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This just in from a friend of mine who is watching the activities of the very powerful Ohio-based "pro-life" group (which recently endorsed Rick Santorum) FAMiLY LEADER, headed by Bob Vander Plaats:

End of Life Decisions House Study Bill 511 under the direction of Representative Joel Fry advanced out of the Human Resources committee on Wednesday. The legislation supports what are known as Physician Orders for Scope of Treatment (POST). Intended for terminally ill patients, these orders specify the desires of the individual patient regarding life support. Safeguards are established to protect against unwarranted termination of care. The FAMiLY LEADER cautioned against the tendency to “drift” in the direction of physician-assisted suicide. We trust and respect Representative Fry, and encourage our readers to pray for him to have wisdom as he prepares for House debate on the bill. As a cautionary signal, The FAMiLY LEADER is registered as “Undecided” on the bill.

BioEdge reminds us that the "dead donor rule," the medical standard that is used to determine when life ends for the purpose of organ removal, is in need of a revisit.

The prison population across the nation is getting old and prison administrators are grappling with how to best handle health and aging concerns, Fox reports. A new report by Human Rights Watch report on the aging prisoner population is here.

Catholic Health Care West has changed it's name to Dignity Healthcare, to varied reactions. Here's "pro-life" advocate Wesley J. Smith's.

Hawaiians support aid in dying, a new poll finds. While support is slightly higher there, the poll is consistent with attitudes across the rest of the nation.

While I'm all for advancement of medicine--who isn't?--the recent push to "kill" or redefine the persistent vegetative state diagnosis is fascinating and a little worrisome. Ever since the death of Terri Schiavo, activists have been working to undermine the diagnosis and qualify it as a severe disability. Studies like the recent one that shows "some" PVS patients wake up when given a sleeping pill or that EEGs can help find "locked in" patients have caused huge amounts of attention but are strangely politically motivated and seemingly statistically unviable. Furthering understanding of PVS and brain dead patients (both, admittedly, are nebulous terms that offer no hard answers) is necessary. But the irresponsibility of some of the articles these recent studies is hard to stomach. Truth, they say, is truth. With issues as profound as the definition of life, truths look a lot more like wishes, on which beggars and activists can ride.

The Pope Doesn't Donate Organs

Many proponents of organ donation used the example of Joseph Ratzinger as an organ volunteer as a selling point. See, donating organs is a good thing! But recently, Polish Archbishop Zygmunt Zimowsky, of the Vatican's health office, clarified that no one will be receiving Pope Benedict XVI's organs. The body of the "belongs to the entire church."

"The End" Special Issue by Scientific American: Organ Donation

Scientific American editor, Mariette DiChristina, writes in her introduction to September's special issue that the concept, "The End," had been picked up and put down in their offices for years because of "the difficulty and possible discomfort about some of the topics we wanted to cover."

I can't speak for SA's regular readers, but DiChristina needn't have worried. The issue is a treasure trove of intriguing questions and answers, ones too important and timely to be ignored: Does acetaminophen (Tylenol) reduce feelings of rejection and paranoia? (I say let's do a test study on the Tea Party.) What are the chances the world will end by asteroid impact? (1 mill in next 100 years) Runaway global warming? (2 in next 200 years) Killer pandemic? (2 in the next 30 years) What are the four stages of body decomposition? (Fresh, Bloat, Active Decay, and Dry); What cultures are disappearing?; What scientific discoveries should rightly come to an end? (Daylight savings time, the space shuttle, landfills, teflon, among others); And how much time is left for glaciers? Gold mining? (20 years) Time? (Yes, how much time does time have?)

