The MacNeil/Lehrer NewsHour

INTRO

JIM LEHRER: Good evening. The major headlines this Friday include the death of Baby Fae, the five-week-old infant with the transplanted baboon heart; the triumphant return to Earth of space shuttle Discovery and its five astronauts; the arrest of 2,300 blacks in South Africa; and the decision by the U.S. government to send another $37.5 million in famine aid to Africa. Robin?

ROBERT MacNEIL: On the NewsHour tonight, after we summarize the days news, we focus on three stories. First, the death of Baby Fae; three doctors debate the medical wisdom and ethics of the baboon transplant. Then Judy Woodruff tracks the pressures on Budget Director David Stockman as he tackles the record deficit. And a bank analyst tells us why federal regulators are getting tough with big banks.

MacNEIL: Baby Fae, the infant girl who made medical history when doctors gave her a baboon's heart, died last night, a few hours after Loma Linda University Hospital reported her in serious but stable condition. She began to experience kidney failure and then the animal heart gave out after working in her tiny chest for three weeks. Until last night her doctors said the five-week-old infant was recovering after her body attempted last weekend to reject the heart. At a press conference today an emotional Dr. Leonard Bailey, the chief surgeon, praised Baby Fae for her contribution to science.

Dr. LEONARD BAILEY, Baby Fae's surgeon: For her part I and my colleagues believe Baby Fae has opened new vistas for all, including the as-yet-unborn infants with similar lethal heart disease. The Baby Faes and their parents are the real pioneers in this quest to enrich our quality of life. Today we grieve the loss of this precious life which could have been an absolute loss to her loved ones. Her unique place in our memories will derive from what she and her parents have done to give rise to a ray of hope for the babies to come.

MacNEIL: Dr. Bailey said he plans to do more such transplants in the near future. For our first focus section after the news summary we'll examine the medical and ethical questions that have surrounded this case from the beginning, but now surface more urgently. Jim?

LEHRER: Space shuttle Discovery landed safely and triumphantly this morning as five astronauts, having made history's first salvage expedition into space. Inside the spacecraft were two communications satellites the Discovery team found, retrieved and then packed away to be repaired on earth and eventually to fly another day. This was the scene after touchdown this morning at Cape Canaveral, Florida.

MISSION CONTROL [voice-over]: Mission Control, Houston. We now have exit of the 51-A crew led by commander Rick Hauck, of pilot Dave Walker, Mission Specialist Joe Allen, Anna Fisher and, bringing up the rear, Dale Gardner. They're being met by director of flight crew operations, George W. S. Abbey from Johnson Space Center.

LEHRER: The mission was for eight days and 3.3 million miles. The next shuttle is due off the ground in January.

To another, very different subject. The chairman of the U.S. Civil Rights Commission today labeled the concept of comparable worth a "loony idea." Clarence Pendleton said the idea of forcing higher pay for many jobs traditionally held by women simply won't work. Pendleton's views were expressed in a Washington news conference held by him and commission staff director Linda Chavez. Here's what each had to say.

LINDA CHAVEZ, staff director, U.S. Civil Rights Commission: Most people, I think, believe in equal pay for equal work. It is certainly a part of our legal system. It is a part of federal law. And we wholeheartedly endorse that. But when you begin to try and talk about paying equal wages for very different and often dissimilar jobs, I think you would find most people not supporting that concept.

CLARENCE PENDLETON, Jr., chairman, U.S. Civil Rights Commission: I'm not speaking for the commissioners, the rest of the commissioners. I think this is probably the looniest idea since "Looneytunes" came on the screen. I think you just cannot begin to do things to the marketplace that has served this country so well.

LEHRER: The Reagan administration and many conservatives, among others, oppose the comparable worth idea. Walter Mondale and many Democrats, as well as leaders in the women's movement, support it.

And, speaking of the Reagan administration, another cabinet member said today he will be sticking around for the second term. A spokesman for Agriculture Secretary John Block said President Reagan asked Block to remain, and the Secretary agreed.

Robin?

MacNEIL: One of the leaders of the Salvadoran guerrillas, Guillermo Ungo, said today his group is willing to consider a unilateral ceasefire and some form of participation in elections next March. Ungo was speaking at a news conference in Washington sponsored by Foreign Policy magazine. Ungo, head of the rebels' political arm, the Democratic Revolutionary Front, said they'd agree to a ceasefire if the Salvadoran army agreed to certain conditions, but he didn't say what they were. The rebels are expected to hold more talks with the Salvadoran government within a few weeks.

Also in Washington today, the Reagan administration announced it's stepping up efforts to ease the famine in Ethiopia. The additional aid was announced at the White House by the director of the Agency for International Development, Peter McPherson.

M. PETER McPHERSON, Agency for International Development: The decisions that we're announcing today are as follows: $37.5 million additional dollars for Ethiopia. That's 85,000 tons of food. That'll bring the total amount we've done to Ethiopia since October 1, about 45 days, to $97.5 millions of dollars. And it amounts to 215,000 ton of food -- an enormous amount by any measure.

MacNEIL: McPherson also said the United States will send $20-million worth of food to three other African countries -- Chad, Mauritania and Mozambique.

In South Africa, police arrested 2,300 black migrant workers following unrest in black townships near Johannesburg. The townships were the center of a recent general strike and rioting in protest against living conditions. Jim?

