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Organ Donors and Imprisoned People

photograph of jail cell with man's hands hanging past bars

Should people who are in prison – even on death row – be allowed to donate their organs? Sally Satel has recently made the case. After all, there is a “crying need” for organs, with people dying daily because they do not receive a transplant. But, as Satel points out, the federal prison system does not allow for posthumous donations and limits living donations to immediate family members.

Imprisoned people, whether they want to donate a kidney whilst alive or all their organs after an execution, are rarely able to do so.

There seem to be a couple of practical justifications for this. For one, it might interfere with the date of execution; secondly, the prison system might have to bear some of this cost. I want to address these two issues before moving on to some of the other ethical issues involved.

It’s important to see that the actual date of execution has no ethical significance – it is not a justice-driven consideration. If it turns out that an execution is delayed two weeks to enable a kidney transplant, so what? Executions are delayed by stays all the time, and if there is some good to come out of changing the date then keeping it fixed doesn’t seem particularly important.

Secondly, there may well be costs to the prison system in, say, medical care for a patient who has donated a kidney (or for the removal of organs post-execution). But the prison system is part of the state. Given there is a nationwide shortage of organs, we might expect the state to play a role in addressing this, and if it has to bear some cost, why should it matter that the prison system – not the health system – must pay? After all, the criminal justice system is meant to help broader society. (That is not to mention that there might be other ways of funding these transplants that don’t increase costs for the prison system.)

There are further explanations for why states do not permit donations. Christian Longo – who sits on death row in Oregon for murdering his wife and children – asked to posthumously donate his organs and was told that the drugs used in executions destroy the organs. But Longo points out that other states use drugs that do not cause such destruction. Still, the specific drugs used in executions brings up an ethical concern: how painful these drugs are is not clear, and there seem to be some incredibly distressing executions.

Fiddling around with these drug cocktails in order to ensure the viability of organs may introduce major risks to the condemned.

Longo asked to donate his organs, so too did Shannon Ross, who is serving a long prison sentence. The fact that people are requesting to donate means that there seems to be more than mere consent here, there is an eagerness to donate. But this might hide some deeper worries, and to see this we need to investigate why inmates wish to donate.

We might also worry that Longo wants to get some “extra privileges” or to somehow improve his own situation. Perhaps an appeals or parole board would look more favorably upon somebody who has given up a kidney. But that doesn’t seem to be the case for Longo, who is resigned to death (though he has not yet been killed, Oregon has a moratorium in place). Yet others might volunteer to donate in the mistaken belief that this will help their case. This might make the expressed consent less voluntary than it seems, since they don’t fully understand the risks and benefits of what they are consenting to.

And this leads to what I think the most difficult moral issue here is: whether prisoners can autonomously consent. Longo points out that consent can sometimes be exploited: prisoners in the 60s and 70s were paid to volunteer for “research into the effects of radiation on testicular cells.”

That, even if it is seemingly voluntary, is unacceptable – prisoners are in a vulnerable position and we shouldn’t exploit them for medical research.

Both for prisoners who will be released and those on death row, I think we can find a useful parallel with cases of voluntary euthanasia. The key similarity is that both are in a desperate situation and are offered a chance that seems to help them improve their position.

David Velleman, for example, poses this challenge to defenders of voluntary euthanasia: perhaps even offering somebody the choice to die is coercive. To simplify a very complex argument, if someone thinks they might be a drain on their family, then offering them the chance to be euthanized might not actually help them do what they would autonomously choose. They want to carry on living, and they regret that this burdens their family. But once confronted with the option to die, they are called upon to provide a justification for continued existence and might, then, feel compelled to take an option they might otherwise not. And we can see how a prisoner on death row might similarly feel compelled to donate – lacking a suitable justification to refuse – once confronted by the choice.

In addition to these concerns about mistaken beliefs and the coerciveness of choice, there might be another deep temptation to donate. Longo notes that he has little opportunity to give back to society in any way – a society that he recognizes he has wronged and harmed. Giving away his organs seems to be a way of giving back. Donation, then, provides a way of atoning, if only to a limited extent.

The worry here is that the prospect of atonement is a bit like the worry of being a burden on your family.

When you’re given the option – donate your organs in the one case, end your life in another – this prospect burns too brightly.

It might be that the prospect of atonement blots out an individual’s proper concern with, say, their own future health (or, if they are on death row, with objections they might have to organ donation).

