Linda Glenn
(WASHINGTON) — More than 4,600 Americans die each year while waiting for organ transplants. In 2003, only 20,000 of 83,000 patients waiting for organs in the United States received them. Despite widespread consensus that organ shortage is a national tragedy, bold initiatives to address the problem—such as creating a fee-based and regulated market for organ transplantation—have been fiercely rejected by the federal government, the medical community, and many religious faithful. But why? If most Americans accept the notion that the market is the most efficient means to distribute resources, why should body parts be exempt?Also due out - we found out from our comments - is James Stacey Taylor's treatment of the same problem, Stakes and Kidneys: Why markets in human body parts are morally imperative. His book garnered pretty amazing reviews too:In Kidney for Sale by Owner, bioethicist Mark Cherry contends that the market is a legitimate means to procure and distribute human organs. Cherry carefully examines arguments against a market for body parts, made by such figures as John Locke and Immanuel Kant and Thomas Aquinas, and shows these claims to be steeped in myth, oversimplification, and bad logic. He contends that equality, liberty, altruism, social solidarity, human dignity, and, ultimately, improved health care are more successfully supported by an organ market rather than through its prohibition.
Rather than focus on the purported human exploitation and "moral repugnance" of selling organs, Cherry says we should focus on saving lives. Many deaths could have been prevented, and many more lives saved, were it not for the moral hand-wringing over the concept of selling human organs. Cherry boldly deconstructs the roadblocks that are standing in the way of restoring health to thousands of people.
"Mark Cherry's book is the definitive treatment of the bioethical and business ethics questions that have been raised about a market in organs,” says Nicholas Capaldi, Legendre-Soule Distinguished Chair in Business Ethics at Loyola University. “It is must reading for anyone interested in these issues, and it will be the basis for all future discussion of this topic."
Mark J. Cherry is associate professor in the Department of Philosophy at Saint Edward's University in Austin, Texas; and is coeditor with H. Tristram Engelhardt, Jr., of Allocating Scarce Medical Resources, senior associate editor of The Journal of Medicine and Philosophy, senior associate editor of Christian Bioethics, and editor-in-chief of HealthCare Ethics Committee Forum (HEC Forum).
'James Stacey Taylor has written the most comprehensive treatment of the problem of markets in kidneys. It is probably also the best treatment of the subject. His arguments that a legal trade in human organs would best solve the organ shortage are more sophisticated and compelling than any I have seen.'Dave Undis of lifesharers reports some donation statistics today:
Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar, Georgetown University, Washington DC
The number of organ transplants in the United States increased 6% in 2004. That's over 27,000 lives saved. Organs from deceased donors were up 11%, and organs from live donors were up 2%. That's the good news.- updated 4/2/5Here's the bad news:
- Last year 43,128 people were added to the national transplant waiting list.
- Last year 6,228 people were removed from the waiting list because they had died. Another 1,594 were removed from the list because they had become too sick to undergo transplant surgery.
- At the end of 2004, over 87,300 people were on the national transplant waiting list. That's up from abou 83,900 at the end of 2003.
* In the event I lapse into a persistent vegetative state, I want medical authorities to resort to extraordinary means to prolong my hellish semiexistence. Fifteen years wouldn't be long enough for me.
* I want my wife and my parents to compound their misery by engaging in a bitter and protracted feud that depletes their emotions and their bank accounts.
* I want my wife to ruin the rest of her life by maintaining an interminable vigil at my bedside. I'd be really jealous if she waited less than a decade to start dating again or otherwise rebuilding a semblance of a normal life.
* I want my case to be turned into a circus by losers and crackpots from around the country who hope to bring meaning to their empty lives by investing the same transient emotion in me that they once reserved for Laci Peterson, Chandra Levy and that little girl who got stuck in a well.
* I want those crackpots to spread vicious lies about my wife.
* I want to be placed in a hospice where protesters can gather to bring further grief and disruption to the lives of dozens of dying patients and families whose stories are sadder than my own.
* I want the people who attach themselves to my case because of their deep devotion to the sanctity of life to make death threats against any judges, elected officials or health care professionals who disagree with them.
* I want the medical geniuses and philosopher kings who populate the Florida Legislature to ignore me for more than a decade and then turn my case into a forum for weeks of politically calculated bloviation.
