Commerce in Human Body Parts: A Critical Symposium
presented by Patrick Henry Reardon
This symposium is formed of two parts, the first of which is a short article of mine, “The Commerce in Human Body Parts: An Eastern Orthodox View,” that appeared last year in Christian Bioethics: Non-Ecumenical Studies in Medical Morality, a journal published in Holland. That article was itself a response to several others that were printed in the same issue (Volume 6, 2000, No. 2), all of them dealing with the ethical questions raised by the prospect of the commercialization of human body parts for purposes of medical transplant. Of the articles in that particular edition of Christian Bioethics, mine was the only one that argued, as a matter of uniform principle, against such commercialization. My article is reprinted here with the permission of Christian Bioethics.
The second part of the present symposium, which appears here for the first time, is formed by seven responses to my article from other Christian thinkers and writers enjoying some expertise of a moral and/or medical nature. These include four Roman Catholics, one Lutheran, one Anglican, and one Eastern Orthodox. The list likewise contains one bishop, one abbot, and three physicians. Unlike those in the aforementioned edition of Christian Bioethics, all the writers presented in this symposium stand opposed to the commercial use of human body tissue. At the same time, as the reader will see, most of them do take issue with some aspect or other of my own argument on this question, or with one another. Several of these writers raise, in particular, the more radical question of whether the very idea of transplanting vital organs from a dead body is biologically possible, or whether it does not involve even a logical contradiction.
I added some closing remarks at the end of these critical reflections.
The Commerce in Human Body Parts
An Eastern Orthodox View
by Patrick Henry Reardon
I do not intend, in these reflections, to provide full answers to the many moral questions raised by the advanced surgical procedures and other medical technologies that have, in recent years, rendered the transplanting of human organs more available than even our immediate past could have imagined possible. I have been asked, rather, to proffer an Eastern Orthodox response to the specific proposals recently advanced.
In order to do this, I propose to provide what I think to be a necessary doctrinal context in which Eastern Orthodox Christians typically assess matters of this kind. That is to say, I will begin the ethical discussion with doctrinal theology. Eastern Orthodox Christians have no trouble accepting the bon mot of Hans Urs von Balthasar: “Ethics is an echo and a thanksgiving for theology.”
Narrative being my normal and preferred form of moral discourse, I plead to begin this outline with a personal story. It involves a memory from distant childhood—what was probably my first attendance at a funeral. I must have been 6 or so, I think, and most of that liturgical service is a hazy blur in my mind now. I recall vividly, nonetheless, that what struck me most about that burial rite was its use of incense. I was quite surprised and more than slightly puzzled to see our pastor, clothed in black brocade vestments, walking around the casket three times, waving the smoking censer over the dead body repeatedly with the deepest and most intentional reverence.
This action not only made a strong impression; it also posed to my young mind a rather serious question of liturgical propriety. My experience of the liturgical worship up to that point in my young life had prompted me to associate the burning of incense solely with the veneration of the Holy Eucharist. I had never seen a censer or the smoke of incense except in the context of the Blessed Sacrament of the Altar. Why, then, I wondered, would a dead body be venerated with the wafting of incense smoke, treated like the Holy Communion, as it were? What could this ritual possibly mean in such a context? My father being away at the time (making life hazardous for the Japanese army in such places as Guam and Okinawa), I took this theological question to my mother.
I could not have done better. Nearly six decades have passed since then, but to this day I cherish and hold the clearest memory of my mother’s very correct answer. “Well, of course, the priest incensed the body,” she said. “The bodies of Christians are the temples of the Holy Spirit.” Her answer, I distinctly recall, was delivered without the slightest hesitation or uncertainty, and it showed her intuitive grasp of the special dignity of the Christian body in properly theological terms. She knew exactly why the body of a Christian, whether living or dead, is properly venerated by the liturgical use of incense. Quite simply, the Christian body is holy. It is the consecrated dwelling place of the Holy Spirit.
As I reflect on the matter now, at a distance of more than half a century, I find yet another thought inescapable by way of inference: What my mother told me about the Christian body must have been a common understanding at that time. She was not especially educated; indeed, she had not even finished high school. Nor, when I was young, did my mother strike me as a particularly devout person, though I am much disposed to question and correct that impression now. Anyway, the point is that my mother’s theological assessment about the reason for incensing the dead bodies of Christians, an assessment overwhelmingly confirmed by all my later studies in dogmatic and liturgical theology, must have reflected a rather widespread understanding among believers in those days. Back during World War II, I suspect that many a child would have received exactly the same answer to the same question, and with equal quickness and assurance.