But the articles that most speak to my own writing interests -- patients' rights, primarily -- are great too. Thomas Kirkwood addresses why we can't live forever (pp 42). SA's various advisory board members look at anticipated reproductive trends in the next decades ("What Comes Next" pp 92). And Robin Marantz Henig contributes a brief but spot-on look at organ donation ("When Does Life Belong to the Living?" pp 50) and the contested definition of death. She writes:

To address this issue [establishment, with the advent of organ transplantation, of "dead-donor rule" in 1960s to prevent organs from being taken from the living; in essence, the definition of death], a blue-ribbon Harvard Medical School panel met in 1968 and arrived at the concept of "irreversible coma," more commonly known as brain death. By this term, they meant that the cerbral cortex -- the seat of consciousness, language, empathy, fear and everything else that makes us human -- is irreversibly destroyed. Destroyed, too, is the brain stem, which orchestrates such basic physiological functions as breathing, heartbeat and homeostasis. Modern medical machinery may keep the body oxygenated, but the person inside is gone.

The definition of death has been reviewed periodically since then by groups of bioethicists, and although the terminology sometimes changes, the substance remains basically the same. The concept of breain death (often knows by the more modern and clinical term "the neurological standard of death") has since become encoded into law in nearly every state in the U.S. Ethicists and the law agree: a person whose cortex and breain stem are destroyed has ceased to be alive, even if the body is warm and pink. That body is no longer considered a person. Instead it is a heart-bearing cadaver.

All this means quite a bit to the hundreds of thousands who wait for years on organ recipient lists. And it means a lot too to "pro-life" activist groups who would like to remove decision-making from individuals and family members burdened with terrible choices in dire situations.

Think Terri Schiavo (and the Terri Schindler Schiavo Foundation) or Wesley J. Smith (a staunch, vocal advocate for the Schiavo family and removing such decisions from doctors or patients who wish to determine their own end of life care) or the United States Conference of Catholic Bishops (which as recently as November changed the guidelines in all 624 of the U.S. hospitals they oversee to leave the question of removal from artificial nutrition and hydration up to hospital management and not the patient or family, living will or advance directive be damned).

Citing the three cases in Denver between 2004 and 2007 in which the Pittsburgh Protocol (waiting a full two minutes after removal from life support before removing organs from a "brain dead" patient, despite risk of organ deterioration) was violated for the sake of needy infants, Martanz Henig makes a fascinating point in her article that notes the root of the medical profession's tip-toeing around the definition of death. Robert D. Truog of Harvard supported the doctors' (and the hospital ethical board's) decision, saying that the "dead donor" rule was unimportant when considering whether an injured person's recovery was impossible and what the family consented to. But:

...Arthur L. Caplan of the University of Pennsylvania, recoiled at Truog's suggestion, mostly because of how it would be interpreted by an already skittish lay public. "We ought not underestimate public unease," he said. "Making people wonder if you're going to cut corners on their care in order to salvage organs from them is a very dangerous area to be in."

In other words, altering the "dead donor" law to allow, say, waiting less than two minutes, would deter the (already wary) population from signing up as organ donors. The number of people each year who die from lack of viable, transplant-ready organs (currently about 7000) could increase because of a fear of doctor's ethics regarding the definition of death. (See my post here some months ago regarding a New York Times article on organ donation which points out how rather arbitrary that two minute designation is.)

While I think that Caplan's fears are legitimate, I'm more interested in asking why. The medical profession has a long history of discomfort and distrust with minorities and females, particularly African Americans. Often this distrust, as with abortion and end of life care, is fueled by political motivation ("black genocide") or exceptions that don't prove a rule (Terri Schiavo again; there are 30,000 patients like Schiavo in our hospitals any given year). In other ways, history has proven that the medical profession preys on patients: futile care, aggressive elder treatment, lack of research into disease causes (see Barbara Ehrenreich's Cancerland) or lack of discipline in telling patient's the truth (because, you know, they can't handle it).

