- Email: [email protected]
The emergence of “personhood” in organ procurement
Available online at www.sciencedirect.com
Transplantation Reviews 22 (2008) 163 – 166 www.elsevier.com/locate/trre
The emergence of “personhood” in organ procurement David J. Plevak Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
Abstract This article begins and ends with an account of the actions of one person. I propose that such heroics are rooted in an instinctual recognition of “personhood” as it emerges from a particular human “other.” I propose that heroism grounded in the recognition of “personhood” is descriptive of those acts of organ donation that are founded on free will. The moral principles involved in deliberations for organ transplantation can provide a duplication of concerns (recipient and donor). However, the enterprise of organ transplantation increasingly depends on the altruism of free-will donation, the adherence to donor qualifications, and the defense of human rights. © 2008 Elsevier Inc. All rights reserved.
1. The emergence of “personhood” A January 2007 New York Times article chronicles the heroics of a 50-year-old construction worker who leapt on the New York subway tracks to save the life of a man from an oncoming train [1]. Wesley Autrey was in the company of his daughters (ages 4 and 6). While waiting for the downtown local at the 137th Street and Broadway in Manhattan, an unknown young man experienced an epileptic attack and stumbled to the platform's edge, falling across the tracks. As the subway train headlights appeared, Mr Autrey made his decision. He left his children, leapt upon the tracks, grabbed the stranger, and with the weight of his body, forced both himself and the actively seizing man in the space between the tracks. What compelled Wesley Autrey to leave his young children and risk his life to save the life of a stranger? In making this decision, Mr Autrey transcended sociologic, educational, economic, and racial differences, drawn by something which he and the stranger had in common. Aristotelean [2] and Thomistic [3] philosophy would pose that this connection between individual beings arises through natural law from the intrinsic value that each person possesses, solely and completely from their shared membership to the human race. John Kavanaugh would call this commonality “personhood,” or that intrinsic quality emanating from both men's “embodied awareness of awareness” E-mail address: [email protected]. 0955-470X/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.trre.2008.04.006
[4]. Some current biologic and physical scientists call upon the term emergence [5]. “Emergence” poses that the article of interest (ie, the human person) consists of more than the mere sum of its elemental components. Wesley Autrey was able to recognize and identify with that which emerged beyond the mere arithmetic sum of material composition as it laid seizing across the subway tracts. Mr Autrey saw a fellow human person. The concept of “emergence” and “personhood” is well illustrated by another story. Physician and author Dr Sherwin Nuland tells of his grandmother who lived with him when he was a boy [6]. “Bubbeh moved from room to room in slippered feet with great care. As the years passed, the walk became a shuffle, and finally a slow sliding, the foot never leaving the floor… After some years, Bubbeh could no longer see well enough to wash dishes or even sweep the floor because she couldn't tell where the dust and the dirt were. Nevertheless, she wouldn't give up trying in a futile effort to retain even a small evidence of her usefulness… In my teen years, I saw the last traces of the old combativeness disappear and my grandmother became almost meek… About 5 years before her death, Bubbeh could no longer make the long walk to the synagogue even with both grandsons to help her. Relying on her still intact long-term memory, she recited the liturgy at home, sitting by the open window as she had done every Saturday morning during the all the years I knew her. After a few years, even that became too much. She could barely see the sentences and her memory for the prayers learned in her youth was giving out…
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Finally she stopped praying altogether.” When, in the course of her aging, did Dr Nuland's grandmother lose her usefulness? When, in the course of her aging and illnesses, did she lose her “personhood?” I believe the story illustrates a disconnect between Bubbeh's loss of quality of life or usefulness, and her intrinsic value or “personhood.” The emergent essence or intrinsic value of Bubbeh (the “embodied awareness of awareness”) seems to behave as a nominal characteristic, either present or not present. Bubbeh's “personhood” would be present until the time of her death. 