The death-penalty has been imposed using a wide
variety of methods:
hanging, shooting, electrocution, gassing, & (more recently) lethal
chemicals.
The goal of the executing authority is to make
certain
that the prisoner is absolutely
and completely dead at the end of the procedure.
And in the more advanced countries of the planet Earth,
there has been increasing concern for the comfort of the condemned.
Many jurisdictions are abandoning
capital punishment entirely.
But wherever the death-penalty is still employed,
the most peaceful and painless methods of achieving death are often
used.
In light of the new possibility of allowing some
prisoners on death-row
to donate their organs and tissues after execution,
we can consider even more humane methods of execution:
How can we guarantee that the prisoner is completely and permanently dead?
And at the same time, how
can we best preserve the organs and tissues of the
executed prisoner
so that they will be healthy enough to transplant
into patients who will otherwise die without them?
OUTLINE:
1. BRAIN-DEATH IS WIDELY ACCEPTED IN ADVANCED COUNTRIES.
2. CHOOSING BRAIN-DEATH AS A METHOD OF VOLUNTARY EXECUTION.
3.
THE PROPER SEQUENCE OF EVENTS:
A. THE EXECUTION,
B. THE DECLARATION DEATH,
C. HANDING OVER THE BODY TO THE
TRANSPLANT-TEAM,
D. HARVESTING THE DONATED ORGANS.
A. THE EXECUTION.
B. THE OFFICIAL DECLARATION OF DEATH BY A
PHYSICIAN.
C. HANDING OVER THE BODY TO THE
TRANSPLANT-TEAM.
D. HARVESTING THE DONATED ORGANS.
4.
IF THERE ARE PROBLEMS WITH THESE PROCEDURES,
USEFUL CHANGES
CAN BE SUGGESTED AND
IMPLEMENTED.
1. BRAIN-DEATH IS WIDELY
ACCEPTED IN ADVANCED COUNTRIES.
One reason for considering brain-death
as an
acceptable method of execution
is that public awareness in the advanced countries of the Earth
now widely accepts brain-death
as a definition of death.
There will always be
some people who cannot accept this new concept.
But the medical and legal professions—and
most of the general public—
now acknowledge that when a
human brain has ceased to function, that whole person is dead —even
if the body is maintained by 'life-support'
systems.
Most commonly, brain-death happens because of an
injury to the head.
Motorcycle and automobile accidents cause many
brain-deaths.
When the human brain has been deprived of blood for a few minutes,
it begins to die because of lack of oxygen,
starting with the higher centers of consciousness
and finally causing the cessation of the automatic functions
controlled by the brain-stem such as heart-beat and breathing.
When the human brain dies in a hospital,
mechanical and chemical supports can keep the heart and
lungs operating.
The patient whose brain has died will be declared dead
after sufficient time has passed to permit various neurological tests
to confirm that the
functions of the brain will never return.
When the specific cause of the brain-death is not
known with certainty —such
as with possible freezing, drowning, or drug-overdose— the
body will be restored to its normal condition as quickly as possible,
with the hope that the brain will also recover from whatever happened
to it.
And sometimes such victims of accidental drowning or freezing
are completely restored to life.
But frequently, there is no way to save the victim.
In such cases, only repeated testing will confirm that this brain is now
completely and permanently dead.
2. CHOOSING BRAIN-DEATH
AS A
METHOD OF VOLUNTARY EXECUTION.
However, when the exact medical conditions
of the body and brain are well known in advance —which
would be the case in any application of the death-penalty—
repeated neurological testing will not be necessary,
since there will be no
mystery about the cause of this brain-death.
The exact means of achieving brain-death in the
prisoner being executed
will have to be tested and improved until the best methods are
discovered.
First, there must be no doubt that the executed prisoner is really dead.
A state of suspended animation would not be acceptable. (And
science fiction will imagine various methods of faking the execution
so that the prisoner can be rescued and resuscitated by
criminal colleagues.)
The official determination of death by a doctor must be
100% certain.
The physician who completes the death-certificate
will know the precise methods
by which the execution was achieved.
As when using lethal injection to carry out the
death-penalty,
the doctor does not directly
administer
the lethal chemicals.
That is the role and duty of the executioners,
who are employed by the prison system to administer capital punishment.
