Organ Donation by Death Row Inmates - Get Ready to Start Hearing More About How it's "Good" for Everyone

Wesley Smith has two related pieces on an op-ed by a death row prisoner that was published in the NY Times on March 6th.  Christian Longo, who admits to being guilty of killing his wife and three children, wrote to the newspaper to promote voluntary organ donation by death row prisoners.

In Wesley's first blog post on this, which I'll be quoting later on, he blasts the concept - a sentiment I wholeheartedly share.  In the second post, he describes the unmentioned history that the NY Times has with Longo and discredited former reporter Michael Finkel.

While I was surprised at this particular promoter of this proposal getting published in the NY Times, it really wasn't that surprising to see the idea of death row prisoners as an untapped source of organ donors being pushed in their pages.

This issue resurfaces from time to time, usually around media coverage of a specific death row inmate making the request - wanting to donate organs after his or her death or a kidney while alive.

But right now we might be seeing a deliberate push to popularize this idea by at least one player with both money and media savvy.  See, I've been meaning to write something about this topic since last February.  February 14th, to be exact.

I was working at home that day with the TV tuned to MSNBC in the background.  I got distracted by the TV when I heard Dylan Ratigan say something about debating death row organ donors after the break.  This was kind of weird.  Ratigan generally covers issues related to business and the economy, and he's pretty good when he sticks to his comfort zone.  This was a bizarre topic for his show.  Ratigan's guests were bioethicist Eric Meslin and Ben Goldhirsh, the CEO of Good:

Visit msnbc.com for breaking news, world news, and news about the economy

If you highlight selections at the bottom of the video screen, accurate subtitles will run on the video - there is also a selection for a transcript.

This was no "debate" on the issue.  Both Meslin and Goldhirsh gave their one-sided arguments in favor of allowing organ donations from Death Row inmates.  Ratigan, who is generally very articulate, animated and aggressive when on his turf, was clearly over his head and offered virtually nothing in the way of counter-arguments.  It had about as much lively "debate" as I imagine Larry King exchanging views on collective bargaining with the Koch brothers would have.

To me, one of the most important points of discussion that should occur when this idea is floated has to do with what kind of impact the practice would have on the implementation of the death penalty by juries who would know this was a possible benefit.  There is no way I can improve on Wesley Smith's concerns about the impact of this proposal if it was adopted:

Think very carefully about this.  Do we want the society to have an increased stake in executing prisoners?  No.  Even if one is for the death penalty, the issue should be strictly limited to crime and punishment.  Do we want prisoners deciding to give up appeals early–as here–so their organs are more uselful, because even if they win, they face life in prison?  No. Such a system could subtly skew the system against justice and toward the view that the organs of these murderers matter more than their lives.  It could also impact other condemned prisoners depressed or bored on death row, who would be celebrated if they decided to allow themselves to be killed for their organs–as in the adamantly anti-death penalty Times is facilitating by publishing this piece.  Ah, the noble wife and family killer!

Before Ratigan's show, I was already familiar with "Good" and Good Magazine.  See, in 2008, the magazine published a story by Graeme Wood, a journalist who is a contrubuting editor of The Atlantic.  His story was titled "Let's Harvest the Organs of Death Row Inmates."  Here's an excerpt:

But by using what the bioethicist Arthur Caplan calls “the Mayan Protocol”—a term derived from the ancient Mayan practice of vivisecting their human sacrifices—the removal of organs would itself be the method of execution. If this sounds inhumane, compare it to current practices: botched hangings, painfully long gassings, and messy electrocutions. Removal of the heart, lungs, and kidneys (under anesthesia, of course) would kill every time, without an instant of pain.

So far, the organs of all criminals executed in the United States have stayed with their original owners. Consider the loss. Someone died waiting for that killer’s heart. Two died waiting for his kidneys, and two more suffocated for lack of his lungs. The liver, split two ways, could have saved two babies. Take the hair, bone, skin, ligaments, and fluids for grafts and transfusions, and all that’s left of the donor’s body could be shuffled off into a very petite coffin indeed. The inmate could allow nearly a dozen people to live, in exchange for a body he wouldn’t be around to enjoy anyway. The math says we should encourage death-row organ donation.

I received confirmation from Art Caplan that he did use the term "Mayan Protocol" and has argued against this proposal whenever he's encountered it.

I reacted to this article when it was first published, when I became aware of it through a post to bioethic.net.  There was another aspect - an omission - that struck me at the time and still strikes me as dishonest and most likely intentional, as I'll go into a bit later.