2. “Emergence,” “personhood,” and the “particular other” When one person receives a homologous organ transplant, both patient and a “particular other” are involved. The “particular other” (a consenting alive person or a deceased former person) has bequeathed the organ, either directly or via proxy. When my father received his kidney 18 years ago, he was very much aware that this organ came from another person who had recently died [7]. Throughout his recovery from surgery, and years thereafter, he made frequent comments that he received this gift from a “particular other” person. Although he recognized the importance of supporting structures, practitioners, and technology, he did not view his organ as coming from an organ procurement agency, institution, physician, principle, or piece of legislation. In my years as a transplant physician, I have worked with several hospital chaplains who have cared for transplant recipients. It is the repeated realization of these chaplains that many organ recipients experience a profound connection to the person from whom they received their organ [8]. Proper consideration of the “personhood” of the “particular other” can make ethical deliberations in transplantation more complex. Those 4 moral principles invoked as important in medico-ethical deliberation are beneficence, nonmalfeasance, autonomy, and social justice [9]. In instances of organ procurement-transplantation, the donor (“particular other”) can sometimes provide duplicate concerns for all 4 of these factors. I believe that a donor can be identified as belonging to one of 3 categories: the consenting alive person, the depersonalized alive human being, and the dead former person. When the “particular other” is a consenting alive person, the issue of donor autonomy and noncoercion is paramount. When money or some other tangible transaction occurs between donor and recipient, the issues of autonomy and noncoercion are challenged [10]. A second category of “particular other” is the depersonalized human being. When the potential donor is alive and depersonalized, individual autonomy and societal justice are disregarded. A current example of depersonalized humans being used as organ donors is the religious group known
internationally as Falun Gong [11,12]. These religious practitioners are stripped of their human rights, and in essence their “personhood,” as their valuable organs are taken by the Chinese government, in a systematic process often involving serial planned donation from living persons or coercive donation from executed prisoners. These donations are presumed involuntary on the part of the political detainees. This depersonalization of the “particular other” is an alert to all transplant practitioners to avoid complicity with this type of practice (ie, the education of physicians and surgeons from offending regions, the publication of manuscripts from suspected institutions, and the reception of human rights violators at scientific meetings). A third category of “particular other” in organ transplantation is the dead former person. Ethical issues regarding this type of donor concern whether the donor made a sufficiently strong indication that she wished donation in event of death, or if currently incompetent, the legal power of attorney indicates sufficiently strong wishes. Also concerning the dead former person as potential donor is a potential controversy over the time point in which human death occurs. Most dead organ donors receive their declaration of death via the Harvard Brain Death criteria [13]. These criteria serve to determine when irreversible death of brain (including brainstem) has occurred. Recently, the Harvard Brain Death criteria have received criticism. Ironically, this criticism appears to have originated from 2 disparate factions. One faction, consisting largely of theologians and medical practitioners, views the Harvard Brain Death criteria as difficult to accomplish without harming the patient. These practitioners have been particularly critical of the apnea test that is frequently used to document brainstem inactivity. They have also been critical of the lack of absolute certainty in making the diagnosis of brain death in some patients. These theologians and practitioners are arguing for more stringent brain death criteria, or possibly for the elimination of brain death as a diagnosis that could legally result in organ procurement [14]. Another scrutinizing faction, consisting of ethicists and clinicians, is using the same arguments of a lack of diagnostic certainty to justify endorsement of more liberal criteria for organ donation [15]. These individuals would argue that a potential donor need not be dead before donation takes place. I believe that both factions represent absolutist extremes that neglect or deny the uncertainty inherent in all clinical medicine. The impact of uncertainty in medical prognosis has parallels in other disciplines, which can be understood to amplify this discussion. For example, a familiarity with the character of reproducibility in Newtonian physics [16], the relatively short human lifespan, and a limited sensory and intellectual perception can sometimes give one the impression that the entire physical world can be certain and nothing need be left to chance. However, over the last few decades, scientists working in subatomic physics have realized the counterintuitive and seemingly random nature of the subatomic universe. In an effort to provide a reasonable framework for
D.J. Plevak / Transplantation Reviews 22 (2008) 163–166