* I want total strangers - oily politicians, maudlin news anchors, ersatz friars and all other hangers-on - to start calling me "Bobby," as if they had known me since childhood.
* I'm not insisting on this as part of my directive, but it would be nice if Congress passed a "Bobby's Law" that applied only to me and ignored the medical needs of tens of millions of other Americans without adequate health coverage.
* Even if the "Bobby's Law" idea doesn't work out, I want Congress - especially all those self-described conservatives who claim to believe in "less government and more freedom" - to trample on the decisions of doctors, judges and other experts who actually know something about my case. And I want members of Congress to launch into an extended debate that gives them another excuse to avoid pesky issues such as national security and the economy.
* In particular, I want House Majority Leader Tom DeLay to use my case as an opportunity to divert the country's attention from the mounting political and legal troubles stemming from his slimy misbehavior.
* And I want Senate Majority Leader Bill Frist to make a mockery of his Harvard medical degree by misrepresenting the details of my case in ways that might give a boost to his 2008 presidential campaign.
* I want Frist and the rest of the world to judge my medical condition on the basis of a snippet of dated and demeaning videotape that should have remained private.
* Because I think I would retain my sense of humor even in a persistent vegetative state, I'd want President Bush - the same guy who publicly mocked Karla Faye Tucker when signing off on her death warrant as governor of Texas - to claim he was intervening in my case because it is always best "to err on the side of life."
* I want the state Department of Children and Families to step in at the last moment to take responsibility for my well-being, because nothing bad could ever happen to anyone under DCF's care.
* And because Gov. Jeb Bush is the smartest and most righteous human being on the face of the Earth, I want any and all of the aforementioned directives to be disregarded if the governor happens to disagree with them. If he says he knows what's best for me, I won't be in any position to argue.
William Kristol, already quoted: "Perhaps it is time, in mature reaction to this latest installment of what Hugh Hewitt has called a "robed charade," to rise up against our robed masters, and choose to govern ourselves. Call it Terri's revolution."It really is pretty incredible to read such venomous attacks on officers of the court, although of course not so much so as Congress taking on a single medical decision in late-night session. Hilary "hilzoy" Bok shreds the stupid conservative arguments, of course, but that will be small comfort to Michael Schiavo and 280 million other Americans who have fought so hard to allow Terry Sciavo some peace.John Gibson, Fox News: "So Jeb, call out the troops, storm the Bastille and tell 'em I sent you."
Bill Bennett: "It is a mistake to believe that the courts have the ultimate say as to what a constitution means. (...) It is time, therefore, for Governor Bush to execute the law and protect her rights, and, in turn, he should take responsibility for his actions. Using the state police powers, Governor Bush can order the feeding tube reinserted. His defense will be that he and a majority of the Florida legislature believe the Florida Constitution requires nothing less."
Ann Coulter: "As a practical matter, courts will generally have the last word in interpreting the law because courts decide cases. But that's a pragmatic point. There is nothing in the law, the Constitution or the concept of "federalism" that mandates giving courts the last word. Other public officials, including governors and presidents, are sworn to uphold the law, too. (...) Just once, we need an elected official to stand up to a clearly incorrect ruling by a court. Any incorrect ruling will do, but my vote is for a state court that has ordered a disabled woman to be starved to death at the request of her adulterous husband."
Alan Keyes: "When time is of the essence, necessity authorizes the executive to safeguard the security of the constitution before citizens and the polity suffer irreversible damage. Terri Schiavo's survival depends on Gov. Bush's faithful execution of this responsibility, and the survival of American self-government on the willingness of all those in a like position to faithfully execute the duties of their high office."
Elizabeth Farah: "Gov. Bush, you have the right to exercise your authority to save this woman's life. You have the authority to reject a corrupt judge's corrupt decision. Remember when the pharoah issued the order that all Hebrew male infants should be killed? What did Moses' mother do? She broke the law of the civil authority. She saved the life of her son. (...) Jesus says that yes, you will have many detractors – people who will revile you for doing the right thing, but you will be rewarded greatly by God."
Come to think of it, why was it that eBay stopped allowing the sale of organs?
Take a digital picture or video of your medical problem – tennis elbow, acne, runny nose, hemorrhoids, or whatever ails you - and send it to the doctor in charge of the US Senate and your health care.