But this distrust should not be used as an excuse to let thousands of people die, to cruelly prolong the lives of the "heart-beating cadaver." I'm not saying that fear isn't real, I'm saying that it results from a lack of bodily autonomy. As recently as the 70s, women would go in for a simple biopsy of a breast lump and come out with full mastectomies. This kind of patriarchal, "doctor knows best" is a wound that the industry has brought on itself. It exists. It is real. But it should be combatted -- not by playing into it with arbitrary definitions that become arbitrary rules but by addressing it candidly. For the sake of patients, a frank discussion about the way death has changed over the past 40 years must be had.

Recover from Brain Death?

At Science and Religion Today I found this great study on faith and organ donation. It's an issue I've written about in the past, here and here. But the astounding fact that I pulled out of the study is this one:

When the researchers spoke with those who are unwilling or reluctant to donate their organs, they found that the majority of them—52 percent—think doctors might not try as hard to save the lives of organ donors, and 61 percent erroneously think it’s possible for a brain dead person to recover.

What's 61% of 49%? That's how many Americans who say they wouldn't be willing to donate organs actually believe that a patient can recover from brain death. What percent of Americans, whether signed up for organ donation (38%) or not, believe in miracles?

Organ Donation and Death's Timing.

Dr. Michael Kirsch posted a comment on this site this morning that is reiterated in his column at MDwhistleblower. That column in part reads:

I think we should provide more incentives to donate, although I do not advocate buying and selling organs on the free market. This would lead directly to economic and physician exploitation of our most vulnerable people. I also vigorously oppose bending the definition of death for the purpose of saving others. One life is not worth more than another. Of course, it’s easier to make principled and categorical statements as a blogger. But, don’t ask me for my high and mighty opinion if my child is on the transplant list. I’d pay the ransom.

If it were up to me, health care - period - would not be monetized or profit-driven. So of course I agree that buying and selling organs should be out of the question. Forever. Always.

I don't think anyone posits that one life is worth more than another's - to justify any type of organ donation. Such a statement is insensitive to the difficult decisions that face both families of the dying and families of those in need of organs. Demonization of any faction of society is so unnecessary - and plays into the overblown fears of a "culture of death" that in actuality doesn't exist. So let's just leave that strawman to those who want to have irrelevant, emotional conversation.

The challenge to organ donation in the US is that fewer people donate than organs are needed. And as Sanghavi noted in his NYT article, when organs are harvested is vital. That schedule is contingent on a medical and legal question that does not have a clear answer: when does death start?

The very best answer is to do what we already do: leave decisions regarding organ donation up to patients and/or their medical proxies. Technology constantly evolves and allows us greater understanding of the dying process. So until someone can tell us definitively what death's schedule is, I think we'll be left to discuss this issue for a while.

Another thing we can do - as Dr. Kirsch suggests - is promote organ donation. I add that this should be done with a sensitivity to the fears that minorities and the disabled have historically had about donation.

I'm thinking I'll change my living will to say something like, "In lieu of flowers, mourners are asked to ensure that they have marked their driver's licenses for organ donation."

Organ Donation and Determining When Death Starts.

Yesterday's New York Times article is titled with the loaded question, "When does death start?" and tells the sad story of a parent whose daughter is hit by a truck. The grief-stricken mother realizes that her daughter has lost all but a few basic physical reflexes and requires life support to survive. And she knows that her daughter would have agreed to organ donation.

Organ transplantation must abide by the so-called dead-donor rule: a person has to be declared dead before any vital organs can be removed. Yet organs have to be alive if there is any hope of successful transfer to a recipient. Medical professionals have handled this paradoxical situation — finding a dead body with live organs — by fashioning a category of people with beating hearts who are said to be brain-dead, usually after a traumatichead injury, and who are considered just as dead as if they had rigor mortis.

