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Research ethics
Right of the living dead? Consent to experimental surgery in the event of cortical death
  1. R Sparrow
  1. Faculty of Arts, Centre for Human Bioethics, School of Philosophy and Bioethics, Monash University, Victoria 3800, Australia
  1. Correspondence to:
 Robert.Sparrow{at}arts.monash.edu.au
 Received 24 August 2005

Abstract

Ravelingien et al have suggested that early human xenotransplantation trials should be carried out on patients who are in a permanent vegetative state (PVS) and who have previously granted their consent to the use of their bodies in such research in the event of their cortical death. Unfortunately, their philosophical defence of this suggestion is unsatisfactory in its current formulation, as it equivocates on the key question of the status of patients who are in a PVS. The solution proposed by them rests on the idea that it should be up to people themselves to determine when they should be treated as dead. Yet the authors clearly believe (and state) that patients who are in a PVS are in fact dead. Finally, given the public good that their proposal is intended to achieve, the moral importance they place on the consent of a person to the use of his or her body in research is ultimately only defensible in so far as this consent represents the wishes of a living person. It is thus only a gentle caricature of their position to suggest that according to their account, consent to participation in xenotransplantation research is a “right of the living dead”. The equivocation by Ravelingien et al on the question of whether these people are living or dead means that they avoid confronting the implications of their argument. The solution proposed by Ravelingien et al to the problem of how we should proceed with xenotransplantation research is therefore not as neat as it first seems to be.

  • PVS, permanent vegetative state

https://doi.org/10.1136/jme.2005.014027

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    Footnotes

    • ↵i This is not to deny that major ethical issues on the use and treatment of sentient non-human animals in xenotransplantation research and practice exist and remain to be resolved.

    • ↵ii Fost also discusses the possibility that we may proceed with sourcing organs from people in a PVS, if they had previously consented to this.

    • ↵iii This is not to deny for a moment the extent of the controversy surrounding the definition of death, or the possibility that there is more than one reasonable position on the matter. It is to insist, however, that what the controversy is about is a distinction that has a fundamental role in the life sciences and that requires a definite resolution.

    • ↵iv It is difficult to know how to refer to the bodies of people who are in a PVS, as their status is the central issue in the controversy under discussion. In this section, however, where I am discussing the possibility that such individuals are dead, “cadavers” does not seem inappropriate.

    • ↵v In Victoria, Australia, the circumstances in which autopsies are permitted or required are set out in the Coroners Act 1985. A discussion on the legal status of bodies and the circumstances in which the consent of the person can be overridden in the service of the public interest in the Swedish context is provided by Machado,15 p 171–83.

    • ↵vi They may also rightly reason that if such experiments are carried out on them they will remain unaware of it and, arguably, unharmed by it.

    • ↵vii Indeed, recent scandals in the UK suggest that at least some people in the medical and research communities have embraced it.

    • ↵viii I owe this point to Neil Levy who made it in a seminar at the Centre for Applied Philosophy and Public Ethics, University of Melbourne, at which An Ravelingien et al presented their ideas.

    • ↵ix The argument here presumes that harm is measured according to a baseline of interests, which would exist independent of the action being considered.

    • Competing interests: None declared.

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