nihilism “the most extreme form of pessimism”.

The path to becoming a nihilist starts with weariness and a loss of faith in social, legal and cultural values widely held in our society. When people begin to feel alienated from their values and do not replace their value system with any other known system, such as a new religion or political philosophy, they become nihilists. They are disappointed with the egoistic nature of ‘truth’ and ‘morality’ but at the same time recognise that those things are necessary.

Often, free will seems contradictory: we depend on a value system that doesn’t exist and have depended on previous value systems which we have seen crumble. Each time we encounter a new system we conform to those values, we feel bound by them and those of us who rebel, i.e. criminals, are cast out from society. If none of these systems ever even existed, as the nihilist claims, we are just going around in a cycle of limiting our life choices for no reason. Basic values such as getting an education or a good job are placed in a sphere far beyond what is reachable.

The nihilist realises that every time someone begins to talk about “the real world” they are merely talking about a fictitious world because, from a nihilist perspective, every category used to measure and qualify our world is fake. In summary, the beginning of a nihilist lifestyle sounds a lot like the act of giving up and becoming a recluse, not to mention very dejected.

However, Nietzsche claims that nihilism is a necessary step in the transition to a devaluation of all values one holds. He outlines two distinct forms of the philosophy: passive and active.

Passive nihilism is characterised by a weak will. This is the kind of nihilism commonly made reference to in popular culture, which brings about little more than mental exhaustion and no change. A passive nihilist would see the emptiness of general external values (such as various social constructs) and project that onto individual internal beliefs (such as what you feel is good and bad), which results in a loss of personal authority. This type of nihilism can truly be called hopeless. Passive nihilism plagues the mind, often resulting in the person attempting to remove all responsibility from themselves, as the mind seeks to hold onto something that isn’t arbitrary, which can lead to one searching for hollow escapes such as excessive drinking, meaningless relationships and general “self-narcotisation”. Yet any attempts to escape nihilism without actually re-evaluating one’s own values only makes it worse.

On the other hand, active nihilism is characterised by a strong will. This constructive nihilism goes beyond simple judgement and moves on to action, specifically, the destruction of the remaining, meaningless status quo and the rebuilding of values and ethics through thought and reason. The will is made stronger still by forcing the recognition that practically all our value systems are in fact devoid of meaning, whilst at the same time having the power to accept that this meaninglessness serves a purpose, as ironic and oxymoronic as that may seem. Nietzsche claims that this form of thought is “a divine way of thinking”. An active nihilist will recognise the necessity of the lies and oversimplifications of life and begin to value the irrationality of how we live, as these are the conditions which must exist in order for people to truly have the ability to think for themselves.

It is important to note that nihilism does not replace values, at least according to Nietzsche, but rather makes room for those values to be broken away and reconstructed. Nietzsche stressed that nihilism is merely a means to an end, and not an end in itself. In this way, it becomes a form of existential nihilism, a contradictory principle in which we accept that values are meaningless and fake whilst building new ones for ourselves. Active nihilism opens doors to revaluating and more importantly, constructing new values for ourselves. In this way, we achieve a sense of freedom as well as infinitely greater insight into ourselves and the people around us.

Thus, nihilism is not inherently hopeless, instead, it can be said to create hope, as it pushes us to change, ask questions and find answers for ourselves. Active nihilism is certainly necessary for any kind of social, political or religious revolution. To paraphrase Sartre, if our life is the only thing we get to experience, then it’s the only thing that matters. If the universe has no principles then the only principles relevant are the ones we decide on. If the universe has no purpose, then we get to dictate what its purpose is. So, whilst a loss of faith may lead to nihilism, nihilism leads to new hope.