LEHRER: Our last item in the news summary tonight is about Svetlana, Joseph Stalin's daughter, the one who defected to the West 17 years ago and then returned to the Soviet Union two weeks ago. She held what she said was her last news conference today in Moscow, and she told reporters her decision to return home was done for personal, not political, reasons. But she said she was a favorite pet of the CIA while living in the United States, and that she never really felt free in the so-called free world. The Baby Fae Case

MacNEIL: For our first focus section tonight we come back to the death of Baby Fae and the painful medical and ethical questions it raises. Three weeks ago today doctors at California's Loma Linda University transplanted a baboon's heart into the little girl who became known as Baby Fae. In the five-hour operation a team of doctors replaced the defective heart the baby was born with. Doctors said she probably would have died within hours if the transplant hadn't been performed. For the first two weeks, Baby Fae appeared to be getting along fine. Her doctors, though, said all along they expected her body would try to reject the baboon heart. Finally last Sunday the doctors revealed that Baby Fae was showing mild signs of rejection. In the next few days the hospital admitted the rejection episode was worse than they thought. But as late as Wednesday, after boosting her drug treatment, doctors were saying she was showing definite signs of recovery. Last night she suffered kidney failure and was put on dialysis, and then her heart too began to fail. She died at 9 p.m., Pacific time. Jim?

LEHRER: At that news conference at Loma Linda Hospital today, Dr. Leonard Bailey did some reflecting on what he and his colleagues had done. Dr. Bailey was the heart surgeon in charge.

Dr. BAILEY: While preparing to leave my home this morning, one of my little boys was tuned into "Mr. Rogers," whom most of you know. His guest was the brilliant football star Lynn Swann, and the discussion went something like this: "But, Mr. Rogers, we lost the ballgame." And the response was, "Did you play your best?" "Yes, we did," was the answer. "Then you won," said Mr. Rogers. "Then you won."

I plan to attempt it again by and by. I think we need to look very carefully at what we've learned from Baby Fae. We have already done that to a great degree. And the entire team is remarkably encouraged by what we have learned from her, much of which will be available in scientific form. The last thing that the mom said to me was to not let this experience be wasted, but to carry it on. And I think we'll plan to honor that request.

LEHRER: Heart surgeons and other professionals do not speak with one voice on the Baby Fae case. Some support the original decision to transplant; others do not. One of the supporters has been Dr. Donald Hill, a heart transplant surgeon at Pacific Presbyterian medical Center in San Francisco, where he joins us tonight from public station KQED. Dr. Hill, now that Baby Fae is dead, do you still support the original decision to transplant a baboon's heart?

Dr. DONALD HILL: Yes, I do. Originally I thought it was an acceptable idea, and perhaps even a good idea, to proceed with that surgery, because if you look at it in three possible ways, one was from the standpoint of the child and the family. The child had no opportunity to survive in any other way, and they were giving it an opportunity. From the standpoint of the physicians, they had properly prepared for this. They had done work in an animal lab for five to seven years. They had this piece of information that they hoped was true that a child in its first 20 to 30 days had a poor immune response, and it would be able to -- they would be able to take this little baboon heart and it would find a home inside that child, and the child would not recognize it as a foreigner and allow it to stay there. And that, in fact, turned out to be true to a certain point. And, lastly, from the standpoint of society on the whole, I thought it was a good idea because there is a big problem. And that big problem is that there is 25,000 to 50,000 people per year who are dying with end-stage heart disease and at this point the only viable therapy is to use human-heart transplantation. And that can give you an opportunity, a 50% opportunity to live five years. However, at best, there are 3,000 to 5,000 hearts available. Therefore the only solution to be able to bring care to these people ultimately will be to use artificial hearts such as we are working on and developing, or to be able to use animals that are readily available to do it. And this is, this work that they did represented the first step forward in that, and I think that it was a limited success and perhaps even a very big medical success.

LEHRER: Well, let's go back through your points. In terms of Baby Fae as a person, was it ever reasonable to expect there would be any conclusion other than the one that happened at 9 o'clock last night?

Dr. HILL: I think that -- I mean, my own opinion was that some of the predictions that were made were too optimistic. I don't think there was any reason to believe, based on current medical knowledge, that that child would be able to live 10, 12 or 15 years. But what did turn out to be true, and what they demonstrated very clearly, was that that little window existed that they could get in there and make this heart work that had never been able to be done before and that the reasons, you know, for doing it continued to demonstrate that the cyclosporine in fact had been an effective therapy.

LEHRER: But what about the trauma that this infant child underwent and her parents? Was it worth it to them?

Dr. HILL: Well, I think that when they began they knew, the family knew, that they were undergo a very serious emotional period. But I don't think that that emotional period was a lot worse than many, many families experience when they have a member of their family undergoing surgery, particularly a child. And it was aggravated certainly by the media and exposure. But they were -- they were protected from that quite well.

LEHRER: Now the point about what this has done for medical science. I take it, then, you would agree with Dr. Bailey that this should be tried again and again and again?

Dr. HILL: I agree that it should be -- I agree that it should be tried three or four or five times more for sure, and -- they have done one great immediate service. By demonstrating in this child, that they could keep it alive for five -- I'm sorry, for 20 days, they have demonstrated the principle of bridge to transplantation, and everybody in medical profession are asking themselves --

LEHRER: Excuse me. Explain -- I'm sorry -- "bridge," explain what you mean by that.