The death-penalty has been duly authorized
by the legal system of that place on the Earth.
All legal appeals have been exhausted or abandoned.
Without a shadow of doubt, this execution will proceed as planned.
However, even tho doctors will not use their own
hands to cause death,
doctors have been deeply involved in planning this
execution.
When execution is achieved by lethal injection,
doctors recommend what chemicals to use and how to administer them. They
have made certain that the executioners
know how to insert the tubes that will deliver the lethal chemicals.
When the purpose is to achieve brain-death as a
method of execution,
doctors will have to recommend and describe the precise means
by which the executioners will cause brain-death in the prisoner.
These doctors will know of the plans for donating organs after
execution. And they will do everything
possible to preserve the organs in good
health
so that the donated organs will function well in the recipients'
bodies.
There should be no contradiction in doctors being advisors for execution
while at the same time hoping
to maintain the organs in good shape.
The death-sentence has been duly authorized by the state.
Doctors who philosophically reject the death-penalty
will decide to have nothing to do with any executions.
But other doctors will recognize that the coming execution
has the possibility of
saving
several lives that will otherwise end soon.
These doctors will agree to cooperate because of the greater good
achieved as the result of this execution followed by organ
donation.
Doctors who cooperate in keeping the bodies of
accident victims
'alive'
long enough to harvest organs might also feel some ambivalence:
If possible, they will first
attempt to save the person
who has been injured in a plane-crash.
But if and when it is clearly
impossible to save that patient,
they can turn their attention to saving other patients
who are dying because their own organs are failing. The unavoidable death of one
person (the accident victim) can grant the gift of
continued life to several other people.
Likewise, the death of the condemned prisoner is unavoidable:
The legal procedures have all run their course.
Perhaps the prisoner has chosen a voluntary
execution.
But even if the doctors regret
this loss of life,
they can achieve miraculous
resurrections of other people
who were doomed to die because of organ-failure.
And when the prisoner has agreed to
donate
organs
after execution,
this should make doctors more positive about the
whole process.
3. THE PROPER
SEQUENCE OF
EVENTS: A.
THE
EXECUTION, B. THE DECLARATION DEATH, C. HANDING OVER THE BODY TO THE
TRANSPLANT-TEAM, D. HARVESTING THE DONATED
ORGANS.
Because we in the West live in societies governed by
the rule of law,
we will continue to observe meaningful procedures for executions,
followed by whatever happens to the
body
next. We will not allow living
bodies to be dissected.
We will strictly observe the dead-donor
rule:
Organs may only be harvested from donors who are definitely dead.
Since laws usually require executions to take
place inside prison walls,
this part of our orderly procedures can continue to be observed.
Following all of the protocols for execution,
the warden of the prison where the execution will take place
will ensure that all proper procedures are followed.
There might be some slight modifications of procedure
in light of the fact that this particular prisoner
has volunteered to donate his or her organs after execution.
But all such slight modifications will be approved in advance
by any officials and/or committees that must approve the procedures.
A. THE
EXECUTION.
First, the execution will proceed as planned.
All of the witnesses will be present.
Representatives of the media will be scheduled.
At the appointed hour, the execution will proceed,
using whatever methods can best achieve brain-death in
the prisoner.
The executioner will do something to the prisoner's
body
that will result in absolute and permanent brain-death.
One possible method of execution might be using a simple procedure
to cut off the flow of blood
to the prisoner's brain.
Life-support machinery might be attached first,
so that the prisoner's heart and lungs will continue to function
even after all functions of the entire brain have completely ended.
Or it might be possible to keep
the brain-stem alive
as a means of supporting all vital functions
even when the rest of the prisoner's brain is dead.
This fact of achieving brain-death first
means that the prisoner will
not suffer anything.
Consciousness will disappear (with all thoughts and feelings)
before the other functions of the brain are also turned off.
B. THE
OFFICIAL DECLARATION OF DEATH BY A PHYSICIAN.
Second, a doctor who is familiar with the planned
method of execution
will be on hand to declare death when the procedure has been
completed.
In order to avoid even the appearance of conflict of interest, the
doctor who will declare the prisoner to be dead
should not be
involved in the transplant procedures that will follow.
The role of this doctor is only to determine that death has taken
place,
to complete and sign the death-certificate,
which will say that the
prisoner died as a result of execution,
duly authorized by the state or country where the execution took place.