Everyone, take two minutes and upload your photos to Flickr.com. "Tag" the photo "Frist." If we get critical mass, we'll send everyone's photos to Dean Rosen, the good doctor's Health Care policy director!
Death is the veil that those who live call life- Linda GlennBy Linda MacDonald Glenn
End-of-life issues brought me into the field of bioethics. I lost my first husband, Jack MacDonald, to cancer in 1984. He died after a long struggle that led ultimately to the question of whether to insert a feeding tube to prolong his life. Jack's chemotherapy had caused nausea, mouth sores, and esophageal ulcers and his oncologist had ordered a feeding tube. As I sat by Jack's bedside while the surgeon discussed the procedure, my husband start to cry. "Please no more . . . let me go," he pleaded.
Stunned, I didn't know what to say. Jack took my hand, grasped it and repeatedly said, "Please no feeding tubes, no more tubes . . . no more." He paused, rested a moment, then smiled (as if he knew what I was thinking) and said, "And if you wait until I'm unconscious to put one in, I swear I will come back after I've died and haunt you for doing that." I cried and laughed at the same time and promised I would never do that to him.
I loved Jack and I did not want to let him go, but I did not want to see him suffer any more. Jack had realized the fight was over long before I did; he tried to reassure me that he wasn't frightened and that he wasn't in any pain, and I shouldn't worry. Ultimately, I honoured his wishes; but it was, without a doubt, one of the most difficult decisions of my life. A few weeks later, Jack slipped into unconsciousness and died quietly, peacefully, on Feb. 8, 1984, at 6:33 p.m.
Of course, I sympathize with Michael Schiavo and his decision to remove the feeding tube of his wife Terri, who has been in a persistent vegetative state for 15 years. Maybe, because I'm approaching the half-century mark, I seem be to facing increasingly more end-of-life issues.
At my age, I know that no one escapes this life alive. But that does not ease the grief of losing so many loved ones. What brings me comfort is the belief that the people I have loved and lost are still with us, if not in body, then in spirit. These individuals have been my teachers and have helped me learn that what we experience on Earth is part of a natural and continual evolution of our individual souls.
I believe we are born so that we can learn life's lessons and help one another to grow. When we have learned all we can on this Earth, and served our purpose, we return to God (or, if you prefer, to the Cosmos, Eternity, the Universe, the Multi-verse, Everything-ness). One of my favourite authors, Buddhist monk Thich Nhat Hanh, writes that we are afraid to die because we are afraid we will become nothing when we die. But rather than seeing death as an end to life, we should see our lives as a temporary manifestation, like a parentheses in a sentence that is eternity, or a wave that's part of the larger ocean. Death can teach us valuable lessons about impermanence and the interconnectedness of all things.
This may not provide a lot of comfort to Terri Schiavo's parents, Bob and Mary Schindler, who this week appealed to the U.S. Supreme Court to have their daughter's feeding tube reinserted. This life-and-death case has gripped us and prompted debate about end-of-life care and what the "sanctity of life" means. It has created schisms in religious communities and been the topic of heated conversation at many a dinner table. Watching the Schindlers publicly plead for intervention is heart-wrenching. I have no doubt that they love Terri, and are doing this for her sake. I am reminded, though, that in the bestseller The Road Less Traveled, M. Scott Peck defines love as "the will or willingness to extend one's self for the purpose of nurturing one's own or another's spiritual growth."
The question now is: Whose spiritual growth is being nurtured here? Traditionally, the Catholic Church, of which Terri Schiavo is a member, employs a burden-versus-benefit analysis in determining whether or not to use extraordinary measures to sustain life. Part of the reasoning behind this is the recognition that death is not the ultimate evil, but eternal damnation is. And that our purpose here on Earth is to serve God, and once we have done that, we no longer need to cling to these earthly bonds.
It is ironic that all of this is taking place during Holy Week, a time when the Christian community celebrates the triumph of eternal life over death, through the resurrection of Christ. To the devout Christian, to allow Terri to die would be to allow her to return to God. Her death does not diminish the fact the she and all of her loved ones were created as gifts from God and should be cherished as such. Regardless of her fate, the debate over whether or not Terri's wishes should be honoured has helped us realize that it is our responsibility to exercise our free will to make choices to nurture our own or another's spiritual growth. In searching for meaning and purpose in our lives, we reconnect with others and remind ourselves that ultimately, we are not alone.
