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The man and the value of life. W. G. University of Cincinnati radio presents international leaders discussing the ethical technical and legal issues surrounding the extension of life through advances in medicine. The lectures are from a symposium sponsored by the University of Cincinnati College of Medicine as a part of the university's 100 50th anniversary celebration. Today we present the question and answer period which followed the formal lectures at the Mann and life symposium. The panel members are doctors shocked bars on philosopher and historian from Columbia University Dr Renee Dubow microbiologist and author from Rockefeller University Dr. Michael
DeBakey famed heart transplant surgeon from Baylor University. Judge David L. bass a lot of the U.S. Court of Appeals Washington D.C. and the Right Reverend Roger W. Blanchard bishop of the Episcopal Diocese of southern Ohio. The discussion will be moderated by Dr. Charles herring U.S. professor of neurology and program chairman of the man and life symposium. Here now is Dr. Eric. First. I would like to try to answer. A question that's been asked by over half a dozen. To say something that would clarify the thinking of people who are wondering what value if any electroencephalogram tracing and. Timing. And the definition of. Legal definition of death and so forth. As I said on a National Committee. On this matter.
For the senior neurological society along with Richard Mazlan who's Professor of Neurology at Columbia Richardson and Robert Schwab of the Massachusetts General Hospital. To bring in a report. For this senior neurological society. I've been involved considerably. Description of. The. Meaning or the death definition of death will. And I think I better go over these factors. So that everybody's clear what we're talking about. Death is. Defined in these times of brain death. This. Has occurred when there are one. No reflexes of any type. Available.
Alysa the ball. With the pupils dilated and fixed. There's no movement in the absent muscle tone. There's no respiration. The respirator off for one minute without spontaneous respiratory movement. And the IGI is what we call I saw electric. In the high teens which means that it is flat. There is no electrical recording from the brain. Recording for at least 30 minutes. These criteria must be present for 24 hours. Some transplant surgeons would shorten this to something like two hours and this will probably be safe. The exception. Are as follows. If there's an overdose of sedative. Or if the patient has been exposed prolonged to the cold so he has a low temperature what we call hypothermia. All of
these conditions may exist in the patient make a perfect recovery. This is a. Description of death. Which I think will be. Adopted by most. Most of the scientific societies the country. I think we now make go on unless there's any. Question of this. Proposition. Barzan you'll take his first question read it to you. I'm asked would you speak more directly to what your solutions would be. To avert the breakdown of modern society. My answer is No. Will. You. And there's a point to it. If the breakdown of modern society is what I think it
is they make a vast turning point for fundamental change. Then there are no solutions. There is nothing to advocate such as here just suggested M-I in favor of less equality more manners more physical labor. It's not a question of being in favor of anything or starting a movement. Rather I think the question of observing oneself in the world and. Driving on as courageously as one can along the lines of in cultivated principles as as. Dr. Drew told us we are actors in the light of our whole experience that I don't agree with his notion that society manipulates us all and therefore we shouldn't be afraid of manipulation because I think that he.
He confuses influence and conditioning with with what manipulation really is that is a deliberate conscious and quasar total engineering of results through a human being. Not long ago I was in a panel discussion in which a representative of the neo behaviorist school kept saying man is an organism that can be programmed. And he's working hard at programming us and he meets halfway. The people I met in another discussion who very seriously discussed. The legal rights of computers and. And it it came to the point where someone said Well do you think that when they really achieve their full rights and their total independence as human beings it will be murder to
pull the plug out of the war. There Any comment from the. Panel. If not Doctor good debate he would you continue. There's a question here of Regis powers how does the individual go about being searched. How does the individual go about being certain make useful organs of his body or use them to death. This is done well and I have banks but in no other order. Well there's no way he can go about being certain. For a study useful articles to give. And secondly that there are going to be years. I think that it's awfully important to understand a little bit more about transplantation. The idea that you just simply find a
donor who has useful arguments. Or the person with you so far you can just give his organs whenever he's prepared to do so and that they will be yours. These concepts are the facts this is realistic. You've got to keep in mind that. At least at the present state and. Even kidney transplant patients. Which is less. Risky and more easily done then cardiac transplantation or liver transplant patients. Need to meet a number of criteria to perform procedures.