Until the segment of Dylan Ratigan's show, I figured that the issue had deservedly faded away.  It turns out I was wrong.

In June 2009, "Good" unveiled a short animated feature based on Wood's article, titled "Let's Harvest the Organs of Death Row Inmates."  It's available on Good's website, but the embedded video below is from their Youtube channel.  Sorry - they don't provide a transcript or subtitles, I guess "Good" doesn't figure accessibility is a "good" enough idea to bother with.



In 2010, the animated feature was submitted to the Sundance Film Festival and was shown there in January, 2011.

I figure it was that last bit of promotion that brought the issue to the attention of the producers of Ratigan's show and probably the NY Times as well.

The film version makes it clear that the protocol for organ harvesting involves putting a prisoner under general anesthesia and then removing the organs.  The organ removal would be the cause of death.

If that sounds familiar to readers of this blog, it should.  In his own blog, Wesley Smith noted that Jack Kevorkian advocated for this decades ago.  Specifically, in the 1950s, Kevorkian advocated letting death row inmates become subjects to lethal medical experiments under anesthesia.  In the mid-1970s, he switched gears and started advocating organ donation for death row prisoners under general anesthesia.

All anyone needs to do to confirm this is to check the Amazon listing for Kevorkian's "Prescription: Medicide," published in 1991:

(From the 1991 Publishers Weekly review on the Amazon page linked above)

Kevorkian gained notoriety last year when he performed the first publicly acknowledged "physician-assisted suicide" by helping Janet Adkins, a victim of
Alzheimer's disease, take her own life. The method of death was the Mercitron, the "suicide machine" Kevorkian invented, which enables a person to self-administer a lethal injection. In this self-dramatizing, often strident manifesto he argues that "medicide," his term for doctor-assisted suicide, is an ethical option that should be extended not only to the infirm or terminally ill, but also to inmates on death row. Condemned prisoners, he maintains, should, if they choose, be executed via general anesthesia, with the option of donating organs or having their intact bodies used for medical experimentation. (emphasis added)

Frankly, both the article by Graeme Wood and especially the animated feature come very close to plagiarism - relating Kevorkian's exact protocol without giving him any credit for it.

It turns out there are a number of online sites devoted to information on this topic.  None that I've found mention any of Kevorkian's numerous articles on the subject or the 1991 book cited above.  For example, Eric Meslin, the bioethicist who appeared on Ratigan's show to pitch death row organ donation, has a page devoted to the subject.  Anything by Kevorkian on the subject is conspicuously absent.  How is that?  It seems to me that someone who is some kind of "expert" on this subject would know about Kevorkian's devoted and long-term advocacy, which left a long paper trail, and in that case the omission would be deliberate.  Someone unfamiliar with Kevorkian's work in this area has no basis to call themselves an expert.

I'm guessing that the consistent omission of Kevorkian's material by advocates of the "Mayan Protocol" is deliberate.  My guess is that no advocate wants to put people off further by associating Kevorkian's name with it.

The thing is, I doubt that Graeme Wood has to worry about Kevorkian complaining about theft of intellectual property - even though Kevorkian's been moved to what would seem like outrageous tirades for less.  And he probably won't be complaining for having been erased from the history of advocacy of organ donations of death row prisoners via the "Mayan Protocol," even though he was a trailblazer in terms of his advocacy.

Ironically, Kevorkian and his current boosters, groupies and handlers have worked diligently to erase that part of Kevorkian's past.  As discussed on this blog, the HBO docudrama "You Don't Know Jack" played fast and loose with the facts of his life, mostly by omitting the creepiest parts, such as his decades-long advocacy involving death row prisoners.  The so-called "documentary" of Kevorkian avoided the same uncomfortable areas.

So, ironically, it would seem that Jack Kevorkian's supporters are doing their best to make sure that while they boost Kevorkian and assisted suicide, they do their best to prevent people from knowing those parts of Kevorkian's past in an effort not to creep people out.  Kevorkian appears to be cooperating with these revisionist efforts in regard to his life.

OTOH, advocates of death row organ donation are doing their best to make sure that no one knows about Kevorkian's pioneering role in this advocacy - probably because they don't want to creep people out.

Yeah - the irony, it burns!  It also nauseates.  --Stephen Drake

Steven Salmon: Wisconsin budget cuts will hurt the disabled

From today's edition of the Wisconsin State Journal:

Two days before Gov. Scott Walker won election, a gigantic splash rippled across the lagoon of Lake Mendota. Bystanders ran to the lagoon, calling 911 on their cell phones. Seconds later fire trucks and emergency vehicles soared across Northport Drive, sirens blaring. As local television reporters appeared on the scene, the electric wheelchair dangled from the hook and ladder. Then divers brought up the dead man's body.