To diagnose brain death, doctors typically go through a checklist of about a dozen items, including assessing reflexes like blinking, coughing and breathing, which are all controlled by the brainstem. The criteria are extremely strict, and only a tiny fraction of severely brain-injured people meet them. Kleinman realized that Amanda, despite her severe brain damage, was not one of them. There was, Kleinman told Beaulieu, another option — one that was still controversial and had never been pursued successfully at Children’s Hospital. The procedure was called donation after cardiac death, or D.C.D., and it would exploit the other way the law defines death: as the “irreversible cessation” of the heartbeat.

D.C.D. requires doctors to confront the shadowy question of exactly when somebody dies after the heart stops. To authorize D.C.D., doctors must follow a strict procedure. Amanda would be taken, technically alive, to an operating room, where her breathing tube would be removed. If her breathing ceased naturally and her heart stopped quickly (within an hour), she would be moved to an adjacent operating room and Kleinman would count off precisely five minutes, during which time Amanda would be prepped for surgery with antiseptics and surgical drapes, while Kleinman carefully watched for signs of a returning heartbeat. If there were none, Amanda would be declared legally dead; the stoppage would then be considered “irreversible.” Before her organs were seriously damaged by the lack of oxygen (every minute counts), the surgeons would rapidly open Amanda’s torso and remove them for transplant.

The article tangentially takes up the "pro-life" accusations that determining death "arbitrarily" - in this case, 5 minutes after the heart stops - is really a contrived criteria motivated by the desperate need for organs. In many segments of society, particularly among the black community, failure to agree to organ donation, say on driver's licenses, is fueled by the fear that doctors will see the person as less than human, not worth saving, and rush them off for organ harvesting.

It's a fear that "pro-life" advocates have manipulated in recent years to fight everything from removal of artificial nutrition and hydration (the US Conference of Catholic Bishops has just changed their hospital policies to include ANH as "obligatory") to removal from respiratory machines. All life - unconscious, unrecoverable, slated for a life of machines and vegetative state - is sacred in God's eyes, they say. Doctors are playing God by deciding when a patients is dead. Never mind that doctors are playing God by keeping the patient artificially alive.

Disability rights activists too are concerned that, disability as defined as everything from blindness to frailty at end of life or vegetative state, as they advocate in order to bring more attention and normalcy to disabled states, then brings great concern to qualifications like "quality of life" and "dignity." Particularly concerning aid in dying, disabled groups fear that the medical profession and society have consistently failed to value disabled lives as worthy of advanced medicine.

The Times article give a little history of attempts to define death:

The paradox of needing a dead donor with a live body was first addressed in 1968. Henry Beecher, a Harvard anesthesiologist and medical ethicist, convened a 13-member committee to write a definition of “irreversible coma,” or brain death, for The Journal of the American Medical Association. Not everyone accepted the four-page report’s conclusions. After Norman Shumway, a Stanford University surgeon, performed the first American heart transplant from a brain-dead donor, he was threatened with prosecution by the Santa Clara County coroner. As a result of the widespread disagreement over the meaning of “brain death,” President Jimmy Carter asked a blue-ribbon commission to examine the issue. The commission culminated in the Uniform Determination of Death Act in 1981, which defined death as “irreversible cessation of all functions of the entire brain, including the brainstem.” The procedure to diagnose brain death, however, was never codified into law, and as a result, it varies from hospital to hospital. In 1987, the nation’s pediatrics authorities tried to standardize the diagnosis, listing 14 different criteria to confirm brain death, like the absence of reflexes, and requiring, under certain conditions, additional X-rays and tests for brain-wave activity. Last year, in the journal Pediatrics, researchers from Loma Linda University reported that of 277 brain-dead children in California who were referred to the regional organ bank over many years, only a single child received the full set of diagnostic tests.