chaos, “string theorists” are attempting to construct an acceptable model for discourse [17]. In the process, physicists are learning and acknowledge what seasoned clinicians have long recognized in finding solutions, more questions may arise from setting new limits than are answered [18]. Clinicians have realized the importance of trusting relationships (between practitioner, patient, and patient family) in managing inherent uncertainty. Particularly in navigating crucial conversations, such as the assessment and declaration of brain death, a clinically neutral stance avoids the resultant despair of brain dead patients refused the opportunity to donate, or that potentially workable braindeath criteria are rejected for some arbitrary guideline. 3. “Emergence,” “personhood,” religion, and transplantation The idea entertained in the April 6, 1966, Time article “Is God Dead?” [19] seems today to have been a complete miscalculation [19]. Perhaps, religion today has more influence in individual lives and world events than in any other time in history. To discount the importance of religion and faith in considering the issues of organ procurement and transplantation is, likewise, a miscalculation. The concept of “personhood” had its origin in the major religious traditions of the “Axial Age” (mid-first millennium BCE) [20]. Confucianism arose in China, Buddhism in India, and Judaism in the Middle East. Judaism later begot Christianity and Islam. Not only did all these religions have their origins at a similar time, but from these faiths a common thread emerges. This ethos that transcends the Axial Age is commonly referred to as the “Golden Rule.” Brotherly love emerges from Christianity in the verse, “All things whatsoever ye would that men should do to you, do ye so to them for this is the law and the prophets” [21]. Confucianism states “Do not do to others what you would not like yourself, then there will be no resentment against you either in the family or in the state” [22]. Buddhism teaches “Hurt not others in ways that you yourself would find hurtful” [23]. The Koran teaches “No one of you is a believer until he desires for his brother that which he desires for himself” [24]. Judaism teaches “Whatever is hateful to you, do not do to your fellow man. This is the entire law, all the rest is commentary” [25]. Transcendent faith and acts of humanitarianism speak of the intrinsic value of each human being, even as the importance of recognizing the equal rights of each person may seem to vary in a just society. Conceptually, these rights and values emerge from “personhood” (embodied awareness of awareness). A “horizontal transcendence” [26] occurs when this intrinsic value is acknowledged in one person as acted upon another. This commonality of “personhood” is what Wesley Autrey recognized on that January day in the New York City subway. Shielding Mr Hallopeter his heart pounding, pressing downward, the bodies tucked into a space roughly 1 foot deep. The train's brakes screeched but it
165
could not stop in time…. Mr Autrey heard the onlookers' screams…. “We’re OK down here” he yelled to reassure the crowded platform, as the power was cut to rescue the men. Later that day, Wesley Autrey visited Mr Hallopeter in the hospital before heading to his night shift job…. “I don't feel like I did something spectacular; I just saw someone who needed help, and I did what I felt was right.” This article begins and ends with an account of the actions of one person. I believe that Mr Wesley Autrey's heroics were rooted in an instinctual recognition of Mr Hallopeter as a “person.” I believe that heroism grounded in the recognition of “personhood” is also descriptive of contemporary acts of organ donation founded upon one's exercise of free will. An articulation of such altruism occurred during the “Axial Age” of religious development. The enterprise of organ transplantation depends on the altruism of free-will donation, resonates with adherence to donor qualifications, and argues in defense of human rights. The author reports no conflict of interest that might arise from any relationship between himself, another person organization and/or financial interest. References [1] Buckley C. Man is rescued by stranger on subway tracks. N Y Times November 3, 2007: New York Region. [2] Aristotle, Tredennick H, Barnes J, Thomson JAK. The Nicomachean Ethics. London: Penguin Classics; 2003. [3] Aquinas, Saint Thomas. In: McDermott T, editor. Summa Theologiae: A Concise Translation. Grand Rapids (MI): Christian Classics; 1991. [4] Kavanaugh JF. Who Count as Persons? Human Identity and the Ethics of Killing (Moral Traditions and Moral Arguments). Washington (DC): Georgetown University Press; 2002. [5] Coleman P. Frontier at your fingertips. Nature 2007;446:379. [6] Nuland SB. How We Die: Reflections on Life's Final Chapter. 1st edition. London: Vintage; 1995. [7] Personal communication. Daniel L. Plevak, 2007. [8] Personal communication. Rev. Sylvan E. Hengesteg, 2007. [9] Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. New York (NY): Oxford University Press; 2001. [10] Meckler L. Kidney shortage inspires a radical idea: organ sales. Wall St J. November 13, 2007:A1. [11] A Gestapo Against Falun Gong. Compassion 2004 (Spring), Volume V. [12] Matas D, Kilgour D. Bloody harvest: Revised report into the allegations of organ harvesting of Falun Gong practitioners in China. Available at: http://organharvestinvestigation.net/. Accessed May 9, 2008. [13] A definition of irreversible coma. Report of the Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968;205:337-40. [14] Seeley M. “Not quite dead: The case for caution in the definition of ‘brain death’.” Cathol World Rep 1998:48-55. [15] Truog RD, Robinson WM. Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med 2003;31:2391-6. [16] Keller EF. A clash of two cultures. Nature 2007;445:603. [17] Woit P. Not Even Wrong: The Failure of String Theory and the Search for Unity in Physical Law. New York (NY): Basic Books; 2006. [18] Lindley D. Uncertainty: Einstein, Heisenberg, Bohr, and the Struggle for the Soul of Science. 1st ed. New York (NY): Doubleday; 2007. [19] Toward a Hidden God. Available at: http://www.time.com/time/ printout/0,8816,835309,00.html. Accessed May 9, 2008.