The usual questions were asked: Why was he alone? Where was his care attendant? Then people forgot about the disabled man - it was just another tragic statistic that the news media and disabled organizations tried to hide from the public, especially the disabled community.

But this suicide demands attention to keep another tragedy from happening. My nonverbal friend's suicide was due in part to the bad assisted care he received. Care workers didn't come on time or at all, leaving him lying in a urine-soaked bed. One attendant fed him four grapes at a time, almost choking him. Some call for a job interview, then come late or don't even show up.

I urge everyone to read the entire essay by Steven Salmon, because the warning he's issuing applies to just about every state in the country - in which the amount and availability of community-based services people with disabilities need are being cut or are severely threatened, while insitutions remain relatively unscathed - as do the most wealthy in each state, who are mostly getting their taxes cut.

Salmon describes how insufficient existing systems are for disabled people who have the "strange" desire to work and live in the community.

Salmon finishes his essay with this:

These are tough economic times, but cutting Medicaid isn't an answer. Putting the disabled in institutions would be a disgrace. Walker would never want to attend a funeral for a talented, educated, physically disabled person, caused by suicide. It's the hardest thing to witness, especially when it's avoidable.

Don't cut Medicaid - lives are at stake!

I don't know enough about Scott Walker to venture a guess about how he'd react to someone whose life got so lousy they were driven to suicidal despair - at least partly due to Medicaid cuts planned.

I do know that other players will offer a different kind of "help" for those who find their lives to awful to bear with precious supports taken away from them.

Last week, for example, this blog highlighted New Hampshire legislator Steve Vaillancourt, a Tea Party/Libertarian Republican.  Consistent with his view of the world, he has contempt for the "Nanny" government - we can guess that includes supports like Medicaid.  We also know that his libertarian response to people who are suicidal is that the government should - intervene in those cases, to make sure that a botched suicide doesn't cost the state more money.

If that seems harsh, we've seen it play out before.  Disability activist and author Marta Russell wrote the following account in a scathing essay asking why "humanists" were so in love with Jack Kevorkian:

Is it humanistic to assist in the suicide of a disabled man who has been waiting for nine agonizing months for a wheelchair from his horrible HMO? That is what Kevorkian did to Matt Johnson. Matt's wheelchair came the day after Kevorkian's visit - one day too late to free him from his seemingly permanent bed-ridden state and the actual permanent state of death.

So be doubly concerned.  Not only will cutting fragile supports drive more people into isolation and even to suicidal despair, but the ever-opportunistic groups like Final Exit Network will be sure to offer their own "help" for the coming crisis.  They won't offer help that people need to live better lives - they'll just tell everyone what we (disabled people) really need is help to make it easier to commit suicide.

On another note, I'd planned on a different kind of entry today, but events demanded the two items that have been posted.  Look for some long-ish pieces to go up tomorrow and Friday.  --Stephen Drake

Edit: Forgot to give h/t to Lawrence Carter-Long.

Vermont: VPR Debate on Proposed "Death With Dignity" Legislation

Yesterday - March 8, 2011 - Vermont Public Radio aired a debate of the current bill that would legalized physician-prescribed suicide.  The entire program is about 30 minutes long.  You can listen directly in MP3 format here.  You can also download the program in MP3 format off of this page (I couldn't figure out how to provide a direct link to the download).

Here's a brief excerpt printed on the main audio page:

Supporters call it "Death With Dignity" and opponents call it "Physician-Assisted Suicide." For both sides, the debate over whether physicians should be able to help people die is emotional and contentious. And new legislation introduced last month in the Vermont House is bringing the issue back to the forefront. Already dvocacy organizations on both sides are coming out in force. Dr. Diana Barnard is a physician who for the past year and a half been has been practicing strictly home-based palliative care. She is also on the board of Patient Choices Vermont, which supports the legislation. And Ed Paquin is the President of the Vermont Coalition for Disability Rights, which is opposed to the bill. They have opposing views on how issues including personal choice, ethics, and a physician's role relate to the question of whether doctors should be legally allowed to help patients die. 

There is also a longer print story of the debate that can be accessed here:

(Host) Vermont is once again facing a debate over whether terminally ill patients should have the right to end their own lives with help from a doctor.

VPR's Samantha Fields has more:

(Fields) A bill was introduced in the House last month. Supporters call it "Death with Dignity" or "Right to Die" legislation... opponents call it "physician-assisted suicide."

