The Greek philosopher Epicurus said ‘as far as death is concerned, we men live in a city without walls’. No doubt it comes as certainly as we pay taxes, but are we so sure what it actually is? Can we put our finger on that dividing line between life and non-life? Seeking moral certainty about the big question is more than philosophical idling. The ethics of organ transplantation are largely based on ‘brain death’ - the certainty that brain activity is irreversibly over - to allow harvesting of organs from the cadaver while the heart is still beating. But, apart from divergences of scientific opinion as to just what counts as an irreversible loss of consciousness, there is considerable debate about what the ability of the body to survive such a loss might mean for the ethics of organ transplantation. There are cases, after all, in which the brain may be dead but the body survives. Some pregnant women have been declared dead by neurological criteria yet sustained the pregnancy for several weeks. Are we confident in saying that these living bodies are dead? Confident enough to harvest unpaired vital organs from them? Even to presume consent for donation in these cases? And what about cases in which medical opinion is convinced that the brain is going to die but has not yet? Might it ever be ethical to take much-needed organs in such cases or would it conflict with the requirement that doctors act only to save or at least extend life? Might it amount to a disguised form of euthanasia?

Central to this issue of course is just what we mean by being human and how we value autonomy and free will. If the state presumes our consent with respect to organ donation might it simultaneously contribute to an under-valuing of our ability to make free choices and to act altruistically? Is it a way of avoiding the hard arguments necessary to convince potential donors? Might it even lead to stigmatising the choice to opt out? Much of our morality rests on a feeling that we should treat a human as an end, never as a means, certainly not as a bag of spare parts. Who is it that should pronounce on matters of life and death? Do we trust doctors enough to make the decision for us? Medical ethics boards? Public opinion? Philosophers, theologians, politicians? At just what point is it safe to say we can become a means for someone else’s ends? At what point does death intervene and you end being an end?

Listen to session audio:

Download mp3 (Right-click and choose “Save link as”)