Dr. HILL: What I mean by bridge to transplantation is that they used a baboon heart because they did not have readily available a human heart. But now -- everybody predicted, or many people said, that the day of surgery, one day, two days, they were going to reject and they would have lost everything. However, in fact, their original premise was right. That window was there, they did put it in; they held it there for 20 days. Now, for example, they had 20 days to find a human heart and implant it and suddenly give that child a much better and new lease on life. Now, if you do this four or five times, you know, in the next couple of years, and they demonstrate that every time they have that window, and every time they can go 20 days or so and then they reach an enormous impasse that isn't possible to carry that baboon heart any further, they still have that 20 days to work in. And that's the days that they never had before, and it would give the donor banks the opportunity to find human donors that could be implanted and give an immediate opportunity for this child to have a much better, you know, future than with the baboon heart.

LEHRER: All right, Dr. Hill, thank you. Robin?

MacNEIL: Other doctors have expressed doubts about the operation from the beginning. One of them is Dr. Jacques Losman, who is also a heart transplant surgeon at Beth Israel Hospital in Newark, New Jersey. He previously directed the heart transplant program for the pioneer in the field, Dr. Christiaan Barnard in Capetown, South Africa. Do you now think the operation was the right thing to do, Dr. Losman?

JACQUES LOSMAN: No, I have not thought so at any time. And I have not changed my position at the point of view. Basically I like to think that Dr. Bailey did that operation by a reflex of compassion for a child that was dying, with the hope that maybe something exceptional could happen. And, as Dr. Hill mentioned, maybe hoping that a donor -- human donor would become available. However, from what we know, it doesn't seem that he really made a major effort to get a human donor until probably it was too late. If we look at the scientific aspect -- I will leave the ethical aspect for later. If we look at the scientific aspect, I don't think that people in the transplant community are much surprised by what we found. Twenty years ago Dr. Reemsma, the chairman at Columbia University, did kidney transplants using chimps' kidneys in people; Dr. Starzl did some baboon kidneys. And those kidneys worked, and we know that they worked for a couple of weeks, a couple of months. One patient of Dr. Reemsma lived for six months with a chimpanzee kidney. So at that point of view I don't think this experiment has brought much new knowledge. Another point that I question is, knowing what we know at the scientific base, using animal experiments, that all have shown that interspecific transplantation -- that means from one species to another -- fail, be it between dogs and fox, dogs and wolf and different other animals, I don't think there was much scientifical basis to believe that this would work.

MacNEIL: What about the point that Dr. Hill has just made, that it's a significant gain to have proved that this window, as he put it, of non-rejection is there which would have given them time or would, in a future attempt, give them time to find a suitable human donor?

Dr. LOSMAN: No, this is -- I think that many people thought that there would be some kind of window; that it was 20 days in that child may have surprised some. But, as I mentioned, kidneys have worked for months before. So I don't think that that was that much of a discovery. On the other hand, they used the immuno-suppression that we use today. The management of the child --

MacNEIL: That's the drug cyclosporine that was mentioned.

Dr. LOSMAN: Cyclosporine and steroids and soon. There was nothing much new. So at my point of view this was really doing a basic experiment in a child when similar experiments have not been done in animals. From my knowledge, baby monkeys of different species have not been used to transplant theheart from one in the other with different drugs to see how they grow and how they develop. And I think that many people in the scientific community will see a reluctance --

MacNEIL: Did I follow you correctly? You said that it hasn't been tried yet even among species, or between species that are closer to each other?

Dr. LOSMAN: Exactly. Distant or close. It has not been done, and what has been done has been done with poor results. So I think that a lot of people will be reluctant to see other baboon transplants in children before we have sorted out really the means to control rejection.

MacNEIL: What does it say to you that this child lived three weeks longer than she would otherwise have lived?

Dr. LOSMAN: Well, I think that if Dr. Bailey had done this transplant and immediately focused on finding a human donor, then I think that I would agree much more with the procedure and they would have been able, probably, to save the child's life. I'd like to mention also that the kidney failure is most probably a result of the heart rejection, because what happened is that they increased the cyclosporine dosage -- most probably, we don't know, but that's what I guess -- and this drug is very toxic for the kidneys.

MacNEIL: Thank you. Jim?

LEHRER: Do you agree with that, Dr. Hill, that it was the drug that probably caused Baby Fae's death?

Dr. HILL: I think that the drug certainly contributed heavily to the renal damage and the renal shutdown and therefore her death, yes.

LEHRER: All right, let's go through his points. First of all, the question about a human donor. If that had been the purpose from the very beginning, Dr. Losman says, it might have been a better deal.

Dr. HILL: I think that had they had a human donor available and did it originally that way, that certainly would have been a better opportunity for the child. And the logistics of what happened that day are not clear to anybody except a few people. And all I do is accept the fact that they did do that. Now, once they were into it for 10 or 12 days, you can speculate on which was the best course to go. They were saying to themselves, I'm sure, "We have success. We do not have bad rejection. We are controlling it." And they should say, "Should I go ahead and find a donor and put it into this child when we may have a winning situation?" They don't know yet what they're going to have. If time goes -- that's why I think it is so important to do three or four of these, and then they will know what is the natural history of this operation once they implanted a baboon into a child. And if it becomes repetitive -- three or four times that it always causes rejection -- then definitely this is a bridge system and they should find a donor as soon as they can. But on the other hand, the other hand, Dr. Bailey was saying to himself last weekend, "Can I justify finding and doing another operation when perhaps this donor heart is going to go two months, three months or four months?" So it was a medical dilemma and he chose one route and it was unfortunate, but it has contributed some significant and useful information.