Yet I think that – powerful and troubling as this concern might be – this is only a worry. In offering his argument, Velleman notes that he isn’t opposed to a right to die, just that this is a (perhaps defeasible) argument against an institutional right to die. Likewise, the argument in our domain only goes so far. Many people have no objection to organ donation, so there is no such concern that they, if on death row, are making the wrong choice for themselves. Plenty of people who are under no pressure at all choose to donate a kidney – why can’t we allow prisoners to make that choice, too?

If we worry too much about the possibility of letting prisoners make a bad choice, we might be paternalistic and also take away from them the free choice to selflessly help others.

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Death Row Inmates, Execution, and Choice

photograph of drug vials and vintage syringe

On October 28th, 2021, the state of Oklahoma executed John Marion Grant. This was the first execution the state had carried out for six years, after placing a moratorium on executions following a case where a prisoner was given the wrong drugs (and another prisoner narrowly escaped the same fate). The drug of choice in nearly all modern federal executions had, until that point, been sodium thiopental. But issues with batch contamination shut down the sole factory producing and supplying it to prisons. Additionally, shortly after discovering a therapeutic alternative to sodium thiopental — pentobarbital — the drug company’s CEO imposed distribution restrictions on the product, prohibiting prisons from buying it.

Since then, most states have lost access to their first and second execution drug of choice, nearly slowing federal executions to a stop. In the last couple years, states have managed to re-access both sodium thiopental and pentobarbital, but the humaneness — and, therefore, constitutionality — of their use remain a matter of dispute, with several lawsuits across many states protesting their use in federal executions. Prisoners and their lawyers frequently use these lawsuits to try to achieve stays of execution. After all, if the jury is literally still out on whether a certain drug is a cruel and unusual means of execution, that seems a good reason to delay its use. However, since Justice Alito’s 2014 Supreme Court opinion arguing that “because capital punishment is constitutional, there must be a constitutional means of carrying it out,” states have been forced to come up with some way to perform executions. Oklahoma devised a compromise: take all of the contested methods of execution, and let the prisoners choose their preferred method.

There was a further deceptive aspect of the choice prisoners were given: several of the execution methods had active lawsuits against them. Therefore, if a prisoner chooses one of those drugs, their execution is put on hold indefinitely, at least until the lawsuit is resolved. The prisoners could choose between several different methods: pentobarbitol, sodium thiopental, non-FDA approved compounded versions of either of the first two drugs, firing squad, or a three-injection method that utilized a benzodiazepine, a paralytic, and potassium chloride to end lives.

But there were some prisoners who believed that selecting the method of their execution would be akin to participating in their own death (i.e., suicide). John Marion Grant was one of those prisoners.

Grant’s refusal to choose an execution method, on the grounds that it violated his deeply-held beliefs that this act would be morally wrong, meant that he was, by default, given the three-injection drug execution – a method not without controversy, given that dosing for these drugs represents a sort of guessing game. That is: nobody really knows how much of each drug any particular inmate will require for complete sedation, so they tend to give prisoners massive amounts rather than risk not giving them enough. Grant’s execution did not, however, go as planned. The aftermath of the injections saw him gagging, convulsing, and vomiting for at least 12 minutes before he was officially declared dead. In an op-ed for The Atlantic, Elizabeth Bruenig characterized Oklahoma’s ruling in the following headline: “Oklahoma Tortured John Grant to Death Because He Wouldn’t Commit Suicide.”

But is this a fair characterization of Oklahoma’s law? Is allowing inmates to choose their preferred method of execution really on a par with forcing them to commit suicide? Initially, the answer seems to be no. Merely having some active role in your own execution is surely not sufficient to render one’s actions “suicidal.” As far as John Marion Grant knew, he was going to die no matter what. All the state was offering him was a chance to choose what he would experience in his final moments.

But rhetoric aside, we may still wonder whether having prisoners take this active role presents an ethical problem. Elizabeth Anderson, in her Tanner Lectures entitled “Private Government,” argues that there are many instances in which a choice only superficially increases someone’s autonomy. She uses the example of laws regarding marriage, specifically the changes in the law when divorce became legal. This newly granted “freedom” of entry into (and exit from) a marriage which, on its surface, appeared to grant more autonomy to women within marriage, actually did the opposite. Because women still lost all property rights upon entering into a marriage contract with their husband, choosing to divorce would, for most women, result in almost certain destitution. It was an “option” that was not really an option at all. Such a choice did little to help improve the overall situation for domestic women. Anderson argues that, “Consent to an option within a set cannot justify the option set itself.” That is, a woman who consents to stay in the marriage, because her other option is homelessness, does not, by that acquiescence, justify the situation. Similarly, one might argue that the Oklahoma law only gives a superficial appearance of prisoner choice and autonomy, and does nothing to make the bare set of execution options permissible.