The Temple of the Holy Spirit
According to Eastern Orthodox theology, the rhetorical question “Who shall separate us from the love of Christ?” is one that pertains to the body every bit as much as it pertains to the soul. While it is certain that the soul leaves the body at the time of death, we Orthodox find no reason in Holy Scripture for supposing that the Holy Spirit takes leave of the body simultaneously. Indeed, why suppose that the Holy Spirit leaves the body at all? Were the Holy Spirit to depart from the body at the time of death, what could it possibly mean to say that death has been swallowed up in victory? Why should we imagine that the corpse of a Christian has become less holy, less sanctified, than it was five minutes before it died? On the contrary, we affirm that his body remains forever the temple of the Holy Spirit.
This emphasis on the holiness of the Christian body is an essential feature of Eastern Orthodox dogmatic theology (and, though they may express the matter somewhat differently, I do not doubt that a perspective very much like this is shared by Roman Catholics and many other Christians). We believe and confess that the dynamisms, the energeiai, of the Holy Spirit are poured out, through the sacraments, upon the Christian’s body, its corporeal substance, in a divine action that is no less physical for being spiritual. By the transforming presence of the Holy Spirit there is effected a spiritual, divinized alteration in the very nature (physis) of the Christian’s flesh, the seed of its future resurrection and immortality. In this sense, the alteration is physical.
In Orthodox theology, moreover, we believe that the soul itself is sanctified through the body. Holiness is experienced and thought of as quite physical, meaning that it involves our entire physis, or nature. Sanctification is not “spiritual” in the sense of non-material. It is spiritual, rather, in the sense that divine grace transforms the entire human constitution, including the very structure and organic composition of the body’s living cells. The anatomy itself is spiritually altered. For the Orthodox, “spiritual” does not mean “bodiless.” We believe that there is no part of human experience—and most emphatically not the experience of holiness—that is separated from the body.
According to Orthodox theology, then, salvation and holiness come to man through his flesh. Just as Jesus’ dying in the flesh and rising again in the flesh are the cause of man’s redemption, so this redemption comes to him through the physical channels of the preaching and sacraments of the Church. Man’s soul is saved and sanctified through his body. Divine grace reaches the human spirit through the medium of human flesh. We have it on good authority that even faith comes through something so physical, so carnal, as the act of hearing. Tertullian’s famous sacramental dictum says it all: Caro cardo salutis, “the flesh is the hinge of salvation” (On the Resurrection 8.2).
According to Eastern Orthodox theology, furthermore, what in the West is known as the doctrine of “the mystical body of Christ” is not a simple analogy. When, in 1 Corinthians 12:12, St. Paul says that “as the body is one and has many members, but all the members of that one body, being many, are one body, so also is Christ,” this is not understood in the East as implying some merely metaphorical comparison of the social order to the correct functioning of a living organism, a comparison such as one finds in Cicero. Rather, it is the very bodies of Christians that are made “the members of Christ.”
This interpretation is appropriate to the ethical context in which it appears in 1 Corinthians. In fact, Saint Paul takes this principle of bodily holiness to be a self-evident premise from which a number of moral inferences are necessarily derived. “Do you not know?” he asks three consecutive times in this context: “Do you not know that your bodies are members of Christ? . . . Or do you not know that he who is joined to a harlot is one body with her? . . . Or do you not know that your body is the temple of the Holy Spirit who is in you, whom you have from God, and you are not your own?” (1 Corinthians 6:15,16,19) The body, in short, is “for the Lord, and the Lord for the body” (6:13). The holiness of Christians, that physical sanctification by which they can no longer even claim their bodies as their own property, is treated as a standing principle that places definite moral limits on what sorts of things can be done with those bodies (cf. also Romans 6:13).
The Drug of Immortality
As earlier noted, the childhood question that I put to my mother was spawned by a sense that the corpse in the coffin was being treated in much the same way that I had come to associate with the veneration of the Blessed Sacrament. That seemed to my young mind very inappropriate. That is to say, while I knew without doubt that the Holy Eucharist, as the true body and blood of Christ, is worthy of the most profound veneration, it was not yet clear to me that participation in the Sacred
Mysteries actually effected a change in the human body itself. My mother’s answer to my question, then, served to throw a new light on the meaning of the Eucharist. My later study of dogmatic and sacramental theology, also, would in due course attest to the correctness of the instincts involved in my question. There was more connection between the Holy Communion and the Christian’s body than I had ever imagined.
According to this theology, just as the action of the Holy Spirit, whose descent is sought in the Church’s epikletic prayer, transforms the nature (physis) of the bread and wine to make them be the true body and blood of Christ, so this sanctification passes into the very bodies of those who share in the blessed Eucharist. The mystery of the Holy Communion is the foundational reason for saying that the bodies of Christians are the temples of the Holy Spirit.