LEHRER: Dr. Losman, what do you think of that?

Dr. LOSMAN: Well, I refute that because I think that there is no evidence whatsoever that that heart would have been tolerated. You can have wishful thinking, of course, but at the scientifical basis, never an organ from another species has functioned for a prolonged period of time. So everybody knew that that heart would have been rejected, that once the child's immune system had matured,has gone through that period of low immuno ability after birth it will acknowledge, it will recognize the baboon heart and it would destroy it. And I think that those kind of speculation are not logical. The good way was to take the child when he was in optimal condition and to give him a human heart if, of course, a human heart was available. I do believe that waiting, that things go bad, that you have to give high dose of steroids. Everybody who has been involved in organ transplantation knows that once rejection is there and you treat rejection, the risk of infection becomes enormous, and it is in this typical period that patients develop lethal complications and eventually die.

LEHRER: Dr. Hill, what about Dr. Losman's earlier point, too, that this was done with a human in Baby Fae's case, things that had not even been tried with animals yet?

Dr. HILL: Well, they had been tried with animals. They were not tried with primates, but he has tried this with sheep and goat interspecies --

LEHRER: Who? "He" being Dr. Bailey?

Dr. HILL: Bailey, yes, and he presented this work at a scientific meeting in June at the Western Thoracic, and I had the opportunity to talk to him at that time, and he had a great enthusiasm for this. He's a totally committed guy. And I don't disagree, really, what Jacques just said. This is a medical judgment problem of which there is no immediate answer. If he'd have gone ahead and transplanted the child last weekend when he was healthy and lost the child in the operation, we would have been saying to him, "Why did you do that?" Nobody knows when this child was going to reject. It was true that it was going to reject, but nobody knew when. And that's why I think it is so important to continue to do three or four more of these in small infants where you have, at the beginning, something to offer the child that he no longer has -- which he doesn't have to begin with.

LEHRER: Dr. Losman, I take it you would very strongly disagree with the idea that there ought to be four or five more of these.

Dr. LOSMAN: Well, I would suggest first to do four or five animals first and get some meaningful data. And you have to realize also when you do an experimental protocol you can try different things. We know about children's immune system, how it develops. There are questions. Should the thymus be removed while the --

LEHRER: The what?

Dr. LOSMAN: The thymus. It's a gland in the chest that takes part in the development of the immune system. Should it have been removed? Has it been removed -- we don't know -- during the transplantation? Should maybe some radiation therapy has been added, other drugs? There is lots of possibilities today that we have to try to control and manipulate --

LEHRER: But --

Dr. LOSMAN: -- the tolerance of an organ. Now, you cannot do that in a child, but you can do that in animals. You can take a dozen animals, divide them in two groups, give them different treatment and see the outlook.

LEHRER: What's wrong with that, Dr. Hill?

Dr. HILL: There's nothing wrong with it, and it's true and it's been done. He has done this in interspecies -- with neonate goats and sheep. This work has been presented. It exists.

LEHRER: What about Dr. Losman's point also, his major point that, all said and done, nothing really new came out of this Baby Fae experience?

Dr. HILL: I think there are several things that came out new. I think they demonstrated the premise that in the neonate you have the opportunity during this three or four weeks to get a transplant in there. They have demonstrated the use of cyclosporine in a human with a primate which nobody has known any information about how it might react. And it's true that we can get a lot of that information from animals, but ultimately you cannot directly extrapolate animal data in the human situation. And thirdly, we have data right now to show that you can probably carry this for three weeks and that this would be a viable way to carry a child when you're using -- when you're looking for a human. And those are, to me, three positive things that have contributed to the medical literature that did not exist a month ago.

LEHRER: Thank you. Robin?

MacNEIL: Now a different perspective, from Thomas Murray, who teaches medical ethics at the University of Texas medical branch at Galveston. Prior to that he was at the Hastings Center in New York state, where he founded the research group on the ethics and care of newborns. He's written extensively on the care of newborn babies and human experimentation. From a medical ethical point of view, should there be more baboon transplants, in your view?

Dr. THOMAS MURRAY: Not right away. I think I can be pretty blunt about this. There are three questions you have to ask if you are going to try an experimental treatment which is a desperate measure for a desperate situation like this baboon heart transplant. And the three questions are, first, is the scientific background right? Do we know enough, have we done enough research in animals and in other models to be sure that we have nothing else left to learn and that the next subject is naturally a human being? As you can see from the discussion that has just taken place, that's far from settled in this case. The second question is, we can only do a experiment that is a life-or-death experiment if there is no alternative therapy available that would be superior. And there has been questions raised about that, particularly about the possible availability of another human heart. The third question is, we have to get the informed consent of the subject to the experiment or, lacking that -- this baby could not give her own consent -- of someone who'll be looking out for her welfare, her parents. And we have been told that that happened, though we've been given very little information about that, in contrast to some other also dramatic and important experiments, such as the one on Barney Clark. So I think until we get solid answers to those questions we can't say yes to further experiment. In fact, I want to make a proposal. I would suggest that Loma Linda would be -- it would be prudent for them to ask for a committee made up of some nationally prominent scientists -- people in cardiac surgery, transplantation, immunology -- and some experts of the ethics of human-subject research to review the case of Baby Fae, to hold a moratorium on any further baboon transplants until that review has been completed.

