Ambulance Interior

Imagine you have chest pains. Someone near you calls 911. At dispatch, two ambulances are sent for you. One has paramedics who will do their best to keep you alive, especially if you go into cardiac arrest; the medical workers in the other ambulance have a different purpose in mind–and that ambulance remains hidden. Before the ambulance arrives, your heart stops. A bystander begins CPR, and the ambulance arrives five minutes after that. Paramedics work on you for a half hour, then “call the code,” in effect, pronounce you dead. The paramedics working on you do not know about the other ambulance until their supervisor tells them to call the code. You are then transported to the other ambulance, and CPR is resumed. The other ambulance is marked, “Organ Preservation Unit.” CPR will be continued, not to save your  life, but to preserve your kidneys–and perhaps other organs–which will be removed after you arrive at the hospital. Those organs will be transplanted into others.

$1.5 million dollars of your federal taxpayer’s money is going to such a program in New York City. This practice is fraught with ethical problems. First, even if paramedics on a specific case do not know for sure whether the other ambulance is present, this program is public knowledge (there is a story in the December 1, 2010 New York Times about it). Any paramedic who receives a cardiac arrest or heart attack call will know that the other ambulance may be waiting. This could bring psychological pressure on the paramedics to stop CPR earlier than they would like. In addition, there are cases, especially early in the history of CPR, in which individuals with normal body temperature were successfully resuscitated after more than 30 minutes of CPR. It is clear that just because a patient has 30 minutes of CPR, this does not mean that the patient is dead; the brain can still be living and the heart resuscitatible. What would happen if the person’s heart restarted after the delay between stopping and resuming CPR? And even if the heart does not restart, the patient is only “dead” in a clinical, not a biological sense. It is removing the patient’s organs that kills the patient. This is medicine not to benefit the patient but to preserve organs, and it violates the fundamental end of medicine to “do no harm” (nonmaleficence). How much permission or informed consent can be given by families in such situations? Are the organ transplanters so desperate for organs that they will violate any principle of decency and medical ethics in order to obtain more organs? No utilitarian justification can make up for the distortion of moral medicine in this “trial” policy. It should be stopped immediately.