The Orthodox believe it is in the Holy Eucharist that we are incorporated into the body of Christ: “The cup of blessing which we bless, is it not the communion of the blood of Christ? The bread that we break, is it not the communion of the body of Christ? For we, though many, are one bread, one body, for we all partake of that one bread” (1 Corinthians 10:16f). According to Orthodox dogma the very flesh and blood of Christians are sanctified, theologically defined, by their living, sacramental contact with the flesh and blood of the risen, perfected Christ, in whom they place their trust in life and in death. Their members are thereby suffused with the dynamisms of the Lord’s resurrection. Those very members will rise from the dead by reason of the Holy Communion: “Whoever eats my flesh and drinks my blood has eternal life, and I will raise him up at the last day” (John 6:54). That is to say, the Holy Communion places within the believer’s body the dynamics of its ultimate resurrection. This was the reason why that body in the coffin was being incensed by my boyhood’s parish priest. That body shared in the transforming, mystic consecration of the bread and wine by the outpouring of the Holy Spirit. That incensing was a veneration of the indwelling Holy Spirit, who would continue to abide in that fallen flesh, no matter what its state of decay and degradation, until the Lord himself returned to call it from its resting place.
The goal of the Holy Eucharist is not the consecration of bread and wine, but the consecration of human beings. The risen Christ does not assume the form of the consecrated elements in order to hide in a tabernacle but in order that he may abide in us and we in him (John 6:56). According to St. Justin Martyr in the second century, “we have been taught that the food that is eucharisticized (eucharistetheisan) by the prayer of the word that comes from Him, by which our flesh and blood are fed by metabolism (kata metabolen), is the flesh and blood of that Jesus who became flesh.” Hardly can our bodies any longer be considered common bodies if it is true that “we do not receive these as common bread and common drink” (First Apology 66).
This persuasion with respect to the sanctification of the flesh through the Eucharist appears likewise in the ancient Church’s literature of martyrdom. Thus, in the Martyrdom of Polycarp, a work contemporary with Justin, we are told the blessed martyr referred to his own death as a sharing in the cup of Christ (14.2), and the narrator describes his body, surrounded by the flames of the pyre, as resembling a loaf baking in the oven (15.2). Even earlier in the second century, Ignatius of Antioch, on his way to martyrdom at Rome, had referred to the power of the Holy Eucharist with respect to the Christian’s eternal transformation, speaking of the “one bread which is the drug of immortality, the antidote that we may not die (pharmakon athanasias, antidotos tou me apothanein) but live in Jesus Christ forever” (Letter to the Ephesians 20.2). With specific reference to his own impending death, Ignatius wrote of the Holy Eucharist in similar terms: “It is the bread of God that I desire, which is the flesh of Jesus Christ, of the seed of David, and for my drink I desire his blood, which is incorruptible love” (Letter to the Romans 7.3).
By way of summary, it is the teaching of the Orthodox Church that (1) the bodies of those in Christ are to be regarded as sanctified by the hearing of the Word and faithful participation in the Sacraments, most particularly the Holy Eucharist; (2) because of the indwelling Holy Spirit the consecrated bodies of Christians do not belong to them but to Christ; (3) with respect to the indwelling Holy Spirit there is no difference between the bodies of Christians before and after death; (4) whether before or after death, the Christian body is also to receive the same veneration; and (5) notwithstanding the physical corruptions that the body endures by reason of death, there remains a strict continuity between the body in which the Christian dies and the body in which the Christian will rise again. That is to say, it is the very same reality that is sown in corruption and will be raised in incorruption (1 Corinthians 15:42).
An Orthodox Analysis
The foregoing doctrinal considerations provide a brief but necessary setting for understanding how the Orthodox Church deals with the moral questions attendant on the uses of bodily members separated from their bodies.
Needless to say, in the light of the theological reflections just given, it is not to be expected that an Orthodox theologian will agree with those who argue in favor of commerce in human body parts. The Orthodox Church regards as morally reprehensible the tattooing of a living body and, except under the gravest and most compelling necessity, the cremation of a dead one. The notion of “selling” an integral part of a human being is simply outside the realm of rational comprehension. Indeed, it is profoundly repugnant to those Orthodox Christian sentiments that are formed and nourished by the church’s sacramental teaching and liturgical worship. One does not sell or purchase that which has been consecrated in those solemn ways that the church consecrates the human body.
That question settled, what further may be said about the surgical removal of body parts at all? Two sorts of cases present themselves in this connection. First, the surgical removal of a diseased part of the body for purposes of keeping the whole alive. In these circumstances I am familiar with no teaching of the Orthodox Church that would preclude such an intervention, nor has the conscience of any Orthodox Christian, as far as I know, ever been troubled by the amputation of gangrenous limbs or the removal of infected tonsils or the extraction of rotting teeth.