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[20] Armstrong K. The Great Transformation: The Beginning of Our Religious Traditions. New York: Alfred A. Knopf; 2006. [21] Matt 7:12. King James Version. [22] Confucius, Lau DC. The Analects. 1st ed. London: Penguin Classics; 1998. [23] Nagarjuna, Garfield JL. The Fundamental Wisdom of the Middle Way: Nagarjuna's Mulamadhyamakakarika. New York: Oxford University Press; 1995.
[24] Ali MM. The Holy Qur'ān with English Translation and Commentary. Columbus (OH): Ahmadiyyah Anjuman Isha'at Islam, Lahore, Inc.; 1995. [25] Fonrobert CE, Jaffee MS, editors. The Cambridge Companion to the Talmud and Rabbinic Literature (Cambridge Companions to Religion). Cambridge (UK): Cambridge University Press; 2007. [26] Goodenough U. The Sacred Depths of Nature. New York (NY): Oxford University Press; 1998.
Transplantation Reviews 22 (2008) 163 – 166 www.elsevier.com/locate/trre
The emergence of “personhood” in organ procurement David J. Plevak Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
Abstract This article begins and ends with an account of the actions of one person. I propose that such heroics are rooted in an instinctual recognition of “personhood” as it emerges from a particular human “other.” I propose that heroism grounded in the recognition of “personhood” is descriptive of those acts of organ donation that are founded on free will. The moral principles involved in deliberations for organ transplantation can provide a duplication of concerns (recipient and donor). However, the enterprise of organ transplantation increasingly depends on the altruism of free-will donation, the adherence to donor qualifications, and the defense of human rights. © 2008 Elsevier Inc. All rights reserved.
1. The emergence of “personhood” A January 2007 New York Times article chronicles the heroics of a 50-year-old construction worker who leapt on the New York subway tracks to save the life of a man from an oncoming train [1]. Wesley Autrey was in the company of his daughters (ages 4 and 6). While waiting for the downtown local at the 137th Street and Broadway in Manhattan, an unknown young man experienced an epileptic attack and stumbled to the platform's edge, falling across the tracks. As the subway train headlights appeared, Mr Autrey made his decision. He left his children, leapt upon the tracks, grabbed the stranger, and with the weight of his body, forced both himself and the actively seizing man in the space between the tracks. What compelled Wesley Autrey to leave his young children and risk his life to save the life of a stranger? In making this decision, Mr Autrey transcended sociologic, educational, economic, and racial differences, drawn by something which he and the stranger had in common. Aristotelean [2] and Thomistic [3] philosophy would pose that this connection between individual beings arises through natural law from the intrinsic value that each person possesses, solely and completely from their shared membership to the human race. John Kavanaugh would call this commonality “personhood,” or that intrinsic quality emanating from both men's “embodied awareness of awareness” E-mail address: [email protected]. 0955-470X/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.trre.2008.04.006
[4]. Some current biologic and physical scientists call upon the term emergence [5]. “Emergence” poses that the article of interest (ie, the human person) consists of more than the mere sum of its elemental components. Wesley Autrey was able to recognize and identify with that which emerged beyond the mere arithmetic sum of material composition as it laid seizing across the subway tracts. Mr Autrey saw a fellow human person. The concept of “emergence” and “personhood” is well illustrated by another story. Physician and author Dr Sherwin Nuland tells of his grandmother who lived with him when he was a boy [6]. “Bubbeh moved from room to room in slippered feet with great care. As the years passed, the walk became a shuffle, and finally a slow sliding, the foot never leaving the floor… After some years, Bubbeh could no longer see well enough to wash dishes or even sweep the floor because she couldn't tell where the dust and the dirt were. Nevertheless, she wouldn't give up trying in a futile effort to retain even a small evidence of her usefulness… In my teen years, I saw the last traces of the old combativeness disappear and my grandmother became almost meek… About 5 years before her death, Bubbeh could no longer make the long walk to the synagogue even with both grandsons to help her. Relying on her still intact long-term memory, she recited the liturgy at home, sitting by the open window as she had done every Saturday morning during the all the years I knew her. After a few years, even that became too much. She could barely see the sentences and her memory for the prayers learned in her youth was giving out…
