"The End" Special Issue by Scientific American: Organ Donation

Scientific American editor, Mariette DiChristina, writes in her introduction to September's special issue that the concept, "The End," had been picked up and put down in their offices for years because of "the difficulty and possible discomfort about some of the topics we wanted to cover."

I can't speak for SA's regular readers, but DiChristina needn't have worried. The issue is a treasure trove of intriguing questions and answers, ones too important and timely to be ignored: Does acetaminophen (Tylenol) reduce feelings of rejection and paranoia? (I say let's do a test study on the Tea Party.) What are the chances the world will end by asteroid impact? (1 mill in next 100 years) Runaway global warming? (2 in next 200 years) Killer pandemic? (2 in the next 30 years) What are the four stages of body decomposition? (Fresh, Bloat, Active Decay, and Dry); What cultures are disappearing?; What scientific discoveries should rightly come to an end? (Daylight savings time, the space shuttle, landfills, teflon, among others); And how much time is left for glaciers? Gold mining? (20 years) Time? (Yes, how much time does time have?)

But the articles that most speak to my own writing interests -- patients' rights, primarily -- are great too. Thomas Kirkwood addresses why we can't live forever (pp 42). SA's various advisory board members look at anticipated reproductive trends in the next decades ("What Comes Next" pp 92). And Robin Marantz Henig contributes a brief but spot-on look at organ donation ("When Does Life Belong to the Living?" pp 50) and the contested definition of death. She writes:

To address this issue [establishment, with the advent of organ transplantation, of "dead-donor rule" in 1960s to prevent organs from being taken from the living; in essence, the definition of death], a blue-ribbon Harvard Medical School panel met in 1968 and arrived at the concept of "irreversible coma," more commonly known as brain death. By this term, they meant that the cerbral cortex -- the seat of consciousness, language, empathy, fear and everything else that makes us human -- is irreversibly destroyed. Destroyed, too, is the brain stem, which orchestrates such basic physiological functions as breathing, heartbeat and homeostasis. Modern medical machinery may keep the body oxygenated, but the person inside is gone.

The definition of death has been reviewed periodically since then by groups of bioethicists, and although the terminology sometimes changes, the substance remains basically the same. The concept of breain death (often knows by the more modern and clinical term "the neurological standard of death") has since become encoded into law in nearly every state in the U.S. Ethicists and the law agree: a person whose cortex and breain stem are destroyed has ceased to be alive, even if the body is warm and pink. That body is no longer considered a person. Instead it is a heart-bearing cadaver.

All this means quite a bit to the hundreds of thousands who wait for years on organ recipient lists. And it means a lot too to "pro-life" activist groups who would like to remove decision-making from individuals and family members burdened with terrible choices in dire situations.

Think Terri Schiavo (and the Terri Schindler Schiavo Foundation) or Wesley J. Smith (a staunch, vocal advocate for the Schiavo family and removing such decisions from doctors or patients who wish to determine their own end of life care) or the United States Conference of Catholic Bishops (which as recently as November changed the guidelines in all 624 of the U.S. hospitals they oversee to leave the question of removal from artificial nutrition and hydration up to hospital management and not the patient or family, living will or advance directive be damned).

Citing the three cases in Denver between 2004 and 2007 in which the Pittsburgh Protocol (waiting a full two minutes after removal from life support before removing organs from a "brain dead" patient, despite risk of organ deterioration) was violated for the sake of needy infants, Martanz Henig makes a fascinating point in her article that notes the root of the medical profession's tip-toeing around the definition of death. Robert D. Truog of Harvard supported the doctors' (and the hospital ethical board's) decision, saying that the "dead donor" rule was unimportant when considering whether an injured person's recovery was impossible and what the family consented to. But:

...Arthur L. Caplan of the University of Pennsylvania, recoiled at Truog's suggestion, mostly because of how it would be interpreted by an already skittish lay public. "We ought not underestimate public unease," he said. "Making people wonder if you're going to cut corners on their care in order to salvage organs from them is a very dangerous area to be in."

