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

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by Dr. Scott Henderson, Assoc. Professor at Luther Rice Seminary

by Dr. Scott Henderson, Assoc. Professor at Luther Rice Seminary

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  • 1. Human Persons, Pragmatism,Human Persons, Pragmatism, & Death& Death Presented by:Presented by: D. Scott Henderson, Ph.D.D. Scott Henderson, Ph.D.
  • 2. “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
  • 3. 1966 Ciba Foundation1966 Ciba Foundation SymposiumSymposium  The deterioration of organs (kidneys) obtainedThe deterioration of organs (kidneys) obtained from cadavers.from cadavers.  The possibility of procuring more viable organsThe possibility of procuring more viable organs from brain-injured patients.from brain-injured patients.  Uncertainties in diagnostics.Uncertainties in diagnostics.  Potential ramifications on the reputation of thePotential ramifications on the reputation of the medical profession in general.medical profession in general.
  • 4. 1967 First Human to Human1967 First Human to Human Heart TransplantHeart Transplant Christiaan BarnardChristiaan Barnard South African HeartSouth African Heart SurgeonSurgeon
  • 5. Harvard ReportHarvard Report 1.1. Clinical description of irreversibleClinical description of irreversible comacoma 2.2. Procedures for its diagnosisProcedures for its diagnosis 3.3. Justifications for this new criterionJustifications for this new criterion for diagnosing deathfor diagnosing death
  • 6. Harvard ReportHarvard Report ““With increased experience and knowledgeWith increased experience and knowledge and development in the field ofand development in the field of transplantation, there is great need for thetransplantation, there is great need for the tissues and organs of the hopelesslytissues and organs of the hopelessly comatose in order to restore to healthcomatose in order to restore to health those who are still salvageable.”those who are still salvageable.” ManuscriptManuscript Draft of 11 April, 1968,” Henry K. Beecher,Draft of 11 April, 1968,” Henry K. Beecher, Henry K.Henry K. Beecher ManuscriptsBeecher Manuscripts..
  • 7. Harvard ReportHarvard Report ““There is indeed a life-saving potential in the newThere is indeed a life-saving potential in the new definition, for, when accepted, it will lead to greaterdefinition, for, when accepted, it will lead to greater availability than formerly of essential organs in viableavailability than formerly of essential organs in viable condition, for transplantation, and thus countless livescondition, for transplantation, and thus countless lives now inevitably lost will be saved…At whatever level wenow inevitably lost will be saved…At whatever level we choose to call death, it is an arbitrary decision. . .It ischoose to call death, it is an arbitrary decision. . .It is best to choose a level where, although the brain is dead,best to choose a level where, although the brain is dead, usefulness of other organs is still present. This we haveusefulness of other organs is still present. This we have tried to make clear in what we have called the newtried to make clear in what we have called the new definition of death.”definition of death.” Henry K. Beecher and H. I. Dorr, "The New Definition ofHenry K. Beecher and H. I. Dorr, "The New Definition of Death: Some Opposing Views,"Death: Some Opposing Views," International Journal of Clinical PharmocologyInternational Journal of Clinical Pharmocology 5 (1971): 120-15 (1971): 120-1
  • 8. BeecherBeecher Sought to:Sought to: 1.1. Increase the supply of organsIncrease the supply of organs 2.2. Defend transplant surgeons from theDefend transplant surgeons from the perception of being organ-stealing killersperception of being organ-stealing killers 3.3. Employ brain-dead bodies forEmploy brain-dead bodies for experimentationexperimentation
  • 9. Harvard ReportHarvard Report ““Can society afford to discard the tissues andCan society afford to discard the tissues and organs of the hopelessly unconsciousorgans of the hopelessly unconscious patient when he could be used to restorepatient when he could be used to restore the otherwise hopelessly ill, but stillthe otherwise hopelessly ill, but still salvageable individual?”salvageable individual?” Henry K. Beecher, "Ethical Problems Created by the Hopelessly Unconscious Patient."Henry K. Beecher, "Ethical Problems Created by the Hopelessly Unconscious Patient." New EnglandNew England Journal of MedicineJournal of Medicine 278 (1968): 1427278 (1968): 1427
  • 10. Harvard ReportHarvard Report  The new criterion provided a means toThe new criterion provided a means to obtain fresher transplantable organsobtain fresher transplantable organs from heart-beating brain-dead donorsfrom heart-beating brain-dead donors without violating the Dead Donorwithout violating the Dead Donor Rule.Rule.
  • 11. ObservationsObservations 1.1. No references to scientific literatureNo references to scientific literature 2.2. No explanation as to why irreversibleNo explanation as to why irreversible coma is deathcoma is death 3.3. No conceptual basis, biological orNo conceptual basis, biological or philosophicalphilosophical 4.4. Justification based on pragmatic groundsJustification based on pragmatic grounds