And they are rather restrictive. This is what really restricts the numbers that can be done. And we've had in our experience and other sellers who had this experience. Patients who have waited a year to get a transplant. And the patience to wait that long and they are simply waiting to transplant. Them. There are number of factors that must be met criteria the most important. And so it's not a simple matter of providing reception making available. Now in going back to the specific question that's just one of the reasons that you can't be certain. Secondly. Once that is available
then you must have a recipient that meets that need specific need and the specific typing. For it we are able at the present time to get to do a reasonably good job of matching. It's very crude. Let me assure you one of the reasons we still have a problem of rejection of course. It's possible for the individual to. To will his body and this is really the basis of the recommendation that's been made so called uniform gift back. Perhaps. A bit more but I think that this would be helpful and make making it possible to do well the individual. But at the present time if I understand the legal
in many states even if you yourself will the US once you really becomes. Responsible the legal responsibility of the next of kin and the next of kin decides not to approve the use of that you may not be able to argue and therefore can't be certain you say that you are in the wrong. Thank you any other comment. Panel on this question. Would you like to comment yes Judge better. There are 50 states. And we've got 50 versions of. Legal questions. But for some reason or other probably because I'm a lawyer and a judge I don't think legal questions are very important. Once we get around to deciding just what we want to do about it it will be easier not to have a uniform code and most of the states will follow it and adopt it. I'm not too much
concerned I don't think much is going to rise or fall on whether or not you can do it by will or you have to do it with the consent of the of the heirs. I don't. We could decide that I think that's a detail. Maybe I'm wrong but that's when I see it. As a matter of fact a lot of the so-called legal questions I'd like to say this about lots of people ask me you know what about this is this week is that legal and the answer I have is something like the answer. Dr. Carson said I don't know I mean he said no to his question I and he couldn't. We don't know what the answers are. We really haven't formulated people outside the law or have some kind of a notion in a very simplistic notion that there's a bunch of principles out there on the bookshelves and there are judges and lawyers who look at the book and he's a kind of self-executing and they take care of all situations. When I was really trying to say in my talk today was that I knew I was going to talk to a group outside the law and. I had a great
urge to try to make you aware of that institution the legal institution which is the place where we were resolving these kind of conflicts. An important court personally for the resolution of this conflict will be people like Dr. DeBakey who has had the experience. He's the fellow who should help us a great deal in settling on what rules to follow. But I don't think even even when we settle these rules that we're talking about now the legal rules when even when they die when they don't die I don't think we're solving very much. I think there's something deeper involved than simply the rules. But. If the if the doctors if the people and the biologists over the if. They think there's a body of principles in the world that's going to take care of everything that has come about it will come about and is now happening. They are wrong. You are part of the process. The most important part of the process for developing
along that we ought to have and the principles that we are the one that want to be applied. It's your job not ours. There are certain values we can bring to it. But the most important information for making the decision is yours coming from you. Thank you. Bedlam. Bishop Blanchard would you give us your first question ethically. How was it possible to sanction euthanasia and not support suicide. Well I don't know that you can sanction. Euthanasia without recognising its implications for suicide but you may recall that I was not advocating euthanasia but rather anti dist than Asia. A term which I had. Not come across before I started preparing myself for this paper a term which I believe was coined by Dr. Joseph Fletcher.
Which sent me immediately to the dictionary and you may know all this but maybe not. And I discovered that. By definition euthanasia is the good way to die. Than Asia is the hard way to die. And anti just in Asia is against and against permitting people to die the hard way. And so it is this word which I have found most congenial to my thinking and the point that I was attempting to make. Any comment from the panel on this question. Not just when you take your first to get well before dealing with the. Questions that have come from the floor. I'd like to make the statement above. Some of the. Social rules. Which have been made throughout the day by members of the god. Perhaps
but I believe. The assumption explicitly stated by Bishop Blanchard other members which. The assumption is that there has been any advance knowledge during the past few years. I question that scientific knowledge. Has increased anywhere as much. As people believe. During the past century. In fact I believe scientific knowledge has increased. During the past half century. Functioning body of knowledge scientific knowledge developed during the 17th and first half of the 19th century. Has come to be. And that
as I see. In medical ethics why. Has this assumption made some explosive increase in knowledge becomes explained. Has. Come about. Because. AS. A Community Academy community and especially community. We have decided to consider. Important knowledge. Only those aspects. Of knowledge in which we happen to be interesting to that. But if you will have to take. The tremendous. Body of ignorance which prevents us. To deal. With the problems
of most of the people of the world. Then you will see that. Knowledge has not increased in any significant manner. I am very much impressed and I must say shocked. By the fact that throughout our discussion we have been talking about problems in a very few people. Very few if you thousand perhaps a few absolutes if you will convert files. Whereas in reality. The problem that faces us. If we do not want. To act in the kind of manner. That there are. Three billion people. Suffer.