Terri's case is heart-wrenching because it touches everyone, and its outcome further shapes our relationship with others and the governments to which we delegate authority.
The fundamental lesson seems clear: Decide for yourself how to manage the end of your life, and make it clear to others. Without this guidance, you are the victim or beneficiary of conflicting interests and beliefs -- or of an ad hoc consensus that may, or may not, coincide with your own wishes.
I received this today from a member of our hospital staff with whom i have not spoken about my idea the other day.Florida - Living Will
I, _________________________ (fill in the blank), being of sound mind and body, unequivocally declare that in the event of a catastrophic injury, I do not wish to be kept alive indefinitely by artificial means. I hereby instruct my loved ones and relatives to remove all life-support systems, once it has been determined that my brain is longer functioning in a cognizant realm. However, that judgment should be made only after thorough consultation with medical experts; i.e., individuals who actually have been trained, educated and certified as doctors.Under no circumstances -- and I can't state this too strongly -- should my fate be put in the hands of peckerwood politicians who couldn't pass ninth-grade biology if their lives depended on it. Furthermore, it is my firm hope that, when the time comes, any discussion about terminating my medical treatment should remain private and confidential.
Living in Florida, however, I am acutely aware that the legislative and executive branches of state government are fond of meddling in family matters, and have little concern for the privacy and dignity of individuals.
Therefore, I wish to make my views on this subject as clear and unambiguous as possible. Recognizing that some politicians seem cerebrally challenged themselves (and with no medical excuse), I'll try to keep this simple and to the point:
1. While remaining sensitive to the feelings of loved ones who might cling to hope for my recovery, let me state that if a reasonable amount of time passes -- say, ____ (fill in the blank) months -- and I fail to sit sit up and ask for a cold beer, it should be presumed that I won't ever get better. When such a determination is reached, I hereby instruct my spouse, children and attending physicians to pull the plug, reel in the tubes and call it a day.
2. Under no circumstances shall the members of the Legislature enact a special law to keep me on life-support machinery. It is my wish that these boneheads mind their own damn business, and pay attention instead to the health, education and future of the millions of Floridians who aren't in a permanent coma.
3. Under no circumstances shall the governor of Florida butt into this case and order my doctors to put a feeding tube down my throat. I don't care how many fundamentalist votes he's trying to scrounge for his brother in 2004, it is my wish that he plays politics with someone else's life and leaves me to die in peace.
4. I couldn't care less if a hundred religious zealots send e-mails to legislators in which they pretend to care about me. I don't know these people, and I certainly haven't authorized them to preach and crusade on my behalf. They should mind their own business, too.
5. It is my heartfelt wish to expire quietly and without a public spectacle. This is obviously impossible once elected officials become involved. So, while recognizing the wrenching emotions that attend the prolonged death of a loved one, I hereby instruct my relatives to settle all disagreements about my care in private or in the courts, as provided by law. If any of my family goes against my wishes and turns my case into a political cause, I hereby promise to come back from the grave and make his or her existence a living ____ (fill in the blank)
Recent discussions of the Terri Schiavo case have focused, understandably enough, on its legal and political dimensions. But what propelled this case through umpteen courts and into the US Congress are the neuroethical issues it raises, and we’ve heard almost nothing about them lately. I do not think the lack of attention to the neuroethical issues is simply because they are settled and need not be discussed further. (Indeed, if someone has solved the mind-body problem and I missed it, email me quick!) The issues at stake here concern the relations between conscious awareness, brain and behavior, and these are hard problems. What gives mental life to a brain and how can we tell whether a given damaged brain supports some type of awareness?
Until recently, a patient’s behavior was the one source of evidence we could use to infer their mental state. Now functional neuroimaging has been brought into the mix. Both sources of evidence are trickier to interpret than they appear at first.
Some observers of Terri Schiavo find her behavior indicative of conscious awareness and intentionality. One observer, writing on the website terrisfight.org wrote: “I was pleasantly surprised to observe Terri’s purposeful and varied behaviors... I never imagined Terri would be so active, curious, and purposeful. She watched people intently, obviously was attempting to communicate with each one in various ways and with various facial expressions and sounds.” For me, watching Terri Schiavo in the website videos, it was difficult not feel I was seeing a person interacting with others and aware of her surroundings.
