Implications of Fetal Heartbeat Bills for Organ Transplantation

Fetal Heartbeat bills have been making the rounds in conservative states since about 2011. Such bills restrict abortion to the period of time prior to the fetus having a heartbeat. If a heartbeat can be detected, then abortion is illegal. These bills have been proposeohio_heartbeat-bill-300x168d in Alabama, Arkansas, Kansas, Kentucky, Mississippi, North Dakota, Ohio, Texas, and Wyoming. None of these bills have successfully become law, but in the wake of Trump’s election, the Ohio state legislature decided to test the waters: The House and Senate of that state passed the bill and sent it to the governor. He vetoed it–knowing it would not stand up in court as long as Roe vs. Wade is the law of the land.

Many have analyzed the heartbeat bills and their effects on women’s health. Of note, the heartbeat bills restrict abortion to 6 weeks after conception, which given the way weeks are counted post conception really means that women have 7-10 days of knowing that they are pregnant before their option of getting an abortion ceases to exist. Heartbeat bills are effectively a ban on abortion.

More importantly for thinking about bioethical issues is the fact that heartbeat bills define human life as present and defensible when there is a heartbeat. This definition of human life has significant implications for other aspects of medical ethics as it is practiced clinically. Medical ethics is often case-based and organized around specific issues, such as end of life care, patient autonomy, decision-making, access, etc. From my observation of hospital settings, there is not a lot of thinking across these areas, which in the clinical setting can make a lot of sense: decisions need to be made quickly and ethical thinking needs to be able to take in the specifics of particular cases. But as a theological ethicist, I do think across these compartmentalized areas of clinical medical ethics, and I note that defining human life as defensible when there is a heartbeat has negative implications for organ transplantation.

Organ transplantation requires organ donation. Organ donation can only happen under specific circumstances, which include brain death. Brain death as the definition of death was under consideration as early as 1968 and became nationally acceptable in 1981 after the Uniform Determination of Death Act was approved. Brain dead patients still have heartbeats, though usually those are supported by machines. The continuing heartbeat is essential for an organ donor because the heartbeat circulates blood that keeps the organs supplied with oxygen (etc) and therefore usable. There is a short period of time (hours) when the heart can continue to beat (unsupported) while the patient has been declared brain dead.

To return to our comparison, it seems inconsistent to define the beginning of life with the heartbeat and the end of life with reference to brain function. At stake philosophically and theologically is the definition of the human and the locus of identity. Are we defined by our brain activity or by the functioning of our hearts? Some older worldviews, such as that of the  Israelites, suggests that the heart (lev) is the locus of physical identity, but for the Israelites, the heart is also the organ of thinking. The heart and mind are linguistically connected for them, while in the modern technological West, the brain has increasingly become the dominant organ. Do fetal heartbeat bills fight against this trend? At stake practically is idea that harvesting organs for transplants becomes more ethically problematic if life is defensible when there is a heartbeat.