NRP as a form of MAID: The Role of Death and Consent in Organ Donation

Karen Devon – Women’s College Hospital and University Health Network

Abstract: The Canadian policy on Medical Aid in Dying (MAID) has raised a number of ethical questions regarding physicians’ responsibilities in assisting death and their duty to safeguard patient autonomy and safety. Concurrently, Normothermic Regional Perfusion (NRP) has stirred intense debate over whether this organ-saving procedure is ethically permissible given uncertainty over the patient’s mortal status. We explore the nexus of these controversies through an emerging proposal of Euthanasia by Removal of Vital Organs (ERVO) as a theoretical extension of MAID through NRP. The presentation will focus on whether ERVO could be a logical and ethical instantiation of MAID. Furthermore, we evaluate the moral permissibility of ERVO through NRP, and analyze the relevance of metaphysical questions of whether it is performed under “true death.” We ascertain that in the absence of conclusory metaphysical evidence, an agnostic stance may permit patients the choice to pursue NRP according to their beliefs about whether it is performed under “true death.” If it follows that there can be ethical cases of ERVO under the Canadian MAID policy, then patients may permissibly consent to NRP as a form of MAID based on personal convictions about death and the value of organ donation. We explore the implications of this argument by examining the strengths and challenges of the current Canadian MAID policy, and identifying which issues about NRP, ERVO or MAID are substantive to the debate about the ethical permissibility of NRP as MAID.

Keywords: NRP, MAID, Organ Donation