MacNEIL: You mean reviewing it, having access to all the records?

Dr. MURRAY: Having access to the records, having access to the scientists and to the scientific background papers, and making a dispassionate decision about whether or not it is right to do this with more babies.

MacNEIL: The case was reviewed in advance, the proposed operation, by Loma Linda University Hospital's own medical ethics committee and was passed on. Isn't that sufficient, in your view?

Dr. MURRAY: It would be for more common kinds of research. This is extraordinary. There aren't many people in this country, I suspect, who are really equipped scientifically to fully evaluate the kind of information that you would need to be able to evaluate in order to make an intelligent decision about such a complex, novel and dramatic operation. And it's -- the evidence isn't there. We don't know whether that expertise exists at Loma Linda or not. If it does, it probably exists in Dr. Bailey and perhaps other members of his team, but in a way we want a committee, and this is the usual model of such committees, that is a bit removed from the situation.

MacNEIL: Are the three questions you said are the basis of an ethical experimentation on a human being, are they widely accepted as the three -- as three criteria for such an operation, or are they just your own here?

Dr. MURRAY: Oh, I think they'd be widely accepted. People might phrase them a little differently, but those are really the questions you ask in the review of a medical experiment.

MacNEIL: Then are you not saying this was not an ethical operation because it didn't conform -- you didn't get positive answers to those three questions?

Dr. MURRAY: I'm saying that in some cases we lack the information to be sure that enough was known to make it ethically acceptable, yes. In the case of the scientific information, that is a debate that I can listen to and try to comprehend, but I don't fully yet. In the case, though, of the availability of an alternative therapy, I think that is a more serious critique at this point.

MacNEIL: Well, let's go round on these points. Dr. Hill, availability of alternative therapy. Two have been mentioned; one is the alternative of a human heart perhaps being available. The other is an operative procedure which in fact was used only yesterday in Boston on a six-week-old Florida baby with a similar condition and failed. And the child died. What do you think about alternatives to the baboon transplant?

Dr. HILL: Let me begin by saying I agree with all three points that were brought up, and the answers to them, of course, are judgmental, and it depends on where you sit as being an optimist or a conservative that might influence how you answer. In terms of alternative therapy, of course the first alternative therapy, would -- if they'd had an alternative human heart, would have been the way to do it. And I think everybody agrees on that. But they didn't, for logistical reasons that we can't go into. The other thing is the Norwood operation, and that operation is also experimental and it's being done in two places, and the results even of the people that are doing it say that are not enormously optimistic for the future and particularly not for a long-term result.

MacNEIL: It's a two-stage procedure, isn't it?

Dr. HILL: It's a two-stage procedure, and only several children have gotten through the second stage. And I would say that what that is, it's a palliative procedure, and it may in fact be also a bridge to transplantation, and I don't advocate that we shouldn't pursue that. That route should be pursued diligently by those people in Philadelphia and Boston who have worked very hard on it. And it may in a few years turn out to be the true bridge to transplant. Maybe they will perfect it that far. But that doesn't mean that you shouldn't look at a baboon. I mean, he operated with the baboon heart and the child lived for three weeks. He also -- and yesterday there was an operation in Boston and the child did not survive the operation. And both of these are very experimental, and they're both in the learning phase, but I would support that both of them should go forward so we in fact know it.

MacNEIL: What do you think, Dr. Losman, of the ethical position on alternatives?

Dr. LOSMAN: Well, alternatives open very large ethical questions, and I think that they go beyond ethics to, really, your philosophical attitude because, indeed, a human heart transplant would have been preferable. The Norwood procedure, I think, would be the operation of choice, but as I mentioned, as Dr. Hill mentioned clearly, there is still a very high mortality of 30, 40 percent in the best hands with this procedure. And following the procedure, at the end of those two operations, the child is still with a very abnormal heart because he has only a single ventrical. So I think the problem of ethics is really to know if, with our knowledge of today, we have the right -- and I would say that review committees have very little to do with that -- if we have the right to put a child or patient through a procedure that has a very little, limited life expectancy.

MacNEIL: Let's bounce that off Dr. Murray -- the child's quality of life, the quality of life of this small human infant. Is it enhanced by prolonging its life, no matter what, for three weeks, or letting it die, or what? And is that a part of the ethical dilemma?

Dr. MURRAY: Well, I think it is. I think it is. Let me put the question a little bit differently. People are naturally and understandably enthusiastic about a new therapy that they think might hold some hope, however slim and however uncertain for a child who is otherwise almost certainly going to die. So I can understand the enthusiasm that motivates a committed surgeon to want to try something new if it can save the life of a child. It is in a way almost to restrain that kind of enthusiasm, which can run sometimes beyond the bounds of good sense, that we have set up these review committees, because we recognize that in addition to medical experiments opening the horizons for us, they also do some bad things. For example, if the child were going to die sooner without the pain of an operation, that might have been a better death for that infant, that particular baby. If a parent's hopes are raised unrealistically, the loss of the child might be more painful.And if other parents who are now -- this is not an uncommon condition. As other parents of children with hypoplastic ventricle see this, they may hold out unrealistic hope to save their children. And I don't think we should mislead the public about there being another therapy available when it really is just a --

MacNEIL: Dr. Hill, what's your answer on that point, that you advocate three or four or five more of these. What about the hopes of the parents?

