What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.The article addresses ongoing disagreement among ethicists, lawyers and medical practitioners regarding organ donation after cardiac death (DCD), ie where a patient is neurologically damaged and cannot function without a respirator. Removal for transplantation of organs - eg hearts, livers, kidneys, gonads - from someone who has a pulse but is vegetative is controversial, with US practitioners insisting on a 'dead donor' rule (ie the person whose organs are being removed must be definitively dead). The authors comment that
the dead donor rule is routinely violated in the contemporary practice of vital organ donation. Consistency with traditional medical ethics would entail that this kind of vital organ donation must cease immediately. This outcome would, however, be extremely harmful and unreasonable from an ethical point of view [because patients who could be saved will die]. Luckily, it is easily obviated by abandoning the norm against killing.They argue that rendering someone totally and permanently incapacitated is just as bad as taking a life. Killing a totally disabled patient does that person - although Sinnott-Armstrong & Miller would presumably disagree with the reference to 'person' - no harm: killing cannot disrespect the patient's autonomy because the patient is so incapacitated as to lack autonomy.
The authors dismiss notions that life is "sacred", arguing that the only relevant difference between death and life and death is the existence of abilities. A fundamentally neurologically-injured person no longer has those abilities.
if killing were wrong just because it is causing death or the loss of life, then the same principle would apply with the same strength to pulling weeds out of a garden. If it is not immoral to weed a garden, then life as such cannot really be sacred, and killing as such cannot be morally wrong.