The writer of the story, Darshak Sanghavi, a pediatric cardiologist at University of Massachussetts Medical School, gets at the controversy surrounding the determination of death and the harvesting of organs by citing a recent case:

As Gary Greenberg wrote in The New Yorker, donating organs in such a manner, deliberately and with anesthesia, could simply be “a particular way to finish our dying, at the hands of a surgeon, after some uncertain border has been crossed.” But Francis Delmonico, a professor of surgery at Harvard Medical School and a national leader in organ transplantation, fervently defends the need to establish death before removing organs. “I understand a family’s anguish and inability to have consolation when a child doesn’t die after removal of life support,” he explains, “but I don’t see this as a patients’-rights issue. It’s a matter of public trust in the system.”

Donation after cardiac death already arouses suspicion. Just as transplant surgeons like Norman Shumway were once harassed for procuring organs from brain-dead donors, a California-based surgeon, Hootan Roozrokh, was tried for dependent-adult abuse, a felony, after participating in an attempted D.C.D. A nurse who objected to the proceedings later registered a complaint about how painkillers were administered to the patient. Prosecutors charged him with trying to hasten the patient’s death. Though none of this held up in court — Roozrokh was acquitted last year — the trial left many transplant surgeons shaken. Just think of the outcry, Delmonico cautions, if families and doctors also decided it was acceptable to euthanize patients to procure their organs. “You would destroy organ donation in this country,” he said.

It's an important issue and a well-written article. Though I include excerpts, I recommend you read the entire article at the link above.

UPDATE: from the conservative lifenews, an article on this NYTimes article by Judie Brown that does nothing to understand the challenges faced by parents, like those described by Sanghavi, and everything to bash parents or medical proxies in difficult positions over the head with an ideological position that has little science or medical foundation.

This is not dialogue that Brown invites, this is a law, given to her by doctrinal authority and some hefty self-righteousness, which she demands be enforced, regardless of the patient's rights, faith, particular diagnosis, or a parent's wishes. Sanghavi produced a searching article that examined the challenges medicine and patients face as technology allows here-to-fore life-saving procedures. Inability of the Right to engage in conversation regarding these very nuanced and difficult decisions and ethics will not further advance science or humane response, it will continue to mire the Right in rigid and unchanging, draconian, impossible positions that label them deniers of science and modernity. As a community, we are here to solve emerging problems together. Brown shows that the "pro-life" position may have clout, resources, soldiers, and media outlets but it still lacks compassion for human suffering. Hers is a sad and telling position-piece on obsolescence.

Organ Donation and the Black Community.

I was at the most luscious Thanksgiving dinner last eve with some wonderful friends, old and new. At one point I was talking about my two book projects: a book about death in America; and a literary memoir about death grief and travel. Regarding the first, which I've only begun - and begun discussing - I received a comment I didn't expect from an African American lawyer in our company: the black community has long been wary of organ snatching from otherwise viable patients.

Wesley J. Smith, that font of pseudo-ethical "pro-life" banter, has been harping on the invasion of the organ snatchers for some time regarding end of life care and aid in dying. I've always poo-poohed it as hokum. Turns out the issue has legs, or shall I say guts, depending on who you're talking to. (I never cease to be amazed by the fears my white privilege has shielded me from!)

Today I've dug up a couple of interesting facts and studies regarding blacks and minorities and their views of medicine and organ donation. It seems that Smith, the evil genius, may have found yet another thread of fear in society on which to prey.

Here are some spooky myths, debunked by the Life Goes On Organ and Tissue Donation group in Illinois:

Myths About Organ Donation

MYTH: If I am in an accident and the hospital knows that I want to be a donor, the doctors will let me die.

FACT: Donation is not considered until all efforts to save a person have failed. Additionally, transplant surgeons and their staff are, by law, forbidden from taking part in a patient's care prior to organ donation. They only become involved after the person is declared dead and permission has been given by the family for organ donation.

MYTH: Whites are helped more than blacks.

FACT: Absolutely not. In fact, nine out of ten African-Americans who undergo organ transplant surgery receive an organ from a Caucasian donor. In addition, a computer system fairly matches organs with recipients' based on the recipients' time on an organ waiting list, the severity of the recipients' condition, blood type, size of the donated organ and, in some cases, the donor's genetic make-up.