Diana Barnard is a physician who focuses on end-of-life palliative care, and who supports the bill. She says that it really comes down to patient choice and control.

(Barnard) "The important thing to stay focused on is the right of an individual to have decision making ability at a point in their lives when death is certain. Death is coming"
 
(Fields) But the Vermont Coalition for Disability Rights is opposed to the legislation. The group's president is Ed Paquin . He says the bill would be bad public policy, and would send the wrong signal.

(Paquin) "The message to wider society that perhaps having someone toilet you, having your mobility impaired is a life without dignity, and it's time to get out when that happens, it's broader than the individual suffering." 
 
(Fields) A bill similar to the one currently in the House was defeated in 2007. But advocates are more optimistic about its chances this year. Both House Speaker Shap Smith and Governor Peter Shumlin support the legislation.

Windsor Democrat Donna Sweaney  is one of the lead sponsors of the House bill.

(Donna Sweaney) "I think we have enough votes in the house to pass the bill. As I asked people to sign on with me, they would agree that this was something they supported".
 
(Fields) The legislation is currently in the Human Services Committee.

House Speaker Shap Smith has said he will not bring the bill to the floor for a vote unless he's sure it will pass. Sweaney says she believes that is likely to happen this session.  

I'm pleased to report that  Ed Paquin is just one of many Vermont disability rights activists actively engaged in the coalition to oppose the latest incarnation of this legislation.  --Stephen Drake

NH: More on Steve Vaillancourt, Libertarian/Tea Party and Incrementalist/Slippery Slope Strategies

Some people might have figured that it was possible that Rep. Steve Vaillancourt might have been simply blowing off steam when he was quoted in the March 1st Union Leader as having said:

"If it were up to me, I would say anybody should be able to end their life," he said snapping his fingers, "just like that."

In my previous blog entry, I suggested he was "engaging in misinformation and misdirection," since people end their lives every day in this country - literally thousands of people take their lives in the US every year without any outside help.

I stand corrected.  Vaillancourt really does seem to understand that many, many people take their own lives.  More importantly, he knows that many - most, actually - fail in the attempt. As explained below, when you get his rationale in full, it makes a certain kind of "fiscal" sense.

Vaillancourt felt it important to clarify and amplify his views on "death with dignity," writing on the NH Insider blog on the same day as the Union Leader article:

Yes, I was animated when I testified before the Judiciary Committee on Rep. Chuck Weed's "death with dignity" bill (HB513) yesterday.   In fact this is one area where liberal Democrats like Rep. Weed and libertarian-minded Republcans like me enthusiastically come together.

 As a Libertarian who believes in personal freedom and responsibility, I can think of no reason why governement should be able to tell you when you should end your life.  Rep Weed's bill would allow doctor-assisted suicide similar to Oregon and Washington.  While I would prefer that government not get involved in death decisions at all (in other words, totally legalize suicides), this bill is a reasonable attempt to address medical ethics involved.

We should live up to New Hampshire's "live free or die" motto, fully realizing that living free is only half of that slogan.  Freedom to die should be equally important to those of us who oppose nanny state government, who recoil at government intrusion into our lives (and our deaths).

But there's a contradiction in a libertarian wanting "nanny state" government sanctions and medical intervention into the private choice to end your own life, which isn't really a medical matter - and as a libertarian, I'm guessing he doesn't support guaranteed health care in any case.

It turns out he has a reason.  As a libertarian, he's very concerned about limiting the amount of (his) money the government spends supporting people, as he explains here:

The problem of course is that if I attempt to kill myself without the help of a doctor, I may botch up the effort.  I may leave myself in a maimed condition and live on at state expense.  That's why the assist from doctors is important. (Emphasis added.)

I'm guessing he's not a fan of the "too big to fail" concept that led to the huge bailout of the banks.  However, he does seem to be articulating a "too expensive to let them fail" concept here.

He's right about the failed attempt, of course.  According to the 1999 Surgeon General's Call to Action to Prevent Suicide, overall, "there are an estimated 16 attempted suicides for each completed suicide."  And - yeah - a lot of those survivors might have no insurance and be in need of services that the government would need to pay for.

Obviously, the current bill he's cosponsoring isn't what Vaillancourt ultimately wants, and he says so:

Rep Weed's bill notes that only terminally ill patients would be eligible.  It's a step in the right direction of allowing individuals to control their own destiny.

When Vaillancourt says this nominally narrow bill "is a step in the right direction," I feel it's safe to say that Vaillancourt will be looking for opportunities to expand the scope of "eligibility" for assisted suicide.