164
D.J. Plevak / Transplantation Reviews 22 (2008) 163–166
Finally she stopped praying altogether.” When, in the course of her aging, did Dr Nuland's grandmother lose her usefulness? When, in the course of her aging and illnesses, did she lose her “personhood?” I believe the story illustrates a disconnect between Bubbeh's loss of quality of life or usefulness, and her intrinsic value or “personhood.” The emergent essence or intrinsic value of Bubbeh (the “embodied awareness of awareness”) seems to behave as a nominal characteristic, either present or not present. Bubbeh's “personhood” would be present until the time of her death. 2. “Emergence,” “personhood,” and the “particular other” When one person receives a homologous organ transplant, both patient and a “particular other” are involved. The “particular other” (a consenting alive person or a deceased former person) has bequeathed the organ, either directly or via proxy. When my father received his kidney 18 years ago, he was very much aware that this organ came from another person who had recently died [7]. Throughout his recovery from surgery, and years thereafter, he made frequent comments that he received this gift from a “particular other” person. Although he recognized the importance of supporting structures, practitioners, and technology, he did not view his organ as coming from an organ procurement agency, institution, physician, principle, or piece of legislation. In my years as a transplant physician, I have worked with several hospital chaplains who have cared for transplant recipients. It is the repeated realization of these chaplains that many organ recipients experience a profound connection to the person from whom they received their organ [8]. Proper consideration of the “personhood” of the “particular other” can make ethical deliberations in transplantation more complex. Those 4 moral principles invoked as important in medico-ethical deliberation are beneficence, nonmalfeasance, autonomy, and social justice [9]. In instances of organ procurement-transplantation, the donor (“particular other”) can sometimes provide duplicate concerns for all 4 of these factors. I believe that a donor can be identified as belonging to one of 3 categories: the consenting alive person, the depersonalized alive human being, and the dead former person. When the “particular other” is a consenting alive person, the issue of donor autonomy and noncoercion is paramount. When money or some other tangible transaction occurs between donor and recipient, the issues of autonomy and noncoercion are challenged [10]. A second category of “particular other” is the depersonalized human being. When the potential donor is alive and depersonalized, individual autonomy and societal justice are disregarded. A current example of depersonalized humans being used as organ donors is the religious group known
internationally as Falun Gong [11,12]. These religious practitioners are stripped of their human rights, and in essence their “personhood,” as their valuable organs are taken by the Chinese government, in a systematic process often involving serial planned donation from living persons or coercive donation from executed prisoners. These donations are presumed involuntary on the part of the political detainees. This depersonalization of the “particular other” is an alert to all transplant practitioners to avoid complicity with this type of practice (ie, the education of physicians and surgeons from offending regions, the publication of manuscripts from suspected institutions, and the reception of human rights violators at scientific meetings). A third category of “particular other” in organ transplantation is the dead former person. Ethical issues regarding this type of donor concern whether the donor made a sufficiently strong indication that she wished donation in event of death, or if currently incompetent, the legal power of attorney indicates sufficiently strong wishes. Also concerning the dead former person as potential donor is a potential controversy over the time point in which human death occurs. Most dead organ donors receive their declaration of death via the Harvard Brain Death criteria [13]. These criteria serve