However, clinical and experimental neuroscience have taught us some surprising things about the range of behaviors that can emerge from a decorticate brain. Such behaviors include orienting with eye and head movements toward sights and sounds, generating facial expressions, and producing nonverbal vocalizations that have meaning for us, if not the person producing them, such as cries and laughter. In light of this, we must interpret the behavior seen in the videos cautiously and with a measure of skepticism.
The most natural interpretation for the behaviors we see on the video is not the only interpretation. For example, when a dozing Terri is loudly ordered to “open your eyes!” and does so, does that mean she understood what was said? Or would she have done the same thing if roused with an equally loud order to “open your mouth!” or “stand on your head!”
Humans are hardwired to interpret the behavior of others in terms of mental states. In the psychology literature this tendency is part of a suite of abilities termed “Theory of Mind” (ToM) and in most situations we apply our ToM automatically, without weighing alternative reasons for the behavior. For a particularly striking demonstration of this fact about ourselves, consider the typical response to the robot Kismet. Kismet is part of a research effort at the MIT Artificial Intelligence Lab to design machines that interact socially with humans. Kismet has been programmed to gaze at humans who approach it, orient to salient objects moving within its field of view, pull back avoidantly if an object is thrust forward at it, and so on. People attribute all manner of cognitive and emotional states to this robot on the basis of a fairly small set of simple behaviors, and have been known to become quite attached to it. And this is a contraption made of metal and plastic, not a human being! My point is emphatically not to liken Terry Schiavo to Kismet, but rather to suggest a similarity in our reactions to the woman and the robot.
Recent functional brain imaging results have added a new twist to the debate over Terri Schiavo and the treatment of persistent vegetative state (PVS) more generally. Brain imaging is potentially helpful in understanding the mental life of neurological patients. Behavior is an imperfect measure of cognitive state in anyone, but especially in neurological patients whose verbal and motor systems may be damaged or disconnected from cognitive systems. Brain imaging offers seemingly more direct access to the workings of cognitive areas of the brain. However, at this point in the development of functional brain imaging, the meaning of different patterns of brain activity is not well understood.
A much publicized article in the journal Neurology used fMRI to document cortical responses to speech in patients who were in a minimally conscious state (MCS). This result, reported on the front page of the New York Times, was seized upon by some as evidence that Terri Schiavo may retain more awareness than her behavior suggests. There are two problems with this conclusion.
The first problem is that the patients in this study were in a MCS, not a PVS. What is known about brain activity in PVS? A few studies have shown that the primary sensory cortices of PVS patients respond to touch and sound but higher-level cortices associated with cognition are not reliably activated. However, one PVS patient imaged with PET showed more cortical activation in response to a story told by his mother than to nonsense words.
The second problem is that brain activation, even activation that discriminates between meaningful stimulation and nonsense, does not imply awareness. The cognitive neuroscience literature contains a number of studies in which people’s awareness of stimuli was manipulated while brain activity was measured. In studies with healthy normal participants, awareness of visual stimuli was eliminated by the use of brief, subliminal presentations. In studies with neurological patients, a phenomenon called “extinction” was used to control awareness of the stimuli; visual stimuli on one side of space are extinguished (not consciously perceived) when another stimulus is presented simultaneously on the other side of space. These studies have shown that stimuli can activate relevant regions of cortex even when people are unaware of the stimulus. This is consistent with the idea that the brain activity underlying perception is graded, ranging from nonexistent to the levels of activity observed in normal conscious perception, and that conscious awareness of external events accompanies only the higher end of that range.
The bottom line is that we have two windows through which to look for an answer to the question of conscious awareness in brain-damaged patients, and while neither is crystal clear, both are useful. The first is extended behavioral observation (as opposed to snippets of video), undertaken with an awareness of our susceptibility to the “Kismet” phenomenon. The other is functional neuroimaging, interpreted cautiously and with an awareness of how much remains to be learned about activation-cognition correlations in damaged brains.
There's also a nice interview of Dahlia Lathwick by Alex Chadwick, discussing many of the legal particulars of the Schiavo case.