Depreciation. Mismanagement of life. Which. Affect their life. That they can never recover from these and mismanagement. And it is another form of escapism. To say. That the economy problems problems are not scientific problems. I do not believe that. The plain fact is that if we had all the money we want. Scientific. Person we don't. We would not know how to deal. Today with the problems. Of people in the world. And instead of going in the world. On this continent. The United States and.
Latin America. Where. The percentage of children. Develop under such conditions. That they cannot express. Their potentialities expressing potentially this sense of humor. That the scientific community facing political problems. The fact is that nobody works on this problem. Few. Of us. Can. Provide the kind of understanding that would make it possible for us to design. Clash in the approach. Of. Any. Common. Man. Not to thank you for
anything that you take. Either. You. Can ask what is the place of the professional philosopher in the mixing with that is being invited to consult with. Social psychological and medical specialists. I don't know whether I'm answering the question when I say that this mixture or any mixture. For the purposes of consulting and arriving at. Rules governing medical action. Social judgments. And so on leaves me very skeptical. That's because I've been on many committees and many panels and have learned through harsh experience how difficult it is to cut through the differences of language that have arisen as a result of professionalism in all these fields. And though I trust the medical specialists to talk a language that they understand I do not trust the
sociologists and psychologists to do the same. It seems to me that what the question implies is the desire for a synthesis on moral issues not complete agreement but a synthesis. And it's rarely been achieved by committees. The only example I can think of is that of the men who wrote the French encyclopaedia of the 18th century. And I think that's very instructive. First because they were headed by two geniuses and because the great body of the contributors were rather obscure are second rate people who knew that they were so but who happened to be found in France and other parts of Europe to a lesser degree all prepared all imbued with the same general philosophy. Now that happens only after a long struggle and a struggle between one intellectual party and another.
Namely the church and the establishment for the fellows off so that the feelers off were hammered into a kind of synthetic agreement which we now find in these volumes. I don't see how this can happen in a pluralistic society which is. Fragmenting itself more and more each day. And you can bring the fragments together that they do not make a complete sentence. I think this accounts also for what Dr DuBose referred to as the. Inadequacy of our fields of inquiry. But they all seem to be pursued by people coming from a limited. Group. And they are very much divided among themselves. And that's why I believe even in the. Magical on the regulars but at least effective. Action. Deep cultural changes. In other words all that we say or that we write all that we publish and stored away in
libraries for nobody else to read is going to be swept away by the simple operation of history making it all look obsolete and empty of meaning. That's that's the hope. Common in. The fam. This question has been sort of referred to. Briefly. Well legal redefinition of death those healthy parts of the whole organism use for the mother not hearing you right. Well a legal redefinition of death leave those healthy parts of a whole organism useful in medicine. I think. So much about the need for a legal definition. There are maybe just a few comments about just a few words come out about this might help clarify it. I must say that from a practical standpoint as to be perfectly pragmatic and terms
of. Certainly my experience relating to. To the death of patients patients who are about to die. I must say I fail to see really any need to redefine death and terms of any legal criteria I think that. I period that were given but I caring All right I'm time of the committee relate specifically to. Brain death. That is. When an individual might be regarded as dead from a stamp on the brain. I try to bring out my presentation early on that certainly this this is an important criterion.
One can become very unrealistic about it. But this isn't the way it is so to speak and I think that as far as I can tell from our experience I think the current legal basis for Das definition is quite adequate. This stems from I think English long Judge comment on that. It's why I'm not a certified physician certifies a death as a cause. Now we do need perhaps a more precise definition of a medical standpoint. And this is what Dr. Harry was referring to. If we are to them a sense of the present. I'd say the knowledge if we are to meet in transplantation and techniques and procedures. This is partly because to do so now is
required room Uhaul the organs. And at a time when it is still possible to maintain realty keep about. The time during which circulation can be stuck to. And what we call that any scheme week period. But there is a point at which. It no longer becomes part possible to recover all that is for the cells of that argument to a cover function. Beyond a certain time period. And that is a real no matter what you do if you restore circulation after it has been stopped for a period. It's normal to recover the brain of course is the most sensitive brain cells of the most sensitive tissue in this regard.
And that's why you said that if it's a brain suffers a lapse of circulation the rest of circulation for periods of 5 10 minutes or so it may never come again. I think if this is these are the factors under which were working at the time at the present time I'm not sure that I see any reason for having a legal definition of death in existence.
Man and the value of life
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#5 (Reel 1)
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University of Maryland (College Park, Maryland)
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Identifier: 69-22-5 (National Association of Educational Broadcasters)
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