MYTH: Wealthy and famous people are able to buy their way to a higher spot on waiting lists. Take Mickey Mantle for example. A match was found for him within days of being put on the waiting list.

FACT: Anyone who needs an organ transplant is eligible for one, but you cannot buy a higher spot on waiting lists. Mickey Mantle got his transplant so quickly because his blood type was the most common and because he was among the sickest patients waiting in his area.

MYTH: As African-American organ donors, our organs will go to white folks and never other African-Americans.

FACT: If you donate an organ, such as a kidney, for which genetic make-up is a critical factor in transplantation, then it is probable, though not guaranteed, that your organ will go to another African-American. In addition, African-Americans make up 36 percent of those on organ waiting lists in Illinois. Therefore, even if you don't donate an organ that needs to be genetically matched, the recipient may still be an African-American.

MYTH: African-American organ donors aren't necessarily needed.

FACT: African-Americans make up 36 percent of those on waiting lists in Illinois. Everyone on the waiting lists can benefit from more organ donors. However, African-Americans on waiting lists for kidneys will most likely benefit from African-American donors, because transplantation often is enhanced by matching organs between members of the same ethnic and racial groups.

From a 1999 study:

In our recent survey, we found that white persons were significantly more likely than African- American persons to be unequivocally willing to donate their own organs (69.7% compared with 56.3%) and a relative’s organs (43.5% compared with 33.9%). To a surprising degree, this difference reflected concerns of African-American persons about knowing a relative’s wishes before agreeing to donation. Fully 36.3% of African-American persons would agree to donate a relative’s organs if they knew the relative’s wishes beforehand. In fact, if we combine those persons who would be willing to donate unequivocally with those who would do so if that were their family member’s wish, we find that the differences between white and African-American respondents nearly disappear; 73.7% of white re- spondents and 70.2% of African-American respon- dents would donate. Finally, this study found that African-American persons were less likely than white persons to have discussed their wishes about donation with their families (42.4% compared with 58.2%). This may partly explain lower rates of con- sent to donation by African-American families (Siminoff LA. African American perspectives on or- gan donation [Presented paper]. Fourth Interna- tional Society for Organ Donation Congress. 11 July 1997; Washington, DC). The current campaign to encourage persons to talk with their families about organ donation will probably be especially effective.

Or not, depending on the nature of the campaign.

Third, we believe that the negative opinions of African-American persons about cadaveric organ donation reflect a deeper distrust of the medical system. These perceptions are not directed specifi- cally at organ donation and transplantation; rather, they must be seen as part of the distrust that de- velops among persons who have been subjected to institutionalized racism and to a system that may unconsciously continue to reify the racism of the larger society—for example, the African-American experience as medical subjects in the antebellum South and in the Tuskegee Syphilis Study and as victims of exploitation after the Civil War. More- over, a growing number of recent studies have shown that African-American persons are still less likely to receive the full benefits of the health care system (16).

From another study in 2007:

Having been skeptical about organ donation in the past, I was riveted by the original communica- tion entitled “Many Facets of Reluctance: African Americans and the Decision (Not) to Donate Organs.”1 The study participants were 310 adult members of a New Jersey chapter of the NAACP. The results suggested that a decreased knowledge base about lung trans- plantation, a desire to maintain the integrity of the body, lack of trust of the medical community, and spiri- tuality all played a role in the deci- sion to donate organs.

And from the Mayo Clinic regarding the lack of matching donated organs among minority groups:

Being an organ donor can make a big difference, and not just to one person. By donating your organs after you die, you can save or improve as many as 50 lives. And many families who have lost a loved one who became an organ donor say that knowing their loved one helped save other lives helps them cope with their loss.