Second, the removal of some “dispensable” part of the body for purposes of donating it to another human being who has need of it. Inasmuch as the Orthodox Church does not object to the donation of human blood, it would appear that this instance provides adequate analogy for making the same determination about other body parts.
Once again, there are two types of cases in which this latter determination may be made. First, body parts from a living person. One thinks here of the gift of bone marrow, a kidney, a portion of the liver. Provided that the donor is under no coercion except that of charity, it is my view that this kind of gift, which does not involve the death of the donor, is not only blameless but even heroically generous.
Second, body parts from someone who has died. In this case, of course, the range of possibility is much larger, involving such major organs as the heart and lungs. Once again, it is my view that such donations are morally legitimate for Christians as expressions of their love for others in Christ. Indeed, I have already left instructions with my own family that, in the event of my meeting the Lord somewhat ahead of schedule, the medical profession may remove any part of my body that might be of service to someone in need. What must be strenuously avoided, however, is any behavior suggesting that the body parts of a deceased Christian are (to quote a recent author) “very much like other types of things.” Most emphatically, they are not (as the same author wrote) “parts of a former person.”
Finally, it must be remarked that the censure placed against commerce in human body parts should not be taken to imply that there are to be no commercial aspects to the transplanting of these members. That is to say, those who do this important work may expect to earn their living thereby. What is reprehensible is the actual sale of human organs (whether by the donor or by the agency that handles the gift), not the paying of a reasonable fee for the services involved in the removal, preservation, and transplanting of the organ.
by Gilbert Meilaender
I find myself in the uncomfortable position of agreeing with Fr. Reardon’s chief claim—that commerce in human body parts is wrong and should be prohibited—but unpersuaded by the doctrinal basis he provides to support that conclusion.
First, the theology: I am quite prepared to believe that the sanctifying power of the Holy Spirit “passes into the very bodies of those who share in the blessed Eucharist,” though I would have thought that it is baptism which accomplishes this incorporation into Christ’s body (as Romans 6 seems to teach). But I admit to not understanding why this means that the Holy Spirit should continue to dwell in the corpse, in the body’s “mortal remains.” Still more, it seems peculiar to say that “with respect to the indwelling of the Holy Spirit there is no difference between the bodies of Christians before and after death.” There must be at least this much difference: namely, that before death the Spirit indwells a living person and after death (were Fr. Reardon’s doctrinal claim true) the Spirit would indwell the body or bodily remains of one who had formerly been a living person.
In order to assert, as I would also want to assert, that Christians are—in their bodies—incorporated into Christ, and in order to affirm that there is continuity between this bodily life and the life that shall be ours in the resurrection, it does not seem necessary to claim that the Holy Spirit dwells in a corpse. The dead are truly dead, and ours is a God of the living, not the dead. (To give Fr. Reardon his due, however, there are deep Trinitarian mysteries involved here—in particular the relation of the entombed Jesus to the Holy Spirit between Good Friday and Easter.)
It is, for me at any rate, sufficient to know that the newly dead corpse still bears the human form of one who lived among us. To view that dead body not with veneration but as simply a useful collection of organs available for salvage and sale is to fall beneath even the best human wisdom of those who have not known the light of Christ. One has to be dehumanized indeed to regard the corpse as simply another natural object. If that corpse is no longer my person, as it surely is not, it is, nonetheless, my mortal remains. To treat those mortal remains with respect, to refuse to see them as merely in service of other goods, is our last chance to affirm that the human person is not simply a “part” of a human community and does not belong to us.
So Fr. Reardon is right about the buying and selling of bodily organs for transplant. He is also right to see that, if organs are to be taken for transplant, they should be given. Hence, one need not oppose all organ transplantation. Nor, I think, need we oppose a definition of death as the irreversible loss of all brain function, even if heart and lung activity continue to be mechanically sustained (and, of course, without such a definition most transplantation could not take place). A body that has permanently lost the capacity to integrate those “vital” functions independently, though it will not look like a corpse, is one.
But, at least by my lights, Fr. Reardon may be more positive about organ donation than the facts warrant. I would not call organ donation “heroically generous.” In our society we regularly oversell its possible benefits and regularly underplay its often terrible costs. The “success rates” given for transplants often conceal an enormous amount of suffering and frustration.
Perhaps the doctrinal point we really need here is slightly different from that to which Fr. Reardon points us. The body of Christ which we eat in the Eucharist is his broken body, given willingly into suffering by a man who preferred a faithful life to a long one. Incorporated into that body we may gradually learn to grasp for continued life with a little less desperation.