Dr. HILL: I think that medicine lives on hope a lot of the time, and not only in heart disease but in cancer and everything like that. And doctors are always inspiring hope into patients. What Dr. Murray said, I think, is true. There is an enthusiasm and a positiveness among surgeons to always advocate hope, but I don't think that this family was unrealistically informed of what the future was. I mean, they were told, I'm certain, that it'd never been done before. You wouldn't have to know anything about medicine to know that putting a baboon heart was new and daring to do.

MacNEIL: Well, gentlemen -- I'm sorry to cut you off there, Dr. Hill, but we have to move on and I know this is a discussion that's going to go on and on. We'll come back to it. Thank you all for joining us. Jim?

Dr. HILL: Thank you very much.

LEHRER: Still to come tonight on the NewsHour, Judy Woodruff tells the story of deficits, taxes, politics and David Stockman, and banking expert John Lyons explains new government actions against two of the nation's largest banks. David Stockman: Dealing with the Deficit

LEHRER: Among the things the President of the United States did today was to accept a 53-pound Thanksgiving turkey from a North Carolina turkey farmer. A reporter had a question.

REPORTER: Mr. President, is it true that his name is Budget? It isn't true that his name is Budget, is it?

Pres. RONALD REAGAN: If I said his name was Deficit it would scare him to death.

LEHRER: All of this is by way of introducing our next focus segment on the federal deficit. Judy Woodruff did the work on it. Judy?

JUDY WOODRUFF: Jim, throughout this week President Reagan and his top advisers have been meeting to begin to thrash out the shape of next year's federal budget. It's an annual ritual in the nation's capital, but this year it may be as agonizing a process as it's been for some time, because of certain economic and political realities. We decided to take a closer look at the process from the perspective of someone who could turn out to be the lonely warrior in all this, Budget Director David Stockman.

WALTER MONDALE, Democratic Presidential candidate [November 7, 1984]: I think that this national debt, that problem is the equivalent of the domestic hydrogen bomb.

WOODRUFF [voice-over]: Walter Mondale's failure to make a cutting issue out of the mountain of red ink in the federal budget hurt him as much as anything in the election. His pledge to raise taxes to cure it may have been the kiss of death.

Pres. REAGAN [November 3, 1984]: Many of those rumors suddenly that are being floated around desperately in these last couple of days about some suspected tax increases from our side -- over my dead body!

WOODRUFF [voice-over]: If there was one promise that echoed throughout President Reagan's landslide, it was his pledge not to raise taxes. But the victory celebrations were barely over when reports surfaced in Washington of even bigger deficits, hinting that higher taxes might be necessary after all. What had been $200 billion in projected red ink at the first of the year, and melted down to about $170 billion during the summer, was now back up to $200 billion and more, largely because of a slowdown in economic growth. The man behind the bad news was Budget Director David Stockman, the whiz kid who, in 1981, had infuriated the Congress and dazzled the public and the new President with his mastery of budget detail and bold suggestions of ways to slash domestic spending. He fell from grace a year later when he shared his misgivings about the Reagan economic philosophy with a reporter. Some thought it was just a matter of time before he packed his bags, but that never happened. Economist Alan Greenspan.

ALAN GREENSPAN, economist: His role has been so crucial to this whole administration and process that he, in effect, after being temporarily in considerable difficulty, I think, has come back quite admirably.

WOODRUFF [voice-over]: Just as he did four years ago, Stockman is stressing that government spending is out of control and has to be reined in. But, unlike four years ago, this time the underlying message is that the problem persists, despite Reagan administration promises that a growing economy would make it go away. Stockman's former chief economist at the Budget Office, Lawrence Kudlow.

LAWRENCE KUDLOW, economist: After two very good economic growth years, the budget deficit now seems to have bottomed out, and it looks as though for FY85 and FY86 and FY87, the budget deficit is going to rise rather than continue to fall. And this does run counter to some of the campaign assumptions and some of the assumptions of some of the optimistic people in the White House.

WOODRUFF [voice-over]: One of the most optimistic is the President himself, who did say repeatedly during the campaign that deficits could be largely wiped out by a thriving economy. Stockman's news is no more welcome to Mr. Reagan that it is to one of the biggest promoters of optimistic economics and author of the massive '81 tax cut, New York Congressman Jack Kemp. He calls the new deficit projections "hysteria."

Rep. JACK KEMP, (R) New York: That's the modus operandi of OMB over the past three years, has been to try to frighten the country and the Congress and probably the White House into believing that the only way to get the deficit down or get interest rates down is by draconian cuts and/or tax increases. And I don't think it's going to fly this time.

WOODRUFF: Are you saying they're cooking the numbers?

Rep. KEMP: I'm not saying cooking the numbers, but it's the gloom and doom out of OMB that we've been getting, and CBO as well, as it's based upon slower growth. It's based upon higher interest rates.Those things are not fait accompli.

WOODRUFF [voice-over]: What almost everyone agrees, even Kemp, is that the deficit should be shrunk. Beyond that, unity is hard to find.

Repj. RICHARD GEPHARDT, (D) Missouri: I think there's a split in the administration. I think some of the President's advisors believe that the rhetoric got out of hand in the campaign, that it shouldn't have gone that far, that this deficit really is a problem. I think another half of the administration, or other advisors believe that you don't need to treat the deficit, and they would say if there are any cuts in the budget that need to be made, do them on the spending side. Push Congress as hard as you can push them, make rough proposals, get what you can, and then what you can't get we will grow out way out the problem.