In other words, altering the "dead donor" law to allow, say, waiting less than two minutes, would deter the (already wary) population from signing up as organ donors. The number of people each year who die from lack of viable, transplant-ready organs (currently about 7000) could increase because of a fear of doctor's ethics regarding the definition of death. (See my post here some months ago regarding a New York Times article on organ donation which points out how rather arbitrary that two minute designation is.)

While I think that Caplan's fears are legitimate, I'm more interested in asking why. The medical profession has a long history of discomfort and distrust with minorities and females, particularly African Americans. Often this distrust, as with abortion and end of life care, is fueled by political motivation ("black genocide") or exceptions that don't prove a rule (Terri Schiavo again; there are 30,000 patients like Schiavo in our hospitals any given year). In other ways, history has proven that the medical profession preys on patients: futile care, aggressive elder treatment, lack of research into disease causes (see Barbara Ehrenreich's Cancerland) or lack of discipline in telling patient's the truth (because, you know, they can't handle it).

But this distrust should not be used as an excuse to let thousands of people die, to cruelly prolong the lives of the "heart-beating cadaver." I'm not saying that fear isn't real, I'm saying that it results from a lack of bodily autonomy. As recently as the 70s, women would go in for a simple biopsy of a breast lump and come out with full mastectomies. This kind of patriarchal, "doctor knows best" is a wound that the industry has brought on itself. It exists. It is real. But it should be combatted -- not by playing into it with arbitrary definitions that become arbitrary rules but by addressing it candidly. For the sake of patients, a frank discussion about the way death has changed over the past 40 years must be had.

Top 10 Conservatives of the Decade.

Well, this will be little belly-laugh for your hangover, a top 10 list I can get behind. The Examiner.com (a confirmed conservative shill rag) has a list of the top ten conservatives of the decade.

Read on for a hefty dose of persecution paranoia and gag-reflex-inducing bit of self-righteous discrimination. And remember, they know what is good for you, not you. That's why God put them in positions of power and influence:

Clarence Thomas, courtesy of the Supreme Court
(obtained from civilliberty.about.com)

Conservapedia.com, "The Trustworthy Encyclopedia," today published its list of the Ten Conservatives of the Decade. These are the ten men and women who, in the past ten years, had the greatest impact on American politics and attitudes, according to Andrew Schlafly, founder and chief administrator of Conservapedia.

The number-one Conservative of the Decade isClarence Thomas, Justice of the Supreme Court since 1992. Conservapedia contributors cite him for his opinions clarifying the Establishment Clause of the US Constitution, and holding that capital punishment is not "cruel or unusual" within the actual meaning of the Eighth Amendment. In addition, another senior administrator at Conservapedia described Thomas thus:

Thomas is a distinguished black jurist who understands that the Constitution is not a Ouija board, plus he can relate to Americans (RVing, raising a twelve year old). His silence at oral arguments indicates that he is more interested in what the people are saying, and he is a quiet force behind the scenes.

Schlafly went further:

For ten years he has withstood intense pressure to become more liberal in order to win the media accolades given to less accomplished men. With sincerity, insight, and good spirit, Justice Thomas has become an inspiration for a generation of Americans at a time when there seem to be few role models in public life. His autobiography, published in 2007, traces his path from the most humble roots to the pinnacle of power, and yet he never flinched from his principles as so many others in Washington do.

The immediate runners-up to Thomas were those who propounded, supported, voted for, and defended California's Proposition 8, the proposition declaring that California's constitution would recognize marriage as between one man and one woman, and not dignify any other combinations (man and man, woman and woman, man and animal, etc.) with the term "marriage." Proposition 8 set the so-called "homosexual agenda" back considerably, especially since at last Californians managed to so amend their Constitution and not have California's courts invalidate that amendment.

