Human Persons, Human Persons, Pragmatism, & DeathPragmatism, & Death

Presented by:Presented by:

D. Scott Henderson, Ph.D.D. Scott Henderson, Ph.D.

“The boundaries which divide Life from Death are at best shadowy and vague. Who shall say when the one ends, and the

other begins?”

Edgar Allen Poe

The Premature Burial

1966 Ciba Foundation 1966 Ciba Foundation SymposiumSymposium

The deterioration of organs (kidneys) The deterioration of organs (kidneys) obtained from cadavers. obtained from cadavers.

The possibility of procuring more The possibility of procuring more viable organs from brain-injured viable organs from brain-injured patients.patients.

Uncertainties in diagnostics. Uncertainties in diagnostics. Potential ramifications on the Potential ramifications on the

reputation of the medical profession reputation of the medical profession in general.in general.

1967 First Human to 1967 First Human to Human Heart TransplantHuman Heart Transplant

Christiaan Christiaan BarnardBarnard

South African Heart South African Heart SurgeonSurgeon

Harvard ReportHarvard Report

1.1. Clinical description of Clinical description of irreversible coma irreversible coma

2.2. Procedures for its diagnosis Procedures for its diagnosis

3.3. Justifications for this new Justifications for this new criterion for diagnosing criterion for diagnosing deathdeath

Harvard ReportHarvard Report

““With increased experience and With increased experience and knowledge and development in the knowledge and development in the field of transplantation, there is field of transplantation, there is great need for the tissues and great need for the tissues and organs of the hopelessly comatose organs of the hopelessly comatose in order to restore to health those in order to restore to health those who are still salvageable.” who are still salvageable.” Manuscript Draft of 11 April, 1968,” Henry Manuscript Draft of 11 April, 1968,” Henry K. Beecher, K. Beecher, Henry K. Beecher ManuscriptsHenry K. Beecher Manuscripts. .

Harvard ReportHarvard Report

““There is indeed a life-saving potential in the new There is indeed a life-saving potential in the new definition, for, when accepted, it will lead to definition, for, when accepted, it will lead to greater availability than formerly of essential greater availability than formerly of essential organs in viable condition, for transplantation, organs in viable condition, for transplantation, and thus countless lives now inevitably lost will and thus countless lives now inevitably lost will be saved…At whatever level we choose to call be saved…At whatever level we choose to call death, it is an arbitrary decision. . .It is best to death, it is an arbitrary decision. . .It is best to choose a level where, although the brain is choose a level where, although the brain is dead, usefulness of other organs is still present. dead, usefulness of other organs is still present. This we have tried to make clear in what we This we have tried to make clear in what we have called the new definition of death.” have called the new definition of death.” Henry K. Henry K. Beecher and H. I. Dorr, "The New Definition of Death: Some Opposing Views," Beecher and H. I. Dorr, "The New Definition of Death: Some Opposing Views,"

International Journal of Clinical PharmocologyInternational Journal of Clinical Pharmocology 5 (1971): 120-1 5 (1971): 120-1

BeecherBeecher

Sought to:Sought to:

1.1. Increase the supply of organsIncrease the supply of organs

2.2. Defend transplant surgeons Defend transplant surgeons from the perception of being from the perception of being organ-stealing killersorgan-stealing killers

3.3. Employ brain-dead bodies for Employ brain-dead bodies for experimentationexperimentation

Harvard ReportHarvard Report

““Can society afford to discard the Can society afford to discard the tissues and organs of the tissues and organs of the hopelessly unconscious patient hopelessly unconscious patient when he could be used to restore when he could be used to restore the otherwise hopelessly ill, but the otherwise hopelessly ill, but still salvageable individual?”still salvageable individual?”

Henry K. Beecher, "Ethical Problems Created by the Hopelessly Unconscious Henry K. Beecher, "Ethical Problems Created by the Hopelessly Unconscious

Patient." Patient." New England Journal of MedicineNew England Journal of Medicine 278 (1968): 1427 278 (1968): 1427

Harvard ReportHarvard Report

The new criterion provided a The new criterion provided a means to obtain fresher means to obtain fresher transplantable organs from transplantable organs from heart-beating brain-dead heart-beating brain-dead donors without violating the donors without violating the Dead Donor Rule.Dead Donor Rule.

ObservationsObservations

1.1. No references to scientific No references to scientific literatureliterature

2.2. No explanation as to why No explanation as to why irreversible coma is deathirreversible coma is death

3.3. No conceptual basis, biological No conceptual basis, biological or philosophicalor philosophical

4.4. Justification based on pragmatic Justification based on pragmatic groundsgrounds

IntervalInterval

Conflicting legal rulings and state Conflicting legal rulings and state statutes emergedstatutes emerged

Multiple sets of diagnostic testing Multiple sets of diagnostic testing criteria emergedcriteria emerged

Lack of uniformity in medical Lack of uniformity in medical practicepractice

Created confusion on many levelsCreated confusion on many levels

President’s Commission President’s Commission ReportReport

President’s Commission President’s Commission ReportReport

The tests for diagnosing The tests for diagnosing brain death brain death

The clinical criterion for The clinical criterion for brain death brain death

The definition or conception The definition or conception of death of death

Model Statute Model Statute

Whole-Brain DeathWhole-Brain Death

Ad hocAd hoc ArbitraryArbitrary UnnecessaryUnnecessary

• It is ad hoc because it was created as a solution It is ad hoc because it was created as a solution to the problem of obtaining viable to the problem of obtaining viable transplantable organs. transplantable organs.