An Intrinsic Contradiction
by Earl E. Appleby, Jr.
I greatly appreciate the opportunity to respond to Father Reardon’s article, because it provides an occasion to address a contradiction inherent in much current thinking about the transplanting of human body parts. If I may put the matter succinctly, it is not possible to harvest usable hearts and lungs from “someone who has died.” Living organs are excised from living persons, and the fraudulent concept of “brain death” was concocted to rationalize this murderous practice. Tissues, such as corneas, may be taken from “someone who has died,” but not vital organs.
In this respect, we would do well to remind ourselves of four axioms of the Natural Moral Law: (1) Good ought to be done, and evil must be avoided. (2) Good may not be withheld. (3) Evil may not be done. (4) Evil may not be done that good might come of it. The transplantation of unpaired vital organs violates each and every one of these axioms of the Natural Moral Law.
Pope John Paul II describes the nature of the evil to which I allude in these words:
Vital organs which occur singly in the body can be removed only after death. That is from the body of someone who is certainly dead. . . . The requirement is self-evident, since to act otherwise would mean intentionally to cause the death of the donor in disposing of his organs. (Address to International Congress of the Transplantation Society, August 29, 2000)
This vital truth is indeed self-evident but it remains largely hidden from public view by a pervasive propaganda campaign on the part of the transplant industry that dehumanizes its victims in the style of Joseph Goebbels as today’s Untermenschen, the “brain dead.”
Lincoln once pointed out that if someone called a horse’s tail a “leg,” it would still have only four legs. Calling a tail a “leg” doesn’t make it one. The truth is that for vital organs to be suitable for transplantation they must be living organs removed from living human beings. Calling a living, breathing human being with a beating heart “dead” through the lie of “brain death” does not make him dead—unpaired vital organ transplantation does.
Goebbels’s mentor, Adolph Hitler, boasted that a lie repeated often enough is soon believed. Three decades of trumpeting the Madison-Avenue slogan “the gift of life” has persuaded many naive, if well-intentioned, souls into the ill-advised and anti-life act of signing organ donor cards, but how many of these potential victims of utilitarian euthanasia know just how literal that “gift” really is?
Consequently, persons condemned to death as “brain dead” are alive, and the prohibitions imposed by God himself in the Natural Moral Law preclude the transplantation of unpaired vital organs, an act that causes the death of the “donor” and violates the divine commandment, “Thou shalt not kill.”
More Nuance Required
by John Eudes Bamburger
There is agreement that certain tissues can be used when taken promptly from a deceased person, the most common being the cornea. In view of the abuses connected with the removal of vital organs in someone who is “brain dead,” it is important to distinguish between the case of one who is “brain dead,” yet whose vital signs remain functional, and one who is truly dead. The objection that “brain death” is not an acceptable norm for pronouncing a person “dead,” and so harvesting vital organs from such a person is not ethically permissible, would seem to require a more nuanced treatment than Fr. Reardon’s article provides. Whether vital organs can ever be harvested from one who is truly dead, whose vital signs indicate full death, is a medical question requiring more expertise than I possess. If Mr. Appleby is correct in saying that they cannot be utilized, then his objection would seem to stand, but that assertion pertains rather to medical than moral expertise. In any case, his objection seems to me to be based on serious concerns and indicates that a more nuanced treatment of this issue is needed than Fr. Reardon considered.
Victims of Propaganda
by Paul A. Byrne
We are bombarded with propaganda about organ transplantation. For those who are thoughtful about “brain death,” death, and organ transplantation, numerous occasions may arise that demand a moral decision in such matters. For example, we are regularly required to make a decision about organ transplantation when we apply for a driver’s license.
The first consideration ought to be that God creates the person, who is unique and unrepeatable. The human person, made in the image and likeness of God, is both corporeal and spiritual, and life is the unity of the corporeal and the spiritual. The purpose of medicine is to protect life, furthermore, to preserve life, to prolong life, to postpone death, and to enhance the sanctity and quality of life. Life on earth, finally, is a continuum from conception until death, and the life of the person must be respected from conception until death.
Thus, no one should be declared dead until and unless there is separation of his soul and body. What is left after death is a corpse, an empty body. The absence of life in the corpse is manifest by destruction, disintegration, dissolution, and putrefaction. Therefore, the minimal legal and medical requirement ought to be: “No one shall be declared dead unless respiratory and circulatory systems and the entire brain have been destroyed.”