From a consequentialist perspective, however, an argument could be made that allowing prisoners to choose their method of executions maximizes net good. One may argue that this choice improves the lives of prisoners by alleviating some anxiety they may have otherwise experienced in the lead-up to execution, and that it does this without making anyone else worse-off. For example, if a prisoner had a particular fear of sodium thiopental, they may be relieved to have the option to avoid the drug entirely. Of course, this net gain in utility is not a guarantee — choosing their means of death could exacerbate the anxieties of the prisoner, allowing them to imagine their death in vivid detail in the days before their execution. It may also, as in the case of John Marion Grant, weigh on their conscience as a morally impermissible act of self-harm.

From a Kantian perspective, there may be entirely different reasons to avoid offering this choice to inmates. Kant’s theory of punishment is commonly held to involve a view of justice as primarily retributive — that is, justice is realized when people are rewarded for doing good, and punished for doing bad. Kantian retributivists like the philosopher Igor Primoratz hold that the punishment has to fit the crime in order of magnitude. A crime of murder, therefore, requires for justice that the murderer’s life be taken. The longer we wait to end the life of the murderer, the longer justice waits to be served.

One can, then, imagine a retributivist objection to the Oklahoma law on the grounds that it sometimes results in unnecessary stays of execution. Additionally, one could argue that granting this autonomy of choice to people who are charged with brutally taking innocent lives renders their punishment too light to actually serve justice. After all, the murder victims certainly were not allowed to choose their own means of death.

And so, it seems that, from all normative perspectives, the Oklahoma law regarding choice of means of execution appears morally questionable, at best. We can hope that the law will be replaced with one that is more just — whatever that may look like.

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Implications of Exonerations

black-and-white photograph of empty jail cell

I expect that in the near future we will know, for certain, that at least one innocent person has been executed in the United States. This should not come as a surprise. There have been many cases where those on death row are found to be innocent; indeed by some estimates more than 4% of death row inmates may be innocent. One major reason we have not previously proven someone’s innocence is that there is rarely the political will to continue investigating post execution.

What I want to investigate in this piece is what this should mean for the use of the death penalty. The BBC, in its Ethics Guides, notes that the “most common and most cogent argument against capital punishment is that sooner or later, innocent people will get killed, because of mistakes or flaws in the justice system.” But just how cogent an argument is this?

Let me lay my own cards on the table; I am emphatically anti-death penalty. I think the unnecessary killing of any human being is monstrous, and that the state may only use lethal force when combating an active threat, not as punishment for a past threat. However, I would hold this view even if there was no chance of an innocent person ever being executed; my objection is grounded in an invariant pro-life commitment. Thus, I think I am particularly well placed to assess the ethics of this question. I’m not in favor of capital punishment, and so am not looking for any rationalization to dismiss the argument from innocent execution; but nor do I feel a rationalizing compulsion to think the argument works — my own commitments would persist regardless. Of course, this all may just be a second-order rationalization about my own objectivity, but I’ll put aside worries about meta-level rationalizations for another post.

So here is a simple argument from the possibility of executing the innocent to the wrongness of the death penalty:

  1. If we use the death penalty, eventually an innocent person will be killed. (innocence premise)
  2. Executing the innocent is always morally wrong, no matter how good the consequences. (absolutism premise)
  3. Therefore, if we use the death penalty, we will eventually do something wrong that cannot be justified by the goods of executing the guilty.

Now, there is a certain intuitive plausibility to this argument. Suppose I thought that the death penalty has a strong deterrent effect, and so executing the guilty would save many lives (see this article for a defense of this argument; note there have been, as far as I can tell, several persuasive replies); I still would not think it is permissible to frame an innocent person and execute them to get that same deterrent effect. Thus, it is wrong to kill the innocent, even to bring about the valuable execution of the guilty.

The problem with this argument, is that, by parity, it seems to suggest we should never punish anyone:

  1. If we imprison people, eventually an innocent person will be imprisoned. (innocence premise)
  2. Imprisoning the innocent is always morally wrong, no matter how good the consequences. (absolutism premise)
  3. Therefore, if we imprison people, we will eventually do something wrong that cannot be justified by the goods of imprisoning the guilty.

This argument, as far as I can tell, has the same surface level plausibility as the previous one. If I knew the only way to capture a murderer was to, for some reason, imprison an innocent person for life, it would not be permissible to imprison that person.