That is what you call an "incrementalist" or "slippery slope" strategy.  In this instance, from Vaillancourt's perspective, it would be using a "wedge issue" - "there are people with very unpleasant terminal illnesses who want help to end their lives early" to gain wide support for an initial step toward a final goal.

Vaillancourt could pursue his final goal more directly - introduce bills preventing law enforcement and health care professionals from interfering with someones suicide; forbidding health care providers to treat people who survive suicide attempts.  But those attempts wouldn't get very far.  It's more realistic to get everyone used to the massive change you want in small incremental steps.

There's nothing new about "slippery slope" strategies - they're used widely and by groups of all political stripes.  There's a good overview and discussion of the "slippery slope" strategy at the site Political Strategy.

Remember - in the world of political struggle, don't let anyone corner you with the idea that the "slippery slope" is nothing more than a logical fallacy.  It's also an effective - and common - political strategy and it's up us to redefine it.

I'd also advise folks to keep a sharp eye on this new crop of "Tea Party" elected officials.  They all tend to share the same combination of libertarian outlook and disdain for supporting people through tax-supported government dollars.  In other words, I doubt that Vaillancourt's take on assisted suicide is unique among those who identify with the Tea Party.  --Stephen Drake

NH: After Hearing on Assisted Suicide Bill, Sponsor Says Bill is "DOA"

Yesterday, February 28th, the NH House Judiciary Committee held a hearing on a "Death With Dignity" Bill.  The outcome was not to the sponsors' liking.

From the Union Leader:

CONCORD – It should've been called the "Live Free or Die Free" bill, Rep. Charles Weed said of his bill to allow the terminally ill to end their suffering.

"Death with Dignity" was his initial title. The Keene Democrat said he was asked to change it to tamp down on any political combustibility. And a twist of the state motto was just too much. After Monday, you might want to call it: Dead on arrival.

That's Weed's prognosis, anyway.

The other sponsor was a libertarian-leaning (or falling) Republican:

Co-sponsor Steve Vaillancourt, R-Manchester, promised he would not go so quietly, at one point shouting at a member of the House Judiciary Committee holding a public hearing on the bill. He urged his colleagues to stick up for the state's Libertarian tradition of limited government and personal liberty.

"If it were up to me, I would say anybody should be able to end their life," he said snapping his fingers, "just like that."

Vaillancourt is engaging in misinformation and misdirection here.  People can and do kill themselves - every day - "just like that."  That's not the same thing as saying that everyone who wants to kill themselves should be able to get medical assistance to do that - and that seems to be what Vaillancourt is implying here.  (BTW, this should be a cautionary note to folks who think that all those cost-cutting, libertarian Tea Party people who were elected to Congress are going to be allies in opposing legalized assisted suicide and/or euthanasia.)

Those testifying in person against the bill came from religious groups, prolife groups and hospice entities.  No NH disability activist was able to attend the hearing - between real-life scheduling conflicts and the barriers to affordable accessible transportation in that state, getting folks to an event can be a great challenge.

Nevertheless, NDY president and founder Diane Coleman submitted written testimony on behalf of NDY.  Here is an excerpt:

Disability concerns are focused on the systemic implications of adding assisted suicide to the list of “medical treatment options” offered to seriously ill and disabled people.  The disability rights movement has a long history of healthy skepticism toward medical professionals who are assisted suicide’s statutory gatekeepers.  Our skepticism has grown to outright distrust since the values of managed care have dominated the health care scene.  Anyone who asserts that money will not influence the treatment options offered to people, or that the impact of out-of-pocket costs on an individual’s family will not influence the individual’s feelings of being a burden, is at best unrealistic and at worst dishonest. 

Pro-assisted suicide advocates call it “choice” but, with or without the purported safeguards, the so-called “autonomy” of assisted suicide is not being offered to healthy, non-disabled people.  According to the U.S. Surgeon General, 16 of every 17 suicide attempts fail, and most don’t try again.  (U.S. Public Health Service, “The Surgeon General’s Call to Action to Prevent Suicide,” Washington, D.C.: U.S. Government Printing Office, 1999.)  Assisted suicide is not about parity in the opportunity for suicide.  It’s about a government and a health care system guaranteeing that certain suicides don’t fail.  That’s discrimination. 

Hopefully, for now, the NH legislature figures there are more important priorities to focus on right now.  In the meantime, please make sure that co-sponsor Steve Vaillancourt isn't let anywhere near a suicide hotline.  He doesn't sound like someone you want to get close to someone deciding whether or not they want to kill themselves.  --Stephen Drake