Organs for transplantation are taken commonly after a declaration of “brain death.” “Brain death” is not death. For a heart to be suitable for transplantation, it must be a beating heart. It takes about one hour of operating to take a heart out for transplantation. It takes about three hours of operating to take a liver out for transplantation. During the time of the procedure for excision of these and other organs, the heart must be beating, the blood pressure must be normal, and many internal organs and systems must be functioning. It is common for a paralyzing agent, not an anesthetic, to be used while the organs are being excised so that there will be no movement or visible response during the procedure. At a leading university in the United States of America, in all ten patients studied, there was an increase in heart rate and blood pressure when the scalpel made the incision to remove the organs. Could this increase of heart rate and blood pressure occur after death?
Morally, only one of a pair of vital organs or a part of a vital organ may be transplanted. This may be done only as an act of charity after the donor has been fully informed and when the excision of the vital organ or part of the vital organ will not cause death or debilitating mutilation. Only living organs are suitable for transplantation. Vital organs cannot be transplanted from a dead body. Only tissues, such as corneas or heart valves, are suitable for transplantation after the heart has stopped and there is no circulation. The fictitious concoction of “brain death” is a fraudulent subterfuge coined and expended to deprive defenseless persons of their God-given right to life, often for profit. Removal of vital organs after a declaration of “brain death” is precisely what causes the death of the patient whose vital organ or organs are thus excised.
While this doubtless may prolong the life of the person receiving such organs by transplant, the procedure does violate the moral principle that evil may not be done that good might come of it. That is, a good end does not justify an evil means.
This fundamental moral axiom should be brought to the attention of those tempted to sign organ donor cards authorizing the removal of their vital organs for transplantation. Many have been deceived in these serious matters.
The Empirical Evidence
by H. Tristram Engelhardt, Jr.
Certain metaphysical assumptions to the contrary notwithstanding, brain death is the death of a person. Also, as St. Gregory Palamas (1296–1359) recognized, these are not matters of revelation. One can appreciate the factual matters at hand, as well as the significance of whole-brain death, by considering the execution of the French scientist and politician, Antoine Laurent Lavoisier (1743–1794). Lavoisier was concerned to determine how long a person remained conscious after decapitation. He therefore arranged for those at his execution to observe how long he would blink once he had been guillotined. If one imagines that modern medical technology had been available and Lavoisier’s head had at once been cannulated and perfused with oxygen-rich blood, he would have continued to blink and communicate while his body decomposed. We would have held Lavoisier to be alive, although his body was dead.
Or imagine that the executing authorities had cannulated and intubated the body, preserving its vital functions while the head decomposed. We have come to understand that our presence in this world is radically tied to our brains. One can have liver transplants and heart transplants, but not brain transplants. Were one to attempt a brain transplant, it would be tantamount to a body transplant (not that I would morally celebrate such a technological feat).
All of this means that we have discovered empirical information about ourselves and our embodiment. When the brain is dead, the person is no longer among us, even though other levels of biological life can continue. Cultures of human cells can be kept alive for decades after a person’s death. In the case of our fictional consideration of Lavoisier’s body, long after his head had decomposed and his soul gone to judgment, the French authorities could have removed organs from the remaining heart-beating body, had such technology been available. No doubt, Lavoisier would have been interested in the reflexes that would persist in his now separated body (e.g., increases in heart rate and blood pressure with the surgical removal of organs). This gruesome image is meant as a heuristic device to bring across some empirical facts of the matter we have learned, especially over the last two centuries. We could carry these further by imagining that, after .357 bullets had been shot into a person’s heart and head, the body was cut in half so that the liver could be perfused and maintained long after the heart had stopped beating and the brain been destroyed. That is, one can conjure circumstances in which organs can be removed from bodies lacking either intact brains or beating hearts. The point is that we have come to understand the signal importance of the whole brain, as well as the need to recognize how various levels of human biological life can continue in organs and cells long after a person’s death.
I commend Dr. Paul Byrne for attempting to revivify a Thomistic account of the soul as the form of the body. Also, I surely join him in being concerned about being an organ donor due to non-heart-beating-donor criteria for death, but not because of concerns about the appropriateness of whole-brain death.
Following a Safer Path
by Mark Haverland
Most of Fr. Reardon’s article is lucid and unexceptionable. For example, I agree completely with him that human beings should not be treated as objects of commerce and that their bodies should be treated as befits the creation of God and temple of the Holy Ghost.
My problem is with the final paragraph of his article, which contains a petitio principii. That is to say, Fr. Reardon begs the question: Is the “donor” of a unique (“unpaired”) vital organ, such as the heart, in fact dead?