to determine when irreversible death of brain (including brainstem) has occurred. Recently, the Harvard Brain Death criteria have received criticism. Ironically, this criticism appears to have originated from 2 disparate factions. One faction, consisting largely of theologians and medical practitioners, views the Harvard Brain Death criteria as difficult to accomplish without harming the patient. These practitioners have been particularly critical of the apnea test that is frequently used to document brainstem inactivity. They have also been critical of the lack of absolute certainty in making the diagnosis of brain death in some patients. These theologians and practitioners are arguing for more stringent brain death criteria, or possibly for the elimination of brain death as a diagnosis that could legally result in organ procurement [14]. Another scrutinizing faction, consisting of ethicists and clinicians, is using the same arguments of a lack of diagnostic certainty to justify endorsement of more liberal criteria for organ donation [15]. These individuals would argue that a potential donor need not be dead before donation takes place. I believe that both factions represent absolutist extremes that neglect or deny the uncertainty inherent in all clinical medicine. The impact of uncertainty in medical prognosis has parallels in other disciplines, which can be understood to amplify this discussion. For example, a familiarity with the character of reproducibility in Newtonian physics [16], the relatively short human lifespan, and a limited sensory and intellectual perception can sometimes give one the impression that the entire physical world can be certain and nothing need be left to chance. However, over the last few decades, scientists working in subatomic physics have realized the counterintuitive and seemingly random nature of the subatomic universe. In an effort to provide a reasonable framework for
D.J. Plevak / Transplantation Reviews 22 (2008) 163–166
chaos, “string theorists” are attempting to construct an acceptable model for discourse [17]. In the process, physicists are learning and acknowledge what seasoned clinicians have long recognized in finding solutions, more questions may arise from setting new limits than are answered [18]. Clinicians have realized the importance of trusting relationships (between practitioner, patient, and patient family) in managing inherent uncertainty. Particularly in navigating crucial conversations, such as the assessment and declaration of brain death, a clinically neutral stance avoids the resultant despair of brain dead patients refused the opportunity to donate, or that potentially workable braindeath criteria are rejected for some arbitrary guideline. 3. “Emergence,” “personhood,” religion, and transplantation The idea entertained in the April 6, 1966, Time article “Is God Dead?” [19] seems today to have been a complete miscalculation [19]. Perhaps, religion today has more influence in individual lives and world events than in any other time in history. To discount the importance of religion and faith in considering the issues of organ procurement and transplantation is, likewise, a miscalculation. The concept of “personhood” had its origin in the major religious traditions of the “Axial Age” (mid-first millennium BCE) [20]. Confucianism arose in China, Buddhism in India, and Judaism in the Middle East. Judaism later begot Christianity and Islam. Not only did all these religions have their origins at a similar time, but from these faiths a common thread emerges. This ethos that transcends the Axial Age is commonly referred to as the “Golden Rule.” Brotherly love emerges from Christianity in the verse, “All things whatsoever ye would that men should do to you, do ye so to them for this is the law and the prophets” [21]. Confucianism states “Do not do to others what you would not like yourself, then there will be no resentment against you either in the family or in the state” [22]. Buddhism teaches “Hurt not others in ways that you yourself would find hurtful” [23]. The Koran teaches “No one of you is a believer until he desires for his brother that which he desires for himself” [24]. Judaism teaches “Whatever is hateful to you, do not do to your fellow man. This is the entire law, all the rest is commentary” [25]. Transcendent faith and acts of humanitarianism speak of the intrinsic value of each human being, even as the importance of recognizing the equal rights of each person may seem to vary in a just society. Conceptually, these rights and values emerge from “personhood” (embodied awareness of awareness). A “horizontal transcendence” [26] occurs when this intrinsic value is acknowledged in one person as acted upon another. This commonality of “personhood” is what Wesley Autrey recognized on that January day in the New York City subway. Shielding Mr Hallopeter his heart pounding, pressing downward, the bodies tucked into a space roughly 1 foot deep. The train's brakes screeched but it
