_Letters___________________________________________________

Editor’s note: The Essay in our March issue, on the moral issues involved in organ transplants, was indubitably controversial; some leading Catholic scholars take the contrary position that transplants can be justified—and indeed can be a moral good. Nevertheless, somewhat to our surprise (and even disappointment), CWR did not receive a single letter disagreeing with the Essay. The letters that follow offer a fair sample of those we received.

Transplants and the Pro-Life Movement

At the end of the fine essay and commentary by Bishop Bruskewitz et al. (“Are Organ Transplants Ever Morally Licit?” March 2001), the authors call for “a consistent pro-life argument on the subject of brain death and organ transplantation.” A few years ago the philosopher Peter Singer, certainly no supporter of the pro-life movement, expressed surprise that there was no pro-life movement in response to the introduction of brain-based criteria for human death, and pointed to that silence as the effective end of a sanctity-of-life ethic in the general culture. The pro-life movement can learn from this perspective of its ideological enemy.

Many of the same arguments pro-lifers use to attack abortion can also be used to attack the validity of taking unpaired vital organs from brain-dead patients. A common slogan in the pro-life movement is: Abortion stops a beating heart—yet so does stopping and then removing the heart of a patient who has been declared “brain dead.” Such a claim shipwrecks one of the pro-lifers’ main arguments against the viability criterion for personhood—that viability is being pushed back, because younger and younger premature infants are surviving. They only survive after a period of dependence on machines along with extensive pharmaceutical support. To say that machine-dependence implies death is absurd; there are conscious individuals who are dependent on ventilators, who would surely disagree with a proposal suggesting that they are dead! 

Organ donors diagnosed as dead by brain-based criteria have functioning circulatory systems, and even though they require a ventilator to move the diaphragm and provide oxygenated air, they still have functioning respiratory systems in the much more relevant sense of the exchange of oxygen and carbon dioxide in the tissues. Some “brain dead” women have given birth to healthy babies. These individuals are not dead! Removing their unpaired vital organs, such as the liver or heart, kills innocent human life. May the pro-life movement be just as pro-life in opposing killing by organ removal as it is in opposing the killing of unborn children.

—Michael Potts, Methodist College, Fayetteville, North Carolina

Moral and complete certainty

The Essay on organ transplants does a great service by its careful, respectful examination of the Holy Father’s discourse on organ transplants, and by raising questions concerning the application of moral principles to this practice. In this letter I wish to comment on doubt in moral dilemmas, a difficulty raised in the essay. But first something must be said about certainty.

If certainty is defined as “a firm and reasonable persuasion that conforms to the truth,” we see immediately that certainty as a quality of the human act has truth as its criterion. Firm and reasonable persuasion, if it is to be certain, must conform to what is objective. If, on the other hand, a truth is unknown—in our case, if we are unable to judge whether the person whose organs are available is alive or dead—a state of doubt is present and the transplant cannot take place. In such circumstances there is no other way of respecting the inalienable right to life. The probable opinion (here, “this person is probably dead”) is never sufficient for action in matters connected with natural law, however great the degree of probability in the judgment.

In the essay, the waters are muddied by the comparison between “moral certainty” and “complete certainty” (both phrases are used by the Pope in his talk) and by the subsequent conclusion that moral certainty is of a lower standard than complete certainty. This implies degrees of certainty, and questions about the degree of certainty needed for moral action. Certainty as defined above, however, is not open to such questions, although we may speak of the need for “complete certainty” when a doctor has to complete a death certificate, and of “moral certainty” when a moral dilemma has to be solved. Such an approach would seem to be borne out by the context of the phrases in the Pope’s address. He speaks of “complete certainty” relative to “scientifically secure means of identifying the biological signs that a person has died,” and of “moral certainty” as the “necessary and sufficient basis for an ethically correct course of action.” It would be better, therefore, to avoid distinctions of this kind when dealing with problems solely from a moral point of view. In considering organ transplants, it is sufficient to say that participants must be certain about death before an intervention can take place.

—Denis Cleary, Durham, United Kingdom

A nurse’s perspective

I was deeply impressed by the article on organ transplants. I have waited for years to hear some basic truths about this issue expressed.

I was a registered nurse in an intensive care unit for a number of years. When I first worked there, I had the usual conception of organ transplantations as morally acceptable. After several years my outlook changed dramatically and I went with my concerns to the priest who headed our diocesan Respect Life office and to my spiritual director; I wrote to a Catholic bioethical center and I even wrote to the Vatican. I never had any satisfactory response.