It's especially important to consider becoming an organ donor if you belong to an ethnic minority. Minorities including African-Americans, Asians and Pacific Islanders, Native Americans and Hispanics are more likely than whites to have certain chronic conditions that affect the kidney, heart, lung, pancreas and liver. Certain blood types are more prevalent in ethnic minority populations. Because matching blood type is necessary for transplants, the need for minority donor organs is especially high.

Wesley J. Smith Is Here to Protect Your Endangered Organs.

Is the government killing you, Granny? Death panels rushing you into that good night? Government-enforced euthanasia in your near future?

And lest you think death is their only objective, hide your guts. They want your organs too!

While it sounds like a plot hatched in New Jersey, the ubiquitous Wesley J. Smith has a new mystery article up at CNSNews (that no link will link to) telling us of new organ-harvesting plans - for the living! He summarizes and quotes at his blog, Secondhand Smoke:

Here they come. For years, organ transplant ethicists and some in the bioethics community have agitated to increase the supply of donated organs. There is nothing wrong with that in the abstract, of course. Increasing the supply would alleviate much human suffering and is devoutly to be wished. But therein lurks a great danger. Increasing supply is a worthy goal only so long as the organs are obtained ethically. But there is a growing chorus among the medical and bioethical intelligentsia to obtain more organs by harvesting living patients. Yes, some of our most influential voices now seek a license to kill for organs.They don’t put it that bluntly, of course. Rather—reflecting the spirit of our times—advocates argue that our definition of death should be changed to allow a great pretense that living patients are actually dead, thus permitting organ procurement.

Abstract organ harvesting? And what exactly is the spirit of our times? Sounds like fear-mongering to me. What leads Smith to think that taking organs from the disabled and infirm is nigh?

We are not—yet—at the point that society will permit open harvesting and experimentation on cognitively devastated people, but that doesn’t mean we won’t get there. The slippery slope undermining human exceptionalism—the intrinsic value of human life simply and merely because it is human—is already slip-sliding away. Popular majorities support using nascent human life as corn crops in embryonic stem cell research, if the embryos were “leftovers” and going to be thrown out anyway.

But scientists have already moved beyond that early limitation. Many are now actively researching human cloning toward the end of manufacturing embryos for use and destruction in research. And it won’t stop there if current trends continue. We already see early advocacy for “fetal farming,” that is, gestating fetuses for use in organ transplantation and medical experimentation.

So, Smith is saying, because we legalized aborting fetuses and because we use embryos for experimentation we are very, very close to extracting organs from living human beings because, you know, "current trends continue."

In other words, abortion and stem cell research are like the "gateway drug" marijuana. One good toke and we're on to sucking kidneys out of quadriplegics. That's basically the "slippery slope" argument in an analogy.

To be serious, Smith's got little logic going on here - at least as far as I can tell from the bit of the article still accessible. The "slippery slope" argument - that we erode the "sanctity of human life" by allowing women or the elderly or the disabled choice in their medical care - is not based in fact or law but fear.

When Christiaan Barnard successfully completed the first heart transplant in 1967, giving Louis Washkansky of Cape Town a healthy heart, taken from Denise Darvall who was rendered brain dead in a car accident, he was roundly accused of "playing God." The advancement of medical technology has always caused fear and dire predictions of our lost moral compass.

I expect Smith is either working to drum up some fear for his own "pro-life" purposes. In his spurious logic, heart transplants and other medical developments did lead to abortion (1973) and predicted the rise of the "euthanasia" movement. And yet we know - and as a society approve of - such medical advancements as heart transplants, stem cell research and abortion because they improve our quality of life, preserve personal choice and rights, increase our longevity, and contribute to our success as a society.

I think what Smith is concerned about is a society moving away from traditional and religious valuations of quality of life - and suffering - that he feels should be legally mandated. Striking fear in the disabled and infirm for the safety of their organs is really not the best way to approach an argument for medical ethics. Facts, rational argument, and application of law would work better. But it is the way of cultural conservatives bent on imposing their values on the rest of society.