C.
HANDING
OVER THE BODY TO THE TRANSPLANT-TEAM.
Third, representatives of the transplant-team from
the medical institution
that has agreed to accept donated organs after execution
will then take over the brain-dead body of the donor.
This hand-over will necessarily take place within the prison walls.
But this is the way all bodies of the executed are handled:
After execution, the body will be handled as planned in
advance.
Perhaps a funeral director will transport the remains
for burial or cremation at some other location.
A funeral or memorial service might be held,
as planned by the family
and friends of the executed prisoner.
However, in the case of organ-donation after
execution,
'life-support' systems will be attached to the body of the prisoner,
who is officially declared
and certified to be dead.
Since the transplant-team does not want to operate
inside the prison,
they will send only those necessary members of the medical team
needed to keep the organs viable inside the body of the dead donor.
Attached to whatever medical technology is needed,
the body of the donor will be moved to the transplant center,
which has been prepared to receive the donated organs.
D.
HARVESTING THE DONATED ORGANS.
Fourth, thoughtful preparation and advance planning
will have identified the best recipients of the organs to be donated.
And their planned surgeries will be scheduled in advance,
since it will be known well ahead of time
exactly when these organs will become available for transplant.
This will create a much more
orderly procedure at the transplant center
than happens when the organs of accident-victims must be harvested
after often-traumatic (and unplanned) injuries to the donors.
But with respect to all other procedures at the
transplant center,
the arrival of the dead-donor will be the same:
An ambulance will roll up to the receiving door,
delivering the dead donor attached to various forms of 'life-support'.
The body will be taken to the scheduled operating room,
where all of the re-usable organs will be harvested
and immediately transplanted into patients in nearby operating rooms.
Some of the harvested organs will have a longer
'shelf life' than others.
These can be preserved for transplantation in the next few hours —possibly
in transplant centers some miles away.
The organ-procurement team has already done its work. There
will be no desperate search for the next of kin,
who can authorized the organ-donation. There
will be no grieving relatives saying the deceased has "suffered
enough".
Likewise, there will be no scramble to find the best recipients for the
organs.
All of these organ-procurement steps will be achieved
well in advance of this death by execution.
With respect to the emotional responses of the
medical team,
those who resist the idea of organs donated by executed prisoners
will be assigned to other duties for that day or two.
Only those who whole-heartedly believe in these life-saving procedures
will accept organs from brain-dead executed
prisoners.
As usual, they will never know the donor as a living, conscious person.
This donor—like
all of the others—comes
into the transplant center
only after death has been declared at some other location
by some other doctors.
The transplant-team can harvest the
organs quickly,
so that they have the best chance of resuming their functions
in the bodies of the recipients.
There will be no time to philosophize about organs from the
executed. Such deep thinking will have
taken place months before.
And only those who approve such transplants will participate.
And because of the preparations
possible with this method of donation, the resulting transplants
will probably have a much higher rate of
success:
Good tissue-matching will be achieved.
The prior condition of the organs will be known in advance.
(For example, it will be known that the donor had no diseases,
which is hard to determine when the donor died in a motorcycle
crash.)
Very few medical complications will result
for the grateful patients who will receive
the donated organs.
4. IF THERE ARE PROBLEMS
WITH
THESE PROCEDURES, USEFUL CHANGES CAN BE SUGGESTED
AND IMPLEMENTED.
Because this whole process of harvesting organs from
executed prisoners
is so new both for the prison authorities and for the transplant-team,
there might be some meaningful changes suggested for the
procedures.
And even after the first organ-donations have been achieved,
those early experiences might suggest needed changes in procedure.
Legal and medical history will be made by the first people who
participate.
Reasonable people can agree to change past rules and procedures
when there are obvious good reasons for making such changes.
AUTHOR:
James Leonard Park is an independent philosopher and
medical ethicist.
He has written a few other essays on closely related themes,
which are linked below.
Much more about him is available on his website, linked at the bottom. See
especially the section devoted to medical ethics.
A
Facebook Page has been created: Prisoner
Organ Donation. This
group welcomes participation by anyone
interested in organ
donation from prisoners: prisoners
who have Internet access, family members, friends, lawyers,
prison authorities, transplant surgeons, medical ethicists,
journalists, & students.