The important point which the article emphasized is that major internal organs such as the heart and lungs are taken out of a body which has a beating heart. Many lay people are not aware of that, and need to be. As with abortion, I don’t think this is the “complex issue” that many say it is; a heart that beats on its own means a living person.

There are two other points which I would add, as someone who has worked with donor patients awaiting the removal of their organs. First, the patient’s doctor signs off the case when the determination is made to classify the patient as a donor; a transplant team then takes over to “harvest” (a significant term) the organs. From that point on, medical care is not performed as if this were a live person. As an example, one patient of mine was scheduled to have his kidneys removed, so to keep the renal function adequate, he was placed on a heating blanket, to raise his body’s temperature. If he had not been a donor, the opposite would have been ordered: a cooling blanket to slow bodily responses and to help prevent increased intercranial pressure.

Second, I would like to tell what a supervisor said to me after witnessing organ donation surgery. She told me that after removing major organs, corneas, bones, and skins, what was left on the operating table looked like “a pile of hamburger meat.” I think that was the telling moment for me. How could I reconcile that with respect for the body, the temple of the soul?

I tried for years to come to terms with the Church’s apparent teaching that organ donation is morally good, but never could. I thought this is the only teaching of the Church that I could not accept. It is with tremendous relief that I found your article telling me that I don’t have to feel myself at odds with Church teaching. 

Thanks for ending years of agonizing on this subject.

—Christina Brundage, St. Petersburg, Florida

No real informed consent

The Essay by Bishop Bruskewitz and his collaborators makes the fundamental point that vital organs are being removed for transplant purposes from human beings who are not dead. It also deals with the issue of informed consent —a matter of vigorous debate in the United Kingdom recently because of the illicit removal of organs post-mortem. Their illicit removal from still-living patients is surely of no lesser importance. In times gone by one would have thought it a matter for the law of the land.

To be fully informed, the consent of potential donors must be based on the understanding that organs will be removed in a pre-mortal state, if the offer to donate is ever taken up. That understanding is, perhaps, best ensured by making it known that some anesthesiologists do not believe that the UK tests for the diagnosis of “brain-stem death” —and the certification of death on those grounds—exclude the possibility that the donors may feel pain during their evisceration. They cannot move, of course, because they are paralyzed by drugs. But they exhibit cardiovascular signs which, to the anesthesiologists’ expert eyes, strongly suggest that they may be suffering. Anesthesia is not required by the “harvesting” protocols now in use.

The Organ Donor Register application forms (and driver’s license application forms with boxes to be ticked by those willing to “donate”) carry no explanation of these highly relevant facts. The crucial wording is simply “after death.” Consent on that basis cannot be valid. It is based on wholly inadequate information, to say the least. Some might see it as purposive misinformation—that is, deception.

With regard to the “clearly determined parameters” of so-called “brain death,” the large number of different diagnostic protocols in use worldwide speaks volumes. The simplistic UK protocol is so obviously inadequate for that diagnostic purpose that there has been no attempt to defend it since 1995. Use of the term “brain death” has been officially discouraged since then. The pre-mortal clinical syndrome diagnosed by the UK tests appears to be unnamed at present, there being at least tacit acceptance that it is not brain-stem death in the de facto sense. But it is still the basis of certification of death for transplant purposes. 

—D. W. Evans, MD, Cambridge, England

Trauma from a transplant

I read with overwhelming joy your article, “Are Organ Transplants Ever Morally Licit?” The moment the doctor said to me, “Your son is now brain dead,” was the beginning of a 10-year battle to extract information from an “industry” governed by institutionalized deceit.

I did not believe that my son was dead when the doctors told me that he was. I believed that they were saving me and my husband from further trauma by not turning off the respirator in front of us. I believed that they would do so when we were out of the room. We found out years later that the respirator was kept on so that my son’s heart was still beating, so that his circulation and respiration were still functioning when they killed my son as they cut out his heart. “Brain death” is not death.

The trauma has been overwhelming. We have since formed an organization of organ-donor families in Australia for supporting each other, and we have lobbied ministers of Parliament, hospitals, the transplant industry, and others for truthful information to be revealed to potential donors so that informed consent is just that: informed. To ask the public to tick a box on a driver’s license or to put a name on a register, without the details, is exploitative. Our lobbying took us to someone in one of the highest positions of power in Australia, who responded to our pleas by saying that “whatever is for the greater good” must be done. Attempts to increase the donor pool without truthful information, we believe, only increases the latent fears about brain death, which is reflected by the low donor rates of which the industry complains.