The full list of Conservatives of the Decade is as follows:

1. Clarence Thomas
2. Proposition 8 supporters
3. Antonin Scalia (for his opinions supporting Rule of Law, the Second Amendment, and textualism)
4. Sarah Palin (for advocating less government, standing up to inhuman liberal abuse, and opposing "death panels", er, "end of life counseling")
5. Ron Paul (for advancing the vision of Barry Goldwater, mobilizing activism, and scrutinizing the Federal Reserve)
6. Michele Bachmann (taking on liberals in the House, exposing the global currency, and winning in Al Franken's State)
7. Dick Cheney (protecting America in a dangerous world, and standing up for others who do likewise)
8. Samuel J. Alito (standing up to liberals during his confirmation hearings, and writing superb opinions soon afterward)
9. Ann Coulter (taking it right to the liberals with courage and wit)
10. Michelle Malkin (blogging across-the-board conservatism and speaking on college campuses)

In addition, Conservapedia remembers these famous conservatives who died in the decade just passed:

1. Charlton Heston, who famously said, "Cold dead hands."
2. Jerry Falwell, founder of Liberty University.
3. Ronald Reagan, the fortieth President of the United States.
4. Karol Cardinal Wojtyla, better known to history as Pope John Paul II.

James Carroll: Extreme Bishops and Responsibility for Stupak-Pitts..

James Carroll has a post up at the Daily Beast that addresses what he calls the Catholic church's "sabotaging its broader moral mission."

What happens when a mainstream institution is taken over by its fringe? One answer plays itself out in the Republican Party, where lunatic rhetoric now defines politics. Another shows itself in the Catholic Church, whose leadership has fallen into the trap of single-issue moralism. That the aggressively lobbying Catholic bishops were prepared to kill the health-care reform bill in the House last week over abortion shows how far they have come from the broad tradition of Catholic social teaching that sees the common good as involving multiple values. Negotiation and compromise are essential to solidarity. When values conflict, as they inevitably do in legislation, ethical reasoning assumes a delicate balance, weighing one issue against another. Abortion represents one such moral question that carries special gravity for Catholics. Despite the bishops’ assertions, however, there are others—notably, a universal right to quality health care, which the bishops have supported for years, but which they were prepared last week to throw overboard rather than accept a compromise that would have covered abortions by patient co-payments instead of government funds.

Amen on the assertion that the Republican party has given in to what the DailyKos community calls it's "rump." I'm not sure that the structure of a political party, however, can be applied to the Catholic church. The world body of Catholicism has always had a strict group of rule makers and for the most part, parishioners have been the rule breakers. Myriad Catholics oppose and refuse to live by the dictates of the Pope or bishops. Groups like Catholics for Choice have long exemplified the disconnect between Catholic teaching and Catholic lifestyle. And though I haven't sought out the statistics, I hear that Catholics in America are predominantly pro-choice; I bet most are definitely pro-contraception.

Another thing Carroll misses is that the USCCB and other Catholic groups have been supportive of health care reform. And for the reasons he says they have throw out the window: care of the ill, uninsured, poor, and elderly. Yet the moral conviction of the Catholic leaders, what Carroll calls the "complex and nuanced approach to moral questions," is based on a hierarchical set of values, of which "killing of the unborn" and the elderly is the keystone; the "slippery slope" of moral, societal degradation starts with abortion, not economic injustice or poverty. End or limit abortion and euthanasia to the best of your abilities and you are addressing other societal ills. Carroll wrongly concludes:

We hear little or nothing from Catholic leaders on such questions because, just as extreme voices have made American politics toxic, so extreme voices have poisoned the teaching authority of the church. Slash-and-burn single-mindedness is fanatic. Hence the excluding absolutism on the abortion question. Hence the dangerous exacerbation of the worst trends in American public life.

Asking the USCCB to focus attention on other issues, like the economy, not only overlooks the enthusiasm the abortion issue generates but also misses the point of hierarchical moral priorities. Fund abortion or "euthanasia" and you are opening the door for other societal depravities.

Unlike others who have weighed in on what "right" the USCCB has to meddle in health care reform, Carroