Was den Menschen zum Menschen macht

Precautionary Principle

6 Min. Lesezeit

🇩🇪 Deutsche Version: Vorsichtsprinzip

The precautionary principle is a normative principle of medical ethics that holds in a situation of epistemic uncertainty regarding the determination of death: where certainty has not been reached, the principle of precaution must prevail. The removal of organs may take place only after the true death of the donor.

Benedict XVI formulates the principle in his address to the International Congress on Organ Donation (Rome, 7 November 2008). Its historical root reaches back to Pius XII (Address to anaesthetists, 24 November 1957): death must be established before organs are removed; the definition of the moment of death is not a matter for the Magisterium but for medicine — yet within the limits of natural morality.

The precautionary principle is not directed against the Personalist Norm but is rather its concretization in the field of transplantation medicine. Where scientific clarity about the moment of death is lacking, it binds the affirmation of the person to an overriding duty of protection: in doubt, in favor of life. It protects the First Dimension of personhood — the mere existence as a person — against premature disposal.

Scope

The principle takes effect wherever the definition of death exhibits ontological tensions:

In the case of irreversible loss of brain function, the tension lies between the clinical-legal equation with death (Dead Donor Rule, UDDA, TPG) and the substance-ontological position that only the deutera energeia (second actuality) is affected, not the prote energeia (first actuality). Here the precautionary principle justifies a critical stance toward the identification, without rejecting the practice wholesale.

**In the case of organ donation after circulatory death*, the tension lies between permanence (no further attempt at resuscitation) and irreversibility (anatomically impossible). Substance-ontologically, permanence is not a sufficient criterion for certain death. The precautionary principle therefore demands — in its consistent interpretation — the assumption of the stricter condition: where it is not clear whether the person is definitively dead, the Dead Donor Rule holds in its stricter sense. The consequence: the practice of organ donation after circulatory death potentially violates the Personalist Norm and the Dead Donor Rule, because it bases its determination of death on the weaker condition.

In the case of NRP, especially the TA-NRP variant with surgical clamping of the aortic arch vessels, the precautionary principle is violated by the practice: because the very necessity of the clamping presupposes that, without it, a return of cerebral blood flow would be possible — and thus that death has not been definitively established.

In the case of bereavement support, the precautionary principle operates in an analogous logic: where it is not scientifically established how grief “ought to proceed,” restraint in any fixed prescription applies. The popular Kübler-Ross model of five stages is not sufficiently supported empirically; its prescriptive application can harm the bereaved. The precautionary principle therefore recommends theoretically grounded models (Worden, Bowlby-Parkes) that respect the individual reality of grief (cf. grief models).

Ontological Classification

Superordinate terms: Normative Justification, Norm

Ontological relations:

Chapter assignment: Chapter 4: What is Human Personhood?, Chapter 5: Oblivion of the Person

Relation to Organ Donation as Such

The precautionary principle is not an argument against organ donation. Catholic teaching expressly affirms the free gift of organs as a sign of love and of the affirmation of the other. The principle operates at the level of the determination of death: it binds the practice to the certainty of what it presupposes — namely that the donor is really dead.

In this binding lies the person-ontological point: a donation can be a free gift only if it does not secretly become the cause of death. The precautionary principle protects the dignity of the donor against precisely this inversion.

Sources

Generated by querying the Personhood ontology.

Further sources:

Magisterial sources

Application to brain death

  • Shewmon, D. Alan (2001): The brain and somatic integration: insights into the standard biological rationale for equating “brain death” with death. Journal of Medicine and Philosophy 26(5): 457—478.
  • Bundesärztekammer (2022): Richtlinie zur Feststellung des irreversiblen Hirnfunktionsausfalls (Fifth revision) (German). Terminological clarification.
  • Uniform Law Commission (2021—2023): Drafting Committee on Revision of the Uniform Determination of Death Act — session documents on the failed UDDA revision attempt.

Application to organ donation after circulatory death and NRP

  • Bernat, James L. (2013): Controversies in defining and determining death in critical care. Nature Reviews Neurology 9(3): 164—173.
  • Truog, Robert D. (2024): In Defense of Normothermic Regional Perfusion. Hastings Center Report 54(4): 24—31.
  • Manara, Alex; Shemie, Sam D.; Large, Stephen; Healey, Andrew; Baker, Andrew; Badiwala, Mitesh; et al. (2020): Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal. American Journal of Transplantation 20(8): 2017—2025. UK position on permanence under NRP.

Application to bereavement support (analogical construction)

  • Stroebe, Margaret; Schut, Henk; Boerner, Kathrin (2017): Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief. OMEGA 74(4): 455—473.

Dissertation position

  • Bexten, Raphael E. (2017): Was ist menschliches Personsein? (German). Eichstätt-Ingolstadt, doctoral dissertation. The Personalist Norm and the First Dimension as goods to be protected under epistemic uncertainty.

See also

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