  • 12. IntervalInterval  Conflicting legal rulings and state statutesConflicting legal rulings and state statutes emergedemerged  Multiple sets of diagnostic testing criteriaMultiple sets of diagnostic testing criteria emergedemerged  Lack of uniformity in medical practiceLack of uniformity in medical practice  Created confusion on many levelsCreated confusion on many levels
  • 13. President’s Commission ReportPresident’s Commission Report
  • 14. President’s Commission ReportPresident’s Commission Report  The tests for diagnosing brain deathThe tests for diagnosing brain death  The clinical criterion for brain deathThe clinical criterion for brain death  The definition or conception of deathThe definition or conception of death  Model StatuteModel Statute
  • 15. Whole-Brain DeathWhole-Brain Death Ad hocAd hoc ArbitraryArbitrary UnnecessaryUnnecessary • It is ad hoc because it was created as a solution to theIt is ad hoc because it was created as a solution to the problem of obtaining viable transplantable organs.problem of obtaining viable transplantable organs. • It is arbitrary because there are no good reasons toIt is arbitrary because there are no good reasons to think that the diagnostic tests conform to the criterionthink that the diagnostic tests conform to the criterion or the criterion to the definition.or the criterion to the definition. • It is unnecessary because traditional ethics and case lawIt is unnecessary because traditional ethics and case law allow for the removal of life-support for patients whoseallow for the removal of life-support for patients whose condition falls under the moral classification ofcondition falls under the moral classification of extraordinary care.extraordinary care.
  • 16. 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.
  • 17. Youngner & ArnoldYoungner & Arnold 1.1. It allowed physicians to turn offIt allowed physicians to turn off ventilators on brain-dead patients.ventilators on brain-dead patients. 2.2. It allowed physicians to procure vitalIt allowed physicians to procure vital organs from brain-dead patients fororgans from brain-dead patients for transplantation.transplantation. 3.3. Pragmatic & UtilitarianPragmatic & Utilitarian
  • 18. 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
  • 19. Truog & LizzaTruog & Lizza  Medical & legal fiction.Medical & legal fiction.  Death is a social construct.Death is a social construct.  Personhood & death can change.Personhood & death can change.
  • 20. Problems via Koterski, Pellegrino,Problems via Koterski, Pellegrino, & Mitchell& Mitchell  Legal & social acceptance is not anLegal & social acceptance is not an argument.argument.  Personhood & death not relative.Personhood & death not relative.  Confusion of social esteem withConfusion of social esteem with ontological status.ontological status.  Slippery slope?Slippery slope?  Euphemisms/Reductive terminologyEuphemisms/Reductive terminology
  • 21. Pragmatism’s ProblemsPragmatism’s Problems  UnintelligibleUnintelligible  Social consequencesSocial consequences  Insufficient as a moral systemInsufficient as a moral system
  • 22. 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
  • 23. Alternatives 1. Heart patients now survive as long as those who receive heart transplants 2. Development of the biologic heart 3. Artificial liver grown from umbilical chord srem cells 4. Human bladder grown from patient’s own cells 5. Re-seeding hearts taken from cadavers 6. Sustained, committed, long-term emphasis on disease and injury prevention
  • 24. AlternativesAlternatives U.S. scientists create artificial lungs, of sortsU.S. scientists create artificial lungs, of sorts 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 takenCHICAGO (Reuters) - Two U.S. teams have taken major strides in developing lab-engineered lungmajor strides in developing lab-engineered lung tissue that could be used for future transplantstissue that could be used for future transplants or testing the effects of new drugs.or testing the effects of new drugs. http://www.reuters.com/article/idUSTRE65N5AF20100624http://www.reuters.com/article/idUSTRE65N5AF20100624
  • 25. AlternativesAlternatives Scientists create liver cells from patients' skinScientists create liver cells from patients' skin By Kate KellandBy Kate Kelland LONDON | Wed Aug 25, 2010 6:31pm EDTLONDON | Wed Aug 25, 2010 6:31pm EDT LONDON (Reuters) - Scientists have created liverLONDON (Reuters) - Scientists have created liver cells in a lab for the first time usingcells in a lab for the first time using reprogrammed cells from human skin, pavingreprogrammed cells from human skin, paving the way for the potential development of newthe way for the potential development of new treatments for liver diseases that kill thousandstreatments for liver diseases that kill thousands each year.each year. http://www.reuters.com/article/idUSTRE67O4RC20100825http://www.reuters.com/article/idUSTRE67O4RC20100825
  • 26. AlternativesAlternatives More to come . . .More to come . . .