- Sean Philpott (senior scientist at New York Wadsworth Institute)[thanks Bob Baker (Union)]
JUSTICE SCALIA, concurring. The various opinions in this case portray quite clearly the difficult, indeed agonizing, questions that are presented by the constantly increasing power of science to keep the human body alive for longer than any reasonable person would want to inhabit it. The States have begun to grapple with these problems through legislation. I am concerned, from the tenor of today's opinions, that we are poised to confuse that enterprise as successfully as we have confused the enterprise of legislating concerning abortion -- requiring it to be conducted against a background of federal constitutional imperatives that are unknown because they are being newly crafted from Term to Term. That would be a great misfortune.- Art CaplanWhile I agree with the Court's analysis today, and therefore join in its opinion, I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field; that American law has always accorded the State the power to prevent, by force if necessary, suicide -- including suicide by refusing to take appropriate measures necessary to preserve one's life; that the point at which life becomes "worthless," and the point at which the means necessary to preserve it become "extraordinary" or "inappropriate," are neither set forth in the Constitution nor known to the nine Justices of this Court any better than they are known to nine people picked at random from the Kansas City telephone directory; and hence, that even when it is demonstrated by clear and convincing evidence that a patient no longer wishes certain measures to be taken to preserve his or her life, it is up to the citizens of Missouri to decide, through their elected representatives, whether that wish will be honored. It is quite impossible (because the Constitution says nothing about the matter) that those citizens will decide upon a line less lawful than the one we would choose; and it is unlikely (because we know no more about "life and death" than they do) that they will decide upon a line less reasonable.
"Come down, President Bush," Schiavo said in a telephone interview. "Come talk to me. Meet my wife. Talk to my wife and see if you get an answer. Ask her to lift her arm to shake your hand. She won't do it."
Living Wills May Not Work, but I'm Getting One - There couldn't be a more salient test of the question as to what it might mean if I do not write down "I prefer not to be held hostage by fears about a feeding tube for more than a decade, please." I've argued in several papers that living wills are a mistake and are unlikely to work, and others have found enough empirical evidence to cast doubt on the idea that advance directives make much difference in the care that patients receive. But tell that to Michael Schiavo. Today it is awfully clear that no matter what I and other critics of living wills might have believed about how well they work, they do at least make it easier to avoid the Schiavo level of confusion and wrangling. I have opined over and over again that living wills are too litigious. Um, ok, I was wrong. All around the country people will now begin thinking very seriously about writing down their wishes about feeding tubes and respirators. It is as John Danforth said when he pushed for the Patient Self-determination Act in the first place: young people "should get a Miranda warning" about what can happen if they do not talk to others about health care preferences.
In the Future, it Will Be Tough to Get a Majority of Legislators to Agree to Support Choices by Individuals About Health Care - The scene on the House floor as the debate persisted about Schiavo is staggering. Those who fought for the sanctity of marriage now fight against the importance of a husband's choice. Those who fought for the importance of the 10th amendment and states rights more generally are suddenly desperately fighting against a state's rule of law. The body that made it possible for Cruzan's case to become the Patient Self Determination Act is now deciding that expressed views about dying just don't matter. Why? Because Democrats do not want to run for office against campaign commercials that feature Terri Schiavo dying.
Systemic End of Life Care Is Now Officially Less Important than Jack Kevorkian and Terri Schiavo and Tom DeLay's Own Ethics Problems - Ask yourself when was the last time that President Bush and the Congress undertook anything like a midnight effort - including a flight to get the President from Texas to D.C. during a vacation - on behalf of healthcare. Give up? Never. Just think what could happen if Congress worked this hard or spent this much of our tax money to discuss and vote quickly on reform of managed care. It could never happen - but why? Because the battle over Terri Schiavo is illuminated by a single, vulnerable woman. If Democrats could manage to make a symbol out of a young woman dying of a curable chronic disease because she has no insurance, we might have 40 million fewer uninsured people in the nation today. And the lesson doesn't end there: this case is sucking the life out of the end of life care debate. Just as Kevorkian turned the nation's attention away from the problems that made his services seem desirable, the Schiavo case turns our attention away from dozens of critical questions about the funding of hospice and a dozen other issues.