When a clear moral duty, such as the duty not to take innocent human life, is known and is involved in a moral choice before us, we are obliged to take the morally safer path, even if doing so may bring some losses. So, for instance, the hunter in the woods is not free to blast away at a moving object unless he is certain that that object is a deer and not a human being. The obligation not to take innocent life obliges us not to shoot at what might be a person, even if that means going hungry. It obliges us not to abort a fetus, even if we are not certain at what point ensoulment occurs, even if the birth of the child may result in various hardships.
Similarly, unless we are morally certain that ensoulment has ceased in the case of a “brain dead” person, we are not justified in removing anything vital to his continued existence. The burden of proof, therefore, rests firmly with those who argue for such removal and for the transplantation system that rests on its macabre “harvest.” In fact, however, they have not shouldered the burden; indeed, they have studiously ignored the moral dilemma.
The Deeper Moral Dilemma
by Patrick G. D. Riley
Organ transplantation is a revolutionary advance of modern medicine, but the moral problems surrounding it are as old as mankind. I believe a Greek legend from the mists of pre-history gets to the heart of those problems.
The heroine of this legend is Antigone, immortalized by the playwright Sophocles. This young woman defies a royal edict not to bury the body of her outlawed brother. For disobeying the law, she is condemned to death. But Antigone holds that she has obeyed a higher law, from heaven itself. For that matter, an unjust law is no law at all.
Antigone’s argument has echoed down the centuries. The play can be considered the first treatise on Natural Law, as well as the most moving. It was framed, after all, by a Sophocles.
The premise of the argument is that respect for bodily remains, especially of a loved one, is a demand of human nature. If such respect is an inclination of all mankind, it meets a classic criterion for a precept of Natural Law. The reasoning here is that Almighty God, in creating the universe, could not help stamping everything he made with his own rationality, his own purposefulness. Nature does nothing in vain, because its Maker does nothing in vain.
What gives the play relevance to commercial traffic in body parts is that Antigone’s quarrel with the king turns on respect for the body, indeed for a corpse. And the special relevance of the play to Patrick Henry Reardon’s appeal to symbol is the key role it gives a symbolic gesture, the seemingly trivial gesture of throwing dust on a corpse.
The king fully understands that the dust constitutes the burial he forbade to Antigone’s brother. When she threw dust on her brother’s body, she knew it would be ineffective against putrefaction or wild beasts, yet nobody in the grip of this play doubts the meaning of the dust, or doubts that principles are at stake.
Respect for the dead demands expression, yet its fullest expression lies beyond the power of words. Hence it demands gestures, symbols. We are driven to such symbols even when we scarcely understand them. Yet everybody understands the drama of Antigone, much as it depends on symbol. She braves death for a symbol in obedience to a profound law of our nature, when civil law rides roughshod over pietas.
None of these considerations militates against the morality of transplanting body parts, most strikingly in saving eyesight or life itself. What is morally objectionable is trafficking in them. Instinctively we discern the gross disrespect for the human body in exploiting it for profit. The parallel to prostitution springs to mind.
Here I make no argument beyond simple human revulsion, universal natural revulsion, itself a kind of knowledge. Of course, natural revulsion can be uprooted by propaganda or by practice. Since the ’60s, ever-lurking contempt for finer feelings has cast off its mask for the first time, I believe, in Christian history. It has infected our world and sickened it. The coarsening of feeling, of behavior, and of society itself is here for all to see and to suffer.
Nowadays, if anything can be done, no matter how revolting, it will be done. If the practice is countenanced, it eventually will be flaunted. Think of sodomy (if you can). Profiting from body parts must lead to technologies too inhuman to contemplate and may already have done so. If countenanced, they too will be flaunted.
Just as pornographers now pose as First Amendment patriots, body-parts profiteers will posture as selfless humanitarians. Indeed they are already doing so. They will brand their opponents narrow, heartless, and bigoted; indeed, they are already doing so. Such revilement has been the lot of pro-life people for a generation. Such may be their fate for generations to come. Unless, that is, Antigone comes to the rescue. Or better yet, faith itself.
While I express my gratitude to each of the foregoing writers for his critical comments, it would seem useful to draw attention to certain general aspects of this discussion.
First, I did not anticipate that all of these respondents would agree with my opposition to the commercialization of human body parts as a matter of uniform principle. As I noted at the beginning, I was the only writer (among five, two of them Roman Catholic and two Protestant) in that edition of Christian Bioethics to take such an unbending negative stand on the question. Since I enjoy no expertise in either moral theology or medical ethics, I confess it is somewhat heartening to find myself supported by those who do.