• It is arbitrary because there are no good It is arbitrary because there are no good reasons to think that the diagnostic tests reasons to think that the diagnostic tests conform to the criterion or the criterion to the conform to the criterion or the criterion to the definition. definition.

• It is unnecessary because traditional ethics and It is unnecessary because traditional ethics and case law allow for the removal of life-support for case law allow for the removal of life-support for patients whose condition falls under the moral patients whose condition falls under the moral classification of extraordinary care.classification of extraordinary care.

PragmatismPragmatism

Is an empirically based philosophy that defines knowledge and truth in terms of practical consequences.

Is anti-essentialist and anti-foundationalist.

Truth is constructed by the vocabulary or concepts one brings to the world in efforts to effect desired results.

Youngner & ArnoldYoungner & Arnold

1.1. It allowed physicians to turn off It allowed physicians to turn off ventilators on brain-dead ventilators on brain-dead patients. patients.

2.2. It allowed physicians to procure It allowed physicians to procure vital organs from brain-dead vital organs from brain-dead patients for transplantation. patients for transplantation.

3.3. Pragmatic & UtilitarianPragmatic & Utilitarian

Arthur CaplanArthur Caplan

New Standard Works:New Standard Works:

Social acceptance.Social acceptance.

Avoidance of legal challenges.Avoidance of legal challenges.

Success on procuringSuccess on procuring

Truog & LizzaTruog & Lizza

Medical & legal fiction.Medical & legal fiction.

Death is a social construct.Death is a social construct.

Personhood & death can Personhood & death can change.change.

Problems via Koterski, Problems via Koterski, Pellegrino, & MitchellPellegrino, & Mitchell

Legal & social acceptance is not Legal & social acceptance is not an argument. an argument.

Personhood & death not relative. Personhood & death not relative. Confusion of social esteem with Confusion of social esteem with

ontological status.ontological status. Slippery slope? Slippery slope? Euphemisms/Reductive Euphemisms/Reductive

terminologyterminology

Pragmatism’s ProblemsPragmatism’s Problems

UnintelligibleUnintelligible

Social consequencesSocial consequences

Insufficient as a moral Insufficient as a moral systemsystem

New Diagnosis of Death

1. Take into account the key bodily systems responsible for maintaining the life of the organism as a whole

2. Include consideration of the cardiovascular, respiratory, and nervous systems conjointly

3. A person experiencing permanent cessation of the functions associated with these systems is dead

Alternatives

1. Heart patients now survive as long as those who receive heart transplants

2. Development of the biologic heart3. Artificial liver grown from umbilical

chord srem cells4. Human bladder grown from patient’s

own cells5. Re-seeding hearts taken from cadavers6. Sustained, committed, long-term

emphasis on disease and injury prevention

AlternativesAlternatives

U.S. scientists create artificial lungs, of U.S. scientists create artificial lungs, of sortssorts

By Julie SteenhuysenBy Julie Steenhuysen

CHICAGO | Thu Jun 24, 2010 2:45pm EDTCHICAGO | Thu Jun 24, 2010 2:45pm EDT

CHICAGO (Reuters) - Two U.S. teams have CHICAGO (Reuters) - Two U.S. teams have taken major strides in developing lab-taken major strides in developing lab-engineered lung tissue that could be used engineered lung tissue that could be used for future transplants or testing the for future transplants or testing the effects of new drugs.effects of new drugs.

http://www.reuters.com/article/idUSTRE65N5AF20100624http://www.reuters.com/article/idUSTRE65N5AF20100624

AlternativesAlternatives

Scientists create liver cells from Scientists create liver cells from patients' skinpatients' skin

By Kate KellandBy Kate Kelland

LONDON | Wed Aug 25, 2010 6:31pm EDT LONDON | Wed Aug 25, 2010 6:31pm EDT

LONDON (Reuters) - Scientists have created LONDON (Reuters) - Scientists have created liver cells in a lab for the first time using liver cells in a lab for the first time using reprogrammed cells from human skin, reprogrammed cells from human skin, paving the way for the potential paving the way for the potential development of new treatments for liver development of new treatments for liver diseases that kill thousands each year.diseases that kill thousands each year.

http://www.reuters.com/article/idUSTRE67O4RC20100825http://www.reuters.com/article/idUSTRE67O4RC20100825

AlternativesAlternatives

More to come . . .More to come . . .