Compassion for the Dying Schiavo and Her Family Ought Not Be Lost - There is no question in my mind that the Schiavo case illustrates wanton, callous political maneuvering on the part of some. It is equally clear to me that Congress has no business working on this case in this way - interfering in the lives of those who are touched by such tragedy as they make private decisions. But it should not be lost that many who have begun to fight in this matter as it has been quickly escalated have deep compassion for the Schiavos, and that such compassion comes from a vital sense that death and suffering must be understood and respected - and that love for life is important and beautiful. Somewhere in the middle is the opportunity to take this case and use it to move quickly to reform of national policies. I hope that happens. That will of course come as no comfort to the mother of baby Sun in Houston.
People Struggle Most Against the Worst Odds - There is no question about Terri Schiavo's condition. She is never ever going to awaken, no, to be more blunt, her brain is utterly destroyed and there is nothing of what was Terri Schiavo remaining in her but the simple functioning stem that causes her other organs to continue to function at the most basic level. That much is clear. All that remains of Terri Schiavo is her dignity and the symbolic meaning of her body. So why does anyone fight to keep her in this condition rather than discontinuing a treatment that everyone agrees is not therapeutic? What does it mean to fight against the impossible in this case? Republicans fighting against this measure have tried desperately to avoid discussion of what might re-grow Ms. Schiavo's brain, because God forbid they say what the man who offered Mr. Schiavo $1 million to keep Terri Schiavo said: stem cells. No, there is nothing here for them to point to but miracle. And it should be noted that pushing for a miracle against impossible scientific odds is a critical part of the American culture in an era in which physicians often feel that they must offer treatments that they do not believe are therapeutic. The idea that patients and others have a right to request things whether or not they work is being reinforced right now.
- Glenn McGee
Warning: not guaranteed to protect you against the combined legislative force of a majority of congress.
First, state courts control the handling of end of life care issues not the Federal courts. Second, the facts in this case have been litigated forever and there is no reason to think any Federal judge will find any flaws with the due process according Terri's parents and siblings as they have fought against her husband. Third, Congress is trying to pass a law for 'one' and that is unlikely to be seen as constitutional. Fourth, the Schiavo case is essential a domestic dispute. Federal courts hate to get involved in these. Fifth, and perhaps most importantly, the trial court judge shows no inclination to be bullied. He has already told Congress to pound sand when it issued subpoenas requiring Terri Schiavo to testify in Washington. He may well do the same in response to any Congressional legislation.
- Arthur Caplan
was criticized by ultra-Orthodox leaders and newspapers after he was quoted in the press as saying that the practice of metzitzah b'peh, or oral suction of the circumcision wound, should be conducted with a sterile tube. In many ultra-Orthodox circles, especially within certain Hasidic sects, the ritual is performed by having the mohel suck blood from the wound with his lips directly on the baby's penis.Tendler spoke out against the practice following reports last month that a Jewish infant had died of herpes and that several other babies had contracted the virus after being circumcised by mohel Rabbi Yitzchok Fischer, who practiced direct oral suction. Tendler co-authored an article in the August 2004 issue of the medical journal Pediatrics, which asserted that the risks of herpes infection should outweigh any ritual benefits of using direct oral suction.
In recent weeks, ultra-Orthodox newspapers have condemned Tendler and accused him of reporting Fisher to health officials — a claim that Tendler vehemently denies.
In an article published in the current issue ofThe American Journal of Bioethics, researchers examined the willingness of the public and physicians to support deception of insurance companies for the purpose of obtaining health care services. The researchers asked over 1,600 physicians and 700 public members (drawn from a pool of prospective jurors) what the doctor should do in similar scenarios.
The researchers found that 26 percent of the public sample and 11 percent of surveyed physicians chose deception of the insurance company as the proper response.
Mine is an informal and unscientific poll, but I had the opportunity to ask 22 physicians about their response to the study's findings. No one was surprised that some physicians and public citizens supported deception of insurance companies in the service of obtaining necessary patient care, but all were surprised that the reported percentages were so low. Nearly everyone believed that the majority of physicians at some time or other had "stretched the truth"or "coaxed a patient" or "caved in to a patient's demands" to misrepresent facts in order to satisfy the insurance company's pre-qualification criteria for obtaining costly drugs or tests.
In both circumstances, health care costs may be driven upwards if patients are inadequately treated or diagnosed, and if doctors and patients spend too much time making requests and appeals to insurance companies. Additionally, the medical profession may find its reputation undermined when an insurance company administrator can trump doctors' medical decision-making and determine what constitutes necessary medical care.
"The idea of placing ICT devices “under our skin” in order not just to repair but even to enhance human capabilities gives rise to science fiction visions with threat and/or benefit characteristics. However, in some cases, the implantation of microchips with the potential for individual and social forms of control is already taking place.The intimate relation between bodily and psychic functions is basic to our personal identity. Neurosciences are developing very quickly. The brain implants developed to alleviate tremors in Parkinson’s disease are only one example. They show that ICT implants may influence the nervous system and particularly the brain and thus human identity as a species as well as individual subjectivity and autonomy.
These are the essential reasons why ICT implants in the human body have large and important ethical consequences. Not surprisingly, the respect for human dignity has been the fundamental basis of EGE discussions of where the limits should be drawn for different applications of ICT implants."
Elizabeth Blackburn is a great scientist, the only stem cell biologist who served on the Presidents Council on Bioethics under Leon Kass, and those who watched as she was dismissed from the Council were appalled - particularly at the assertion by Kass in newspapers that Blackburn was dismissed not for her politics but because she did not participate in the panel's discussions. If you followed the scandal you know that Blackburn was in fact very active in the discussions, by email, but that at the heart of the matter was the question of how to cast her contributions as a scientist to the public debate. Benjamin Franklin would have loved Elizabeth Blackburn, and no doubt it is that fact - as well as her basic science acumen - that insipred the judges at the Franklin Institute in Philadelphia to award her the Benjamin Franklin medal, which has been awarded to truly outstanding scientists since 1824.
Blackburn, an Australian who is now a U.S. citizen and a professor at the University of California, San Francisco, was one of 18 people chosen in 2001 to serve on the President's Council on Bioethics. She researched developments in embryonic stem cells and told her fellow council members that the field held great promise in the health-care field.The use of such cells from human embryos is opposed by abortion opponents. Blackburn and another scientist were replaced in 2004 with three people who held more conservative views.
The panel chairman said her removal was not related to politics, but Blackburn disagrees. She wrote of her experience in a two-page column in the New England Journal of Medicine, and said she received positive calls and letters from around the world.
'People don't like the idea that science policy is not being based on evidence,' she said yesterday."
But what Brown was known for in bioethics was its great research and writing, and a kind of leadership in bioethics that allowed it to create the very first "bioethics major" for those who are not yet ready to learn a profession - undergraduates. It was a brilliant concept - teach undergraduates about medicine, philosophy, the social sciences, and so many other things through the filter of ethical issues in biomedical science. And it worked. It was started by Dan Brock, a philosopher and bioethics pioneer who retired from Brown several years ago, taking positions first at NIH, then Harvard.
Brown couldn't get its act together to hire Brock's replacement. It had, instead, a very public implosion in bioethics, in fact, as the Brown philosophy department displayed the nearsightedness that has become typical of philosophy departments, declining to hire any among a pool of strong applicants for Brock's job because none of them were "good enough philosophers." It was the sort of decision that has characterized the past decade in philosophy, a ten year period that has seen the more-or-less total demise of the public role of academic philosophy.
So bioethics at Brown - easily one of the school's best-known areas of accomplishment - essentially died, and with it that incredible bioethics major, which Brown has announced will now die. The bioethics major wasn't just a precedent that a number of other schools would eventually follow, although it did establish that an interdisciplinary undergraduate program in bioethics might make educational sense. What it really represented was the pinnacle of Brown's greatness as an undergraduate institution - back when Brown was a top-10 school in the late 80s. It was a fabulous example of how the Brown "design your own major" program both attracted good students with good motivations and also taught them to combine science and humanities.
So, just like that, Brown disappears from bioethics. R.I.P.
The show has "left me receptive to the view that mortality is, if not precisely a good thing, then at least the necessary foundation of other very good things," she wrote in an article last year. "There is something misguided about the attempt to overcome mortality."Yes, the President digs deep for ethical advice.Her interest in mortality and Star Trek could be regarded as the quirks of an academic if not for her position on the President's Council on Bioethics, a 18-member panel that advises Bush on some of the most polarizing subjects in society.