Second, I fully expected to be criticized for basing my position entirely on the foundation of sacramental theology; indeed, among the writers discussing this question in Christian Bioethics, I was the only one to do so. Taking such a position, nonetheless, would seem to render my argument useless for purposes of civil law and public policy. Much safer, in this respect, would appear to be the normal Roman Catholic practice of basing moral decisions on Natural Law. I expected, then, that one or other of my respondents, perhaps one of the four Roman Catholics in the group, would raise that question. In fact, however, Dr. Gilbert Meilaender is the only one to challenge my sacramental theology at all, but even he does not dispute my using sacramental theology as the basis for moral decisions.
Third, it is obvious that I had not given adequate (or any!) consideration to the major objection raised by several of my critics, namely, whether the notion of removing vital organs from bodies truly dead is even possible. Thinking that the concept of “brain death” was commonly accepted among moral theologians and somewhat aware that it was defended by an institution so prestigious as the National Catholic Bioethics Center, I had not foreseen that my argument would be subject to attack from that direction. Now that this question has been raised so pointedly, however, it is obvious that I must give further serious thought to the matter. I am hardly free to ignore the fact that the official statement of Citizens United Resisting Euthanasia (CURE), which disputes the very notion of “brain death,” has been signed by an impressive international array of experts and scholars.
Finally, I confess that my own “practical” view on the question of organ transplants has changed radically. Shortly after I wrote that original article, but prior to its publication, the Chicago Tribune featured a series of popular reports (in several issues in late May 2000) that spelled out in gruesome detail exactly how extensive and utterly market-driven is the commerce in body parts. It has become obvious to me that a subject that I had been considering in the quiet and relative detachment of our editorial office takes a dramatically different shape in a world dominated by purely selfish and mercantile considerations. In actual practice, whether or not a “donor” is remunerated for his organs, his organs are effectively sold to the highest bidder on an open market subject to precious little governmental regulation.
A person whose driver’s license indicates that he is an “organ donor” should have no doubts on this matter. His cadaver will probably be harvested down to its last useful tissue cell for use in everything from kneecap replacements and cosmetic surgery to the testing and manufacturing of new drugs. While the transplanting of vital organs, such as the heart, is subject to close governmental supervision, this is not the case with respect to “tissue,” a medical euphemism for any other part of the body, such as bones, skin, veins, and corneas.
At current prices, the average body is worth about $80,000 to the “cadaver industry,” which finds lucrative uses for the roughly 130 pieces of body tissue that are extracted, sterilized, cut up, and put on the market. How is it that companies like Cryolife, Regeneration Technologies, Allograft Resources, and so forth, which deal exclusively with products that cannot legally be bought and sold, manage to make such a killing on the New York Stock Exchange?
While federal law does prohibit the sale or purchase of such tissue, the remuneration given to hospitals and clinics for the “processing” of it is lucrative indeed. In a matter of just a few minutes, for instance, a hospital’s surgical staff can snip off and package a patellar tendon, but this little two-inch strip from the knee will bring up to $5,000 when it goes to repair a sports injury. A few years ago the standard “processing fee” for a human liver was about $500, but a competitive market has jumped that figure up to $7,000. Similarly, a family that agrees to donate the skin of a departed loved one to a skin bank, thinking it will be used for burn treatment, would be shocked to learn that certain cash inducements caused their charitable gift to be sidetracked for other surgical procedures. Penis enlargement, for example.
Anyway, when I recently applied for an Illinois driver’s license and was asked if I were an “organ donor,” I answered in the negative for the first time in my life.
Gilbert Meilaender holds the Duesenberg Chair in Christian Ethics at Valparaiso University. He has recently edited a volume titled Working: Its Meaning and Its Limits (Notre Dame Press, 2000).
Earl E. Appleby, Jr., is the Director of Citizens United Resisting Euthanasia (CURE), Ltd., in Berkeley Springs, West Virginia.
The Right Reverend John Eudes Bamburger, O.C.S.O., M.D., is the abbot of Our Lady of the Genesee Abbey in Piffard, New York.
Paul A. Byrne, M.D., a neonatalogist and pediatrician in Toledo, Ohio, is a past president of the Catholic Medical Association.
H. Tristram Engelhardt, Jr., Ph.D., M.D., teaches philosophy at Rice University and medicine at Baylor College of Medicine.
The Right Reverend Mark Haverland, Ph.D., is bishop of the Diocese of the South, Anglican Catholic Church.
Patrick G. D. Riley has been a newspaper editor, a lecturer in Philosophy at the Catholic University of America and Governmental Affairs Director of the Catholic League for Religious and Civil Rights. He is the author of Civilizing Sex: On Chastity and the Common Good (T&T Clark, 2000).
Patrick Henry Reardon is pastor of All Saints Antiochian Orthodox Church in Chicago, Illinois. He is the author of Christ in the Psalms, Christ in His Saints, and The Trial of Job (all from Conciliar Press). He is a senior editor of Touchstone.
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