See Inside September 2010

When Does Life Belong to the Living?

With thousands of people on the waiting lists for organs, doctors are bending the rules about when to declare that a donor is dead. Is it ethical to take one life and give it to another?

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Death used to be a simple affair: either a person’s heart was beating, or it was not. That clarity faded years ago when heroic medical technology started to keep hearts beating in­definitely. Although we have had decades to ponder the distinctions between various states of grave physiological failure, if anything our confusion has grown. When is it ethical to turn off a ventilator or remove a feeding tube? When does “life support” lose its meaning? And most critically, at what point is it acceptable to cut into a body and remove the heart that could save another life?

These issues are not academic. They raise questions about health care costs—is it worth using expensive machinery on a body that is for all intents and purposes dead?—as well as about dignity in end-of-life care. This year’s “death panel” subplot of the health care debate fed off the real fears people have about being taken advantage of when at their weakest.

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