Should the lives of anencephalic newborns be prolonged so their organs can be donated to other infants?
Late last year, a California couple learned that their unborn child was anencephalic—missing most of its brain. Hoping to bring good out of their personal tragedy, Brenda and Michael Winner found a hospital that, after delivery, would tend to their child in such a way that its organs could be donated to another infant.
Anencephalics, in the words of one ethicist, “represent the nadir of handicapped infants.” Many are stillborn, and most who are not die within a week.
The anencephalic has no forehead. A mass of brain tissue, capped by a membrane, tops its shortened head. Its eyeballs usually bulge, and sometimes its ears touch the shoulders.
Both cerebral hemispheres are absent, meaning the child has no potential for conceptualization, memory, or communication with other human beings. It basically possesses only a brain stem, the “primitive” part of the brain accounting for reflexive actions such as breathing and the beating of the heart. At the same time, anencephalics who are born alive cry, swallow, and vomit like other infants. They grasp objects and react to pain.
In the end, the Winner baby was stillborn and the ethical questions surrounding their particular situation rendered moot. Yet the hard questions remain.
The church, like the rest of society, has to face the ethical dilemmas presented by anencephalics and transplantation, and it ought to consider them on its own terms. Christians are people who risk their lives on the truth of God’s kingdom, revealed in the life of Jesus Christ. So whatever the wider society’s decisions, the church needs to ask: How do we treat the anencephalic in such a way that our words and actions point to the kingdom?
On The Church’s Terms
The large majority of physicians and medical ethicists firmly—and rightly—oppose prematurely ending the anencephalic’s life in order to use its organs. But this issue has a twist. Given the ordinary “comfort care” treatment of nourishment and warmth until their death, anencephalics do not meet current brain death criteria until severe asphyxia has occurred. Organs cannot be taken until brain death criteria are met; but severe asphyxia damages the organs beyond usefulness. The only way to make use of the anencephalic’s organs, then, is to put it on a respirator, maintain its breathing until brain death is determined, and then donate its organs if a recipient is available.
Thus the dilemma. Should the anencephalic be kept alive merely to donate its organs? Or is this exploiting an unfortunate, helpless human being, making it the means to our own questionable ends?
Some would neatly avoid the moral quandaries by declaring that the anencephalic infant, since he or she has no potential for communicating or relating on a personal level, is not a person: It is only persons that we should treat as ends in themselves. Therefore, it is not wrong to prolong the anencephalic baby’s life in order to provide organs that will help another infant.
But the church can never be comfortable with so simple a dismissal of the anencephalic’s personhood. Christians insist that persons, whatever else they are, are a complement of soul and body, to be resurrected as a whole: “What is sown in the earth as a perishable thing is raised imperishable” (1 Cor. 15:42, NEB). Since the anencephalic indisputably possesses a human body, Christians will have due caution about declaring that it cannot be a person.
Are there, then, sufficient reasons to treat the anencephalic as a means to the end of better health for another infant? There are at least two reasons we should consider the matter further. First, God’s kingdom calls us to care for the weak and helpless. Concerns for the poor, the sick, the orphaned and widowed, run throughout the Old Testament. Jesus ministered primarily to the same group of people, and said, “How blest are you in need; the kingdom of God is yours” (Luke 6:20). Certainly the anencephalic is among the weakest of the weak, the most needful of the needy. But we must also consider infants in need of donated organs. They, too, are needy—if they were not, there would be no call for the use of the anencephalic’s organs.
Second, God’s kingdom calls us to promote life, not merely guard it. Christians are not concerned with mere survival, but with the good life formed in discipleship. “Choose life,” the Israelites are told (Deut. 30:15–16), and working actively for the wholeness of life may mean we cannot uncritically accept the flaws of life as we know it at the moment, but we must seriously consider the possible benefits each medical innovation presents. If some babies will live a richer, longer life after receiving organs from anencephalics, this in itself is an argument for thinking long and hard about prolonging the anencephalic’s life to do such transplants.
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Precedents And Tragedy
There are precedents for using one person as a means to health for another. The bodies of brain-dead mothers, for instance, have been sustained until the fetus reached an age of viability. In such cases, the dignity of the person being “used as a means” is being respected. The mother would want her child to live: If she could consciously choose to stay on a respirator in order to give the baby life, she would surely do so. In expecting as much of the mother, we respect her capacity to give and to care for others.
Is it possible that parents of an anencephalic might expect (and respect) the same in their child? It may be, in fact, that this child, said to be incapable of relating to others, can enter into relationship in one poignant and significant way: by having its organs shared.
But such talk must be tentative. It is open to abuse and rationalization. There are many specific questions to be answered before the use of the anencephalic’s organs should be promoted. Does the anencephalic suffer significant pain during the artificial continuation of its life? How long can its life be decently prolonged? Does prolonging its life to transplant its organs help or hinder the parents in recovering from their grief? How long will infant organ recipients live, and how much are their lives enhanced? And can society be educated to understand the importance of such life-enhancing transplants? These and other concerns will further shape and sharpen the debate over the anencephalic and its organs.
There are no entirely comfortable answers and probably never will be. But that is part of another call of the people who seek to witness to God’s kingdom. To live after the pattern of a crucified Savior means confronting the agony of the world, never denying the continuing reality of tragedies such as anencephaly, and choices that can, at best, only slightly lessen the resulting pain.
By Rodney Clapp.
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