An aid to ethical discernment

prepared by a working group on behalf of the Church Office of the Evangelical Church in Germany and the Secretariat of the German Bishops' Conference

Joint Texts No.13, 1998


An aid to ethical discernment


Diverging opinion by Dr. med. Wiltrud Kernstock-Jörns

The issue of allotransplantation and the shortage in human donor organs is a topic of its own which does not allow conclusions regarding the ethical imperative applicable to the assessment of xenotransplantation and its further advancement to be drawn. We are neither able to protect human life from dying at some point nor to establish an ethical postulate to prolong the human lifespan to the detriment of fellow creatures. Here, too, applies the primacy of protection rights over rights to benefits, in particular as protection is granted to the weak, while the entitlement to benefits is assigned to the strong. In view of the technically initiated temptation to put protection rights second in ranking to rights to benefits, the ethical imperative claims that we as human beings must learn to solve our problems ourselves and among our own kind, and especially by

  • learning to accept our limits and by promoting the work of hospices;

  • a responsible way of living, improving on a healthy lifestyle (e. g. renouncing excessive meat consumption for the sake of humans and animals) and making use of preventive medicine;

  • shifting resources and efforts to the development of technical alternatives to organ transplants. 

The production of transgenic animals, however, which is a logical consequence of the assumed obligation to carry out xenotransplants, clearly marks the overstepping of the borderline that is founded on the concept that both humans and animals are creatures in their own right, and this borderline has to be respected categorically.

This basic statement is to be amended by some points that link up to the majority opinion expressed in the chapter on psychological aspects:

a) People who were to receive another person's organ and who subsequently underwent the transplantation experience a process of internal ambivalence. The thought of having one's own organ removed and a foreign organ implanted in their body, in particular as this is done on the doctor's recommendation, confronts people with their extremely serious state of health or even with the inevitable imminence of death. Shock and fears caused by it, but also the hope to survive and to get well again require larger and lasting time and space in order to achieve internal clarification. There are many arguments in support of the idea that "dying on the waiting list" cannot be explained exclusively by the fact that organs are not available for a transplant fast enough. Somewhere in the background there might be a hidden unconscious and independent decision by the patient to die now, even though the expressed willingness to undergo a transplant apparently speaks against it.

b) Also of significance are the potential psychological or mental processes within a person after a successful transplantation: in order to develop a positive attitude towards living with a foreign organ it is decisive that the patient is convinced that the organ was a voluntary donation. This is necessary to develop a slowly growing feeling of deep gratitude towards the human donor. Eventually, the "hole" is filled that the patient has visualized in his or her own body, due to the more or less virulently perceived "inferiority" of the sick organ and the subsequent loss of it - and it is not only filled by the healthy new organ, but also by the meaningful and consoling thought that this was a voluntary gift, a voluntary sacrifice. What will it mean to the patient that in xenotransplantation this kind of consolation is not available? Instead, will people receive comfort from the thought that no human had to die to make the donation possible? Or will people seek refuge in a purely mechanical perception of organs, more so than already today, for instance regarding the heart as "the pump"? The attempt, however, to circumvent the problem by proclaiming a new spirit of brotherhood and sisterhood among humans and animals is self-discrediting, as these "brothers and sisters" cannot be asked for their opinion.

c) The existing uneasiness or feelings of guilt regarding our relationship with animals is at present undergoing a harsh update in the context of xenotransplantation. The advocates of xenotransplantation often claim that humans also raise animals to kill them and to eat them. But others, in view of the overstepping of the borderline between human beings and animals, will recall to question in particular the habit picked up by humanity "after the fall" of feeding ourselves on the meat of animals (Gen. 9, 3). They will point to the original vegetarian order of creation (Gen. 1, 29) and urge practicing asceticism in view of the tendency observed in our modern age to expand ever further the human claim to rule over the rest of creation. Due to the fact that in the meantime we not only breed and produce animals, but we also change their genetic structure, the term "product" now also refers to the creaturely uniqueness of animals and the whole of their life-cycle that takes place in a sterile laboratory world foreign to the species.

d) Also with a view to potential recipients of animal organs questions emerge: Will a person with a pig heart be psychologically encumbered by knowing that the "donor" was neither able to consent nor voluntarily became a living donor? Will the recipient therefore feel inferior to other people, "undivided" people? Will the recipient feel observed by family and friends who might be checking on his or her emotions and behavior? Are the "heartfelt" emotions still of a human quality? Would there not be sufficient reason to fear that when internalizing the non-voluntary character of the donation in conjunction with a life spent not in accordance with the needs of the species the dead animal belonged to, the recipient will develop a complex of self-devaluation and destructive inner dynamics? What will be the yardstick of responsibility applied to a human life, if its rescue comes from animals which are freely available - in the graft organ farm right next to the hospital.

e) Questions of this nature usually emerge when the implantation of big and vital organs such as hearts, kidneys, etc. is at stake. By way of how we feel about our body they are closely linked to psychosomatic processes, to the experience of invalidity, but most of all to the feeling of being "at one with myself", my identity. I think that the dissolution of this unity through disease and death is the main reason for the fervent search for organ replacements and "life-savers" turned phantoms. However, the mental and spiritual experiences we can gain in suffering and death wither away in this process.

Therefore, the Churches should not fall behind the insights gained on human responsibility for animals as fellow creatures that they have published in recent years, urgently claiming consequences. The envisaged objectives of animal welfare and respect for animals must not be quoted without showing any effect. The interest in maintaining human life and human dignity does not annul the obligation to protect animals as creatures by their special nature and dignity. The ethical conflict of aims is something we have to endure. For these reasons, further research on xenotransplantation should not be pursued, while a clear, distinctive limit needs to be drawn.



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