Louis J Palmer Jr, Jefferson, North Carolina, US and London, McFarland and Company, 1999, 156 pages, £26.25/$35.

In Organ Transplants from Executed Prisoners, Louis Palmer proposes alleviating the urgent shortage of organs for transplantation by requiring condemned felons to donate their vital organs after execution. The book proceeds as follows.

In his first chapter Palmer reviews the development of the quasi-property rights relating to the bodies of the dead, including the right to dispose of one's own body by means of a will and the right of relatives to bury it. In the second chapter, The Market for Human Body Parts, he goes on to review the current American laws restricting the sale of body parts in order to show that death-sentence removal might be permissible within established principles of law. A C MacDonald has recently provided a good review of the legal restrictions placed upon access to organs of the deceased¹ in which he points out that despite the fact that a large pool of potential donors exists, legislators and the public have consistently and severely restricted access to them—with good justification.

In a most remarkable sequence in the same chapter, Palmer goes on to note that in China, where organs are taken from executed prisoners: “The frequency and volume of executions are traced directly to an international black market in human body parts”. This is a telling argument against such practices. Nevertheless, Palmer continues to argue for required organ removal from executed prisoners—presumably only somebody else's government can abuse power!

In chapter three, Removing Transplantable Organs of Capital Felons, Palmer argues, in the light of the previous two chapters, for the moral appropriateness of capital punishment and of required organ donation.

The problem with this kind of argument of course is that, even if one accepts capital punishment, it is only appropriate if used in a perfectly fair and accurate fashion. But no system can guarantee this. The present American system certainly cannot and is “fraught with error” as documented by the exoneration of thirteen (!) prisoners scheduled for execution in the State of Illinois and the recent suspension of executions in that state.²

In the fourth chapter Palmer develops a quasi-scholarly constitutional justification for his organ procurement scheme. And in The Need for a New Method of Execution he argues self-referentially that: “Execution ‘by anaesthesia-induced brain-death would prevent destruction of transplantable organs’” (page 71), and that this method of execution should therefore be adopted. This too is highly controversial. For whilst it is well known that deep anaesthesia can reversibly mimic brain death it is not the same state. Physicians are always careful to determine brain death in the absence of anaesthetic influence. Thus, while physicians can painlessly remove the heart and other internal organs from an anaesthetised person, that would be unacceptable: an execution performed by physicians. It would have nothing to do with brain death.

In the final chapter Palmer returns to the theme of chapter three and attacks the unfairness of capital punishment—in my view, he should have started and stopped here. Americans have had enough difficulty trying to get capital punishment “right” without introducing issues of secondary gain into the execution process.

Let me present my biases. Major organ transplantation effectively prevents premature death, albeit imperfectly with an expensive technology still under development. Increasing the organ supply is not as important as improving the technology and decreasing the costs of transplantation. But in the pursuit of this important goal we must not trample on other strong moral or medical considerations. Palmer's arguments for the required use of organ transplants from executed prisoners must be rejected. They wish away centuries of governmental abuse of power. They assume that we can achieve perfect justice in capital punishment—an assumption all experience belies. They treat prisoners differently from others and make prisoners more exposed in their vulnerability, not protected. Finally, they require intimate physician participation in the act of execution.