WOODRUFF [voice-over]: Congressman Richard Gephardt is a Democrat, but his assessment of the divisions within the Reagan ranks is borne out by numerous administration officials. Unlike some of the President's more conservative aides, like Ed Meese, Stockman believes the White House would be asking for trouble if it asks Congress just for deep new cuts in domestic programs.Lawrence Kudlow puts the Stockman view this way.

Mr. KUDLOW: If we are to pull all the power centers together that are so important in our political and legislative process, we're going to have to have a compromise. And the compromise is going to have to include three principal areas, starting with domestic spending discipline, moving on to defense spending discipline, and finally moving into the equally controversial area of tax increases or revenue enhancement.

WOODRUFF [voice-over]: The problem, of course, is that those last two areas are precisely what the President has said he doesn't want to do. And that leaves the budget director fighting some very lonely battles -- battles not made any easier since he appeared to betray Mr. Reagan's confidence in him with that magazine interview in 1982. Alan Greenspan talked with producer Mike Mosettig.

Mr. GREENSPAN: I think clearly his capacity to do what he did in 1981 is significantly less. But there's no way that he can be sensed as being a minor player. It's important that somebody formulates what the various different potential solutions are, and there's no question that Stockman is far and away the best-equipped to do that. It doesn't however, that he is capable of selling whatever solutions he comes up with either to the President or to the Congress.

WOODRUFF [voice-over]: To many Democrats on Capitol Hill, however, Stockman's is one of the few voices of economic reason in the Reagan administration.

Rep. GEPHARDT: I think he holds the majority view of economist, which is deficits do make a difference and you can't get rid of them simply by growing out of the problem, and that you have to take a series of specific actions in the budget process to change that deficit path.

WOODRUFF [voice-over]: Ironically, it's a different story with some Republicans, like tax-cut disciple Jack Kemp, who four years ago at this time teamed up with Stockman to sell his so-called supply-side economic ideas to the President.

Rep. KEMP: I think there is a prevalent idea in both political parties at times that, you know, fiscal matters are the sine qua non of economic policy, and you hear it -- you heard it from Walter Mondale at times. Mondale lost. I mean, the Stockman view of the deficit lost in the election.

WOODRUFF [voice-over]: Kemp says he doesn't know why Stockman's views have changed. Kudlow's explanation is this.

Mr. KUDLOW: I think he's had the intellectual courage to admit that we aren't always so darned smart and that we don't know every single answer for every single problem, and a little trial and error is going to be necessary.

WOODRUFF [voice-over]: However Stockman's ideas have changed from the start of the first Reagan term, unlike then he must now compete with a handful of other influential advisors all trying to press their point of view on the President, from Treasury Secretary Donald Regan and White House aide Ed Meese, who oppose any tax increase as much as the President does, to Defense Secretary Caspar Weinberger, who will fight any cuts in his budget, to White House Chief of Staff James Baker, who may or may not end up as an ally of Stockman's. In the end, of course, it is Mr. Reagan who calls the shots, and many close observers of the tough budget choices facing him who agree with Stockman on the need for a compromise, are worried that the President won't compromise or worried that the President won't come around to that view.

Mr. GREENSPAN: The President has got to be in the forefront of the solution, and he probably has to lead the operation wherever it requires leadership. At the moment he has not made that decision, but I don't see a solution unless he does.

WOODRUFF [voice-over]: Congressional Democrats echo Greenspan, saying if the administration decides a tax increase is necessary, the President himself and not the Democrats will have to make the first move.

Rep. GEPHARDT: He just won an election saying that we didn't need to do anything with regard to the budget. We'd grow out of the problem. He got 60% of the vote. I think it's unreasonable to turn to Democrats in the Congress and say now you have the responsibility to change that path, to propose very different solutions, to try to drive them through the Congress and change what the President supposedly got a big vote for. It isn't going to happen and it shouldn't happen.

Mr. KUDLOW: I find that the probabilities of gridlock are sufficiently high at this stage to be scary.

WOODRUFF [voice-over]: In the face of such grim prospects, and given what he's been through already, why does someone like David Stockman keep at it?

Mr. KUDLOW: I think he is willing to make the good fight. In other words, having been through this process many times before, I think Dave believes that if you fail, you just pick yourself up and keep moving ahead and do the best you can.

WOODRUFF: Of course, as we keep hearing, the amount of time the President has to get a favorable deal from the Congress may not last beyond next summer, and that means the pressure is on. For what it's worth, however, most people I talked with said they don't expect any meaningful action on the deficit until there's some kind of a serious further downturn in the economy. Those same concerns were reflected on Wall Street today. At the close, the Dow Jones industrial average was down more than 18 points because investors were worried, both about a slowdown and the prospect that the President and the Congress may not be able to agree on a way to cut the deficit. Big Banks: Shape Up

MacNEIL: For our final focus section tonight we turn to some unusual developments in the banking world. It was disclosed yesterday that the comptroller of the currency, the chief regulator of national banks, has clamped down on two of the largest, Bank of America and First National of Chicago, because they've lost millions in bad loans. He's forced them to agree to strengthen their capital base and improve their procedures to guard against losses from bad loans. When this unprecedented agreement became public today, bank stocks declined.The comptroller required the banks to do these things: increase the amount of money they set aside for problem loans, raise the ratio of capital funds on hand relative to total assets, make bank directors approve some major loans, and permit the government to sue the banks if they fail to comply. First Chicago is reported to have had bad loan losses of $268 million, and Bank of America almost $150 million. For more on the comptroller's action and its significance for the banking industry, we talk with a top banking analyst. John Lyons is a former bank regulator who now runs his own New York consulting firm.