So what has gone wrong with these two arguments? I think it is that there is a difference between killing or imprisoning the innocent as an intended means to punishing others, and foreseeing that the innocent may be killed or imprisoned as a consequence of a broader policy of punishment. While there may be an absolute prohibition on killing or imprisoning the innocent, that does not mean there is a prohibition on anything that could lead to that as a result.

To articulate the innocence argument against the death penalty, one needs to show that a) the fact an innocent person will be killed means we cannot use the death penalty, and b) the fact an innocent person will be punished does not mean we cannot use any schema of punishment (since I assume few people would accept that the inevitable punishment of the innocent means all punishment is unjust).

In fact, the problem for the innocent argument is even more profound. Remember that study I cited at the beginning, saying that as many as 4% of death row inmates are innocent? The way that study worked is that they compared the exoneration rate of those who stayed on death row (about 4%) to those who were shifted to life in prison. Because more scrutiny is given to death penalty cases (especially as the guilty approach execution), those who are actually to be executed (and not just on death row) are more likely to be exonerated. So, the study most commonly cited to support the claim that some innocent will be executed, actually shows that likely more innocent people would be punished if we switched from the death penalty to life in prison (since we are less likely to identify the innocent without the scrutiny provided to death penalty cases).

So, what can we point to in order to say that executing the innocent is uniquely bad — bad in a way that imprisoning the innocent is not?

Barbarity. Perhaps the thought is that the death penalty is, in some way, so much worse than life in person, that we cannot take any risk with the innocent being killed, even if we can take risks on an innocent person going to jail for life. But I’m not sure this is quite right. In other parts of life, we don’t treat risks of death as categorically worse than other risks. Anytime you drive a car there is a disturbingly high chance an innocent person might die (far more innocent people die in car accidents than are executed); but I don’t think we treat such risks as categorically distinct from other types of risks. You might, for instance, choose a small risk of death to avoid a much larger risk of having to spend the rest of your life locked in prison.

Irreversibility. The first thing we might suggest is that the death penalty is irreversible. If you kill someone you cannot bring them back to life, but if you imprison someone you can always let them go later. But it is not quite that simple. For one thing, you really cannot reverse a prison sentence. Even if you are eventually released, you do not get back those twenty years spent in prison. The punishment cannot be reversed, all we can really do is shorten it if we discover you are innocent.

Permanency. Is that the solution then? Is the reason the death penalty is so bad because it is permanent? Perhaps the thought is that if we cannot be certain someone is guilty, no permanent punishment is justified. But here, again, this does not seem quite right. After all, I still permanently lose my twenties and thirties to prison, even if I get released on my fortieth birthday.

And note too, the risk of permanence is not the same thing as permanence. Just because someone could be released does not mean they will. And we know that, since executions receive greater scrutiny, an innocent person is more likely to be sentenced to life in prison than sentenced to death.

Reparability. Perhaps it is not that the death penalty is permanent, but that it cannot be repaired. Sure, someone imprisoned till they are forty permanently, loses out on their thirties, but at least the state can do something to make it up to the person falsely imprisoned. For example, often those falsely imprisoned are given financial compensation from the state.

I actually find this argument somewhat convincing, but we have already seen that as a society we don’t accept the broader implication. After all, it is death, not execution, that is irreparable. But we have already seen that we don’t treat risks of death as categorically different from other types of serious risks. If car accidents just resulted in serious bodily injury, we could imagine making some reparation for such injury. Since they sometimes result in death, sometimes no such reparation is possible. But, again, it seems we don’t see that fact as particularly dispositive when assessing the ethics of driving.

It is a terrible and tragic thing to execute the innocent. But, I think, that is just a subset of the terrible and tragic thing that it is to punish the innocent. Perhaps we should strengthen our criminal standards for conviction (I’m quite sympathetic to that line of thought) so that fewer innocent people are punished. But I’m not sure. At the very least, if we accept as inevitable that the innocent will be punished it gives us a categorical reason to select some punishments over others.

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Is Death Forever?: The Case of Benjamin Schreiber

photograph of defibrillator practice on a CPR dummy

On Wednesday, November 6th, an appeals court confirmed a lower court’s ruling that a death row inmate had not fulfilled his sentence when his heart stopped in a medical procedure in 2015. The inmate, Benjamin Schreiber, was convicted of murder in 1996 and sentenced to life without parole. Shreiber had argued that his sentence ended when his heart stopped during a medical emergency four years ago, even though he was later revived.

There are cases that blur the line between life and death, either because it is difficult to determine death or define it. In 2018, a woman in South Africa woke up in a morgue after mistakenly being declared dead. Paramedics at the scene found no heartbeat and detected no signs of life, but were later flummoxed when they spotted the patient breathing.

Cases like this are obviously uncommon, but they do happen. At least 38 times since 1982, patients have been recorded as experiencing “Lazarus Syndrome,” or autoresuscitation, after failed cardiopulmonary resuscitation. In such cases, medical intervention failed to restart a patient’s heart but nevertheless the patient’s heart restarted.

Definitions of medical death have changed with advances in possible medical interventions. Globally and historically, people have looked to circulation and breathing as standards for life and death. Schreiber’s standard here, therefore, the lack of a pulse, or circulation of blood throughout the body, is not without precedent. These standards became complicated the more we learned about the brain and its connection to our lives as individuals.

In 1968 the medical community came together to try to address definitions of death as organ transplants became more successful. Removing organs from patients who still had circulating and oxygenating blood increased the probability of successful transplant, but insured the death of the donor patient. According to our legal and moral standards of wrongful harm, there are reasons to only perform such procedures on patients formally pronounced dead. New understandings of the importance of brain functioning for identity and personhood provided useful distinctions to inform this pronouncement.

We know now that blood can continue to circulate without there being any hope of meaningful interaction with the world again on the patient’s part. Neuroscience, meanwhile, shows that certain brain function is necessary for personhood and when particular lacks of brain function occur, doctors can determine that death in the sense of loss of personhood has also occurred. Thus patients can be pronounced dead while their organs are still viable for transplant.

When deciding whether or not to harvest organs, the permanence or irreversibility of the state of the patient is a crucial consideration. As philosophers, we can wonder whether the finality of death is a crucial aspect of the concept for other applications, and potential applications in the future.

Using this ambiguity behind our evolving definition of “death,” Schrieber claimed to have served his time. He accepted his initial sentence of life without parole, but would not accept “life plus one day” (Schreiber claims to have been revived from septic shock against his wishes). The court found Schreiber’s claim original, but refused to side with him on the grounds that he was “unlikely” to be dead, having represented himself legally and signed his own documents.

While definitions of death today include some criterion of finality (such as the cessation of life or the permanent loss of a human’s personhood), the discussion in this case leaves open an interesting possibility: If Schreiber is present to represent his interests in court, then could he nevertheless have been dead, thus fulfilling his sentence? In other words, is a death penalty meant to shorten someone’s life or ensure they experience death?

If we can imagine a future where someone exists after a period of cessation of life that we currently understand as death under some medical criteria, then Schreiber’s case may be a relic of our stage in medical technology (just as pronouncements of life while brains lacked functioning were relics of previous centuries’ understandings of life and death). Say technology advances to the point where we can map the complicated and dynamic connections that make you who you are. If we have the ability to produce such an intelligent mapping, then your physical body could cease to live according to our current medical definitions, but there is the possibility that we could recreate a physical foundation for the map to run so as to support your conscious existence in the world once more.

If this possibility existed, there are two important questions related to Schreiber’s case. First, would we continue to use “death” in a sufficiently close enough way so as to say that if he experienced this process, he would qualify as “dead” at one time? If so, then the legal system could declare his sentence fulfilled if they understand it in a particular way (until death), or not if they understand it differently (for all of Schreiber’s life).

Second, if we had the technology described above, would the person brought into existence with the dynamic mapping of Schreiber be Schreiber? If the original person in the original body ceased to exist, then creating a supporting body for the dynamic mapping may bring in as exact a copy as possible, but this may not count as the original Schreiber. If this is the case, then it would be wrong to apply the legal punishment to the created Schreiber.

We can have a definition of death that does not include finality. With this caveat, Schreiber’s appeal becomes more compelling if the penalty applied to him is understood as “until death.” Regardless, the case brings out how we mean punishment to apply, and raises theoretical questions about how we may apply them in the future.

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Death Row Dilemmas: The Sentencing and Execution of Ronald Smith Jr.

In the early hours of the morning, on November 8th, 1994, Casey Wilson was working his shift at a Circle K in Huntsville, Alabama.  That morning, 23-year-old Ronald Bert Smith Jr. came into the station with the intention to rob it.  He pistol-whipped Wilson and forced him to the convenience store restroom where he shot him.  Wilson died of his wounds.  To avoid detection and identification, Smith removed the store’s surveillance videotape from that night and brought it with him.

Continue reading “Death Row Dilemmas: The Sentencing and Execution of Ronald Smith Jr.”