165
could not stop in time…. Mr Autrey heard the onlookers' screams…. “We’re OK down here” he yelled to reassure the crowded platform, as the power was cut to rescue the men. Later that day, Wesley Autrey visited Mr Hallopeter in the hospital before heading to his night shift job…. “I don't feel like I did something spectacular; I just saw someone who needed help, and I did what I felt was right.” This article begins and ends with an account of the actions of one person. I believe that Mr Wesley Autrey's heroics were rooted in an instinctual recognition of Mr Hallopeter as a “person.” I believe that heroism grounded in the recognition of “personhood” is also descriptive of contemporary acts of organ donation founded upon one's exercise of free will. An articulation of such altruism occurred during the “Axial Age” of religious development. The enterprise of organ transplantation depends on the altruism of free-will donation, resonates with adherence to donor qualifications, and argues in defense of human rights. The author reports no conflict of interest that might arise from any relationship between himself, another person organization and/or financial interest. References [1] Buckley C. Man is rescued by stranger on subway tracks. N Y Times November 3, 2007: New York Region. [2] Aristotle, Tredennick H, Barnes J, Thomson JAK. The Nicomachean Ethics. London: Penguin Classics; 2003. [3] Aquinas, Saint Thomas. In: McDermott T, editor. Summa Theologiae: A Concise Translation. Grand Rapids (MI): Christian Classics; 1991. [4] Kavanaugh JF. Who Count as Persons? Human Identity and the Ethics of Killing (Moral Traditions and Moral Arguments). Washington (DC): Georgetown University Press; 2002. [5] Coleman P. Frontier at your fingertips. Nature 2007;446:379. [6] Nuland SB. How We Die: Reflections on Life's Final Chapter. 1st edition. London: Vintage; 1995. [7] Personal communication. Daniel L. Plevak, 2007. [8] Personal communication. Rev. Sylvan E. Hengesteg, 2007. [9] Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. New York (NY): Oxford University Press; 2001. [10] Meckler L. Kidney shortage inspires a radical idea: organ sales. Wall St J. November 13, 2007:A1. [11] A Gestapo Against Falun Gong. Compassion 2004 (Spring), Volume V. [12] Matas D, Kilgour D. Bloody harvest: Revised report into the allegations of organ harvesting of Falun Gong practitioners in China. Available at: http://organharvestinvestigation.net/. Accessed May 9, 2008. [13] A definition of irreversible coma. Report of the Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968;205:337-40. [14] Seeley M. “Not quite dead: The case for caution in the definition of ‘brain death’.” Cathol World Rep 1998:48-55. [15] Truog RD, Robinson WM. Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med 2003;31:2391-6. [16] Keller EF. A clash of two cultures. Nature 2007;445:603. [17] Woit P. Not Even Wrong: The Failure of String Theory and the Search for Unity in Physical Law. New York (NY): Basic Books; 2006. [18] Lindley D. Uncertainty: Einstein, Heisenberg, Bohr, and the Struggle for the Soul of Science. 1st ed. New York (NY): Doubleday; 2007. [19] Toward a Hidden God. Available at: http://www.time.com/time/ printout/0,8816,835309,00.html. Accessed May 9, 2008.
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[20] Armstrong K. The Great Transformation: The Beginning of Our Religious Traditions. New York: Alfred A. Knopf; 2006. [21] Matt 7:12. King James Version. [22] Confucius, Lau DC. The Analects. 1st ed. London: Penguin Classics; 1998. [23] Nagarjuna, Garfield JL. The Fundamental Wisdom of the Middle Way: Nagarjuna's Mulamadhyamakakarika. New York: Oxford University Press; 1995.
[24] Ali MM. The Holy Qur'ān with English Translation and Commentary. Columbus (OH): Ahmadiyyah Anjuman Isha'at Islam, Lahore, Inc.; 1995. [25] Fonrobert CE, Jaffee MS, editors. The Cambridge Companion to the Talmud and Rabbinic Literature (Cambridge Companions to Religion). Cambridge (UK): Cambridge University Press; 2007. [26] Goodenough U. The Sacred Depths of Nature. New York (NY): Oxford University Press; 1998.