Mr. Lyons, why is the comptroller getting tough with these big banks?

JOHN LYONS: Well, a few weeks ago in the aftermath of the Continental Illinois fiasco, the comptroller of the currency was very, very harshly criticized by Congress, and that criticism was aimed at the comptroller not so much as an investigator as an enforcer.As an investigator he is without peer. He was able to determine that there were serious problems at Continental Illinois three or four years before they surfaced. What he was criticized for was the fact that he could not enforce his findings; he could not prevent them from getting into further difficulties.

MacNEIL: So now he's demonstrating he's --

Mr. LYONS: He's demonstrating that he's tough.

MacNEIL: Does this mean that he's seriously worried about the financial condition of two of the biggest banks in the nation?

Mr. LYONS: I have to believe that he is concerned; he's very seriously concerned. There's just too many instances of this. I would have said two years ago, no, this is isolated. I would have said nine months ago, no, this is isolated. It's just happened too many times; he's got to be concerned.

MacNEIL: What kind of bad loans are they getting into? Where is the money going and not being repaid?

Mr. LYONS: Well, in this case it's not necessarily to foreign countries. In this case it's -- there are some energy-related credits that are left over from the decline in oil prices. In California -- the real estate market in California is extremely poor, so that a lot of loans that would have been made to developers based on the value of property, the values disappeared. And the banking institutions involved here were a little slow at recognizing just how difficult some of those credits were.

MacNEIL: Are these loans that wise banking procedures would not have permitted to be made? Conservative or prudent --

Mr. LYONS: Well, you'd have to go back several years to say that they were not conservative or imprudent. People have a tendency, bankers have a tendency to act as a herd, and if loans of this nature are being made elsewhere, they're being made by their colleagues, they'll have a tendency to make them as well and change the standard for what's prudent or what's conservative.

MacNEIL: Is the measure that he's proposed, or required them to agree to, to increase their capital base, is that really so draconian? Do I understand it correctly, that it's from 5% to 6%?

Mr. LYONS: Well, yes it is. Five percent to 6% is --

MacNEIL: Is that a draconian measure? Is that a really tough measure?

Mr. LYONS: Well, we're talking about enormous numbers. In the case of Bank of America we're talking about $120 billion. So from 5% of $120 billion to 6% of $120 billion is an enormous amount of money.

MacNEIL: That means they've got to put that chunk of money in there and not do anything with it. It's just got to sit there?

Mr. LYONS: Not really. The money is still at work. The capital funds are really just an accounting memento. It's just the difference between assets and liabilities. All the money in a banking institution, with some exceptions, is really at work, including the capital funds. It's just that they must have more assets than they have liabilities.

MacNEIL: I see. What is your assessment? You're an analyst of banks. What is your assessment of the financial condition of these two banks?

Mr. LYONS: Well, the two banks are of course among the largest in the world and, separating them, Bank of America has a consumer deposit base that's second to none. It probably has the strongest consumer deposit base in the whole country, and that form of deposit base covers a multitude of sins.

MacNEIL: Very simply, lots of Americans have got money in the bank.

Mr. LYONS: American people, not American institutions as much as American people. Yes, that's right. In the case of First Chicago, the state of Illinois does not permit branch banking. And, as a result the First National Bank of Chicago, as was the case with Continental Illinois; cannot get down into the soil with the people and draw their funds. So First National Bank of Chicago will depend very heavily on institutions that they'll buy money from. Institutions are not nearly as loyal to an institution as would be the people. So as a result there's always a concern --

MacNEIL: And to go overseas for money too?

Mr. LYONS: Very strongly overseas, very strongly, as did Continental Illinois.

MacNEIL: And those are people who, if there were a scare about a bank's stability, could pull their money out overnight?

Mr. LYONS. That's right.

MacNEIL: And little depositors don't do that?

Mr. LYONS: Well, they don't. They're so protected -- they're fully insured, and they're so protected that there's really no reason for them to pull their money out. With respect to the very large institutions, they have so many alternatives to place their money that they just -- no one is paying them enough to take a chance, so they won'ttake a chance. And if there's anything wrong at all they'll leave, and that's primarily the way institutions act.

MacNEIL: Briefly, is this a good thing he's doing?

Mr. LYONS: I think it is. I think it's good. I think that he has warned everyone, as several of the other regulators have warned them, that he's going to the marketplace to bring back discipline on the banking system, that he's not goint to impose the discipline. He's going to tell the world that something is wrong and let the world impose their discipline on the banks --

MacNEIL: Through their stocks falling and --

Mr. LYONS: It's a sledgehammer, but I think it's probably effective.

MacNEIL: Thank you. The sledgehammer of time has just hit us. Jim?

LEHRER: Yes, again the major news of this Friday. Baby Fae is dead. The five-week-old infant with the transplanted baboon heart died last night of kidney and then heart failure.Her case has triggered an argument within the medical and other communities that promises to be around for awhile.

And space shuttle Discovery made a successful return to Earth, its five astronauts completing a successful eight-day, 3.3-million-mile mission that included retrieving and returning two wayward communications satellites.

Good night, Robin.

MacNEIL: Good night, Jim. That's our NewsHour for this day and this week. We'll see you again on Monday night. I'm Robert MacNeil. Good night.