In early March 2001, an audit was announced in the Australian Parliament into the retention of human organs and tissues removed without consent. Also in Australia, on March 16, 2001, in the New South Wales Parliament, the leader of the opposition, D. Gay, urged that the inquiry should include scrutiny of the current practices of consent for removal of human organs and tissues for transplantation, and ascertain whether these practices comply with contemporary community standards. We will make sure that brain death is firmly on the agenda.

—Peggy Stone, Australia

Progress toward freedom in Cuba

I was surprised recently when a member of the Secular Franciscan Order (Third Order) which I serve showed me a copy of your February issue with my picture on page 33, celebrating Mass in my beloved La Pastora parish in Cuba. I served there with much joy from 1994 until the Cuban government obliged me to leave in 1998, not long after the Pope’s visit. I greatly enjoyed reading the article, and congratulate you for spreading the news about the Church there. But (if you are open to constructive criticism), I found the article excessively negative.

While it is important to speak out against the restrictions of human and religious freedoms in Cuba, it is also important to recognize the substantial increase in freedom that the Church has enjoyed over the past decade. Such fierce persecution as that suffered by Father Loredo in the 1960s should be remembered and honored. But it should also be recognized that the Communists have backed off substantially from such abuses. Restrictions on freedom of information such as those that restrict Palabra Nueva to 10,200 copies are abuses. But the publication of even limited numbers of diocesan and parish periodicals is extraordinary progress as compared with the almost total silencing of Church publications in the past.

In my parish we had available for distribution an insufficient but still substantial number of Bibles, catechisms, Church documents, and so forth, while my faithful catechists showed me the carbon-paper duplicates that were all they had to work with for years (if they could get carbon paper). In the months leading up to the Pope’s visit the Church imported from Mexico and freely distributed, door to door, 1 million copies of the Gospel of Mark. 

The article says that people attended the Pope’s Masses “in spite of . . . the risk of persecution” by the government. But the truth is that Castro spoke on nationwide TV in the week before the visit and urged Cubans—believers and non-believers alike (including Communist Party members) to attend the Masses and to listen respectfully, even forbidding Party members to shout anything at the Masses if they disagreed with the Pope’s words. The government put at the disposal of the parishes massive numbers of buses, trucks, and trains to bring people to the Masses. No one I knew had any fear of persecution for going. Give credit where credit is due.

It broke my heart when the Communists forced me to leave my people in Cuba. But while we speak out against what is bad, we must also honestly recognize what is good. Cuba still has a long way to go. But the positive changes that have been made should be acknowledged and praised, and I wish your article had done more of that.

—Father Patrick Sullivan, OFM Cap, Manchester, New Hampshire 

Defends Charleston diocese

Thank you for your wonderful magazine, and especially for the February edition with the story by Michael Rose on the alleged shortage in priestly vocations. It was excellent.

However, the letter to the editor by W. George Dragan of Milford, Ohio was not so excellent. In that letter, Dragan alleges that the Diocese of Charleston, South Carolina, is part of the problem that Rose identified. Specifically, Dragan states that the reason he did not receive the job as Assistant Vocations Director was due to his spirited defense of moral absolutism in his interview with our vicar general, Msgr. James Carter.

As an accepted seminarian of the diocese, let me set the record straight. I do not know Msgr. Carter well and I was not at Dragan’s interview, so I cannot comment on that. But, I can say that the Diocese hired the very orthodox Rev. Mr. Joe Cahill as Assistant Vocations Director, and his is anything but liberal. Also, our new bishop, Robert Baker, has made vocations one of his major focuses since his ordination in 1999 and the diocese has nearly doubled the number of seminarians since that time—mainly due to his efforts, as well as those of Deacon Cahill and our vocation director, Father Dennis Willey. And these seminarians, in my estimation, are all solidly orthodox and on the youngish side to boot. I’m 31 and on the very old side for our seminarians.

The Diocese of South Carolina, far from being part of the problem, is a big part of the solution in vocations. I request that Dragan consider carefully his remarks in the future.

—William L.A. May III, Cowpens, South Carolina

Map mishap

The map on page 46 of the April 2001 issue is in error. The red area labeled “Ukraine” is in fact Kazakhstan. The real Ukraine is partly visible at the left edge of the map.

—Douglas Dee, Bernardsville New Jersey

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