The Oath and the Abyss
Euthanasia, Organ Donation, and the Duty to Preserve the Hippocratic Principle
“...I will apply dietary measures for the benefit of the sick according to my ability and judgment, and never with a view to injury or wrongdoing.
I will neither give a deadly drug to anybody who asks for it, nor will I make such a suggestion. Likewise, I will not give to a woman an abortive pessary. I will keep my life and my art pure and holy...”
Hippocratic Oath (5th–4th century BC)
Cases reported in Belgium, the Netherlands, and Canada, where organ donation following euthanasia is presented as a pure act of altruism, the ultimate expression of autonomy and compassion, reveal the moral abyss of a medicine attempting to reconcile the irreconcilable: killing and healing.
In these countries, where the practice is lawful and regulated through established protocols, the decision is portrayed as the outcome of an autonomous choice, validated by multiple professionals and capable of producing a paradoxical therapeutic effect: the desire to donate as a means of relieving suffering and reinforcing dignity at the end of life.
The guidelines governing this practice advocate a strict separation between the processes of euthanasia and organ donation, creating what may be called a “procedural ethical engineering” that elevates the discourse of individual freedom: “dying while helping others.” In this view, individual altruism would be sufficient to neutralize the underlying moral tensions.
The reasoning advanced to justify these practices is markedly utilitarian and conciliatory, yet it fails to confront the symbolic implications of normalizing death as a therapeutic means. If death becomes the precondition for benefiting others, the system inevitably risks instrumentalizing the patient. No amount of procedural ethical engineering is capable of resolving this structural contradiction.
This procedural ethical engineering seeks to ensure that “autonomous” decisions are formally valid; it shifts attention away from the moral substance of the act—killing, donating, sacrificing—and toward the process of consent itself. The moral dilemma is reduced to a matter of ethical compliance: once every procedural requirement has been fulfilled, the act is deemed legitimate.
The “potential donor” does not exist outside the system. It is impossible for the decision to die and the possibility of donation not to reinforce one another from the very beginning. The language of individual freedom may conceal subtle social pressures: the patient comes to feel useful in dying within a society that prizes productivity and instrumentalized altruism. The foundational premise of this procedural ethical engineering—the separation between euthanasia and organ donation—is therefore ethically unsustainable.
The ethical framework sustaining this practice—that very procedural ethical engineering—is fragile and morally unstable. It fails to reconcile irreconcilable principles: preserving individual autonomy, maximizing social utility, and maintaining the appearance of fidelity to the principle of do no harm. The union of killing and healing, even when based on consent, violates the telos of medicine and the ontological value of human life.
This framework has become the face of contemporary bioethics, which seeks to remain neutral and multicultural. Yet some questions do not call for balance—they call for moral judgment. The conjunction of euthanasia and organ donation is one such question. It is not a matter of personal taste or moral preference; it is incompatible with the very idea of care.
Modern bioethics has become a form of procedural ethical engineering: moral substance has been replaced by procedural conformity. Once every requirement has been satisfied, the act becomes legitimate—even when it remains morally inadmissible.
We cannot accept the idea of euthanasia as a means of obtaining organs. It is unacceptable to cloak the instrumentalization of human beings in therapeutic language for the sake of a collective good—a principle condemned by the Nuremberg Tribunal.
Even if the outcome is efficient, rational, and compassionate, and even under the argument that “no one is compelled” or that “informed consent” has been obtained, a profound moral inadmissibility remains. The system ceases to serve the human person and begins to use the human person as a means.
Treating the human being as a means is the very expression of ethical materialism in both its essence and its structure, for human life comes to be evaluated according to its physical, biological, or social utility. The body becomes useful matter, a resource to be managed rationally. From euthanasia accompanied by organ donation to euthanasia by organ removal, and ultimately to the expansion of euthanasia into non-terminal conditions, there is only a semantic and bioethical step.
All the procedural ethical engineering that has been constructed is incapable of eliminating professional complicity and the symbolic coercion imposed upon vulnerable patients. It represents a transgression of the moral identity of medicine itself. It marks the decline of civilization—the triumph of moral relativism. This convergence of euthanasia and transplantation undermines the civilizational foundation of medicine: respect for the intrinsic dignity of human life.
Returning to the Hippocratic Oath—
“...I will apply dietary measures for the benefit of the sick according to my ability and judgment, and never with a view to injury or wrongdoing...”
—it is more than a historical relic. It is the last moral anchorage standing before the abyss of relativism.
Author’s Note
This text does not seek consensus. It seeks moral clarity.
I am convinced that there are limits which no law, technique, or protocol may cross without disfiguring medicine itself. Those limits are found in the Hippocratic Oath, which commands us never to inflict harm or injustice upon anyone.
I believe that the discussion surrounding organ donation after euthanasia is not fundamentally a matter of public policy, healthcare regulation, or individual freedom. It is a sign of the ethical collapse of a civilization.
The purpose of this essay is to take a position and to clarify—through philosophical principles that are not my own, but are represented here by Hippocrates, Kant, Augustine, Edmund Pellegrino, Nuremberg, and Helsinki—that human life possesses absolute value.
Prudence does not require silence. It requires lucidity and the courage to affirm that there are boundaries which are not open to negotiation.
This essay was originally published in Portuguese on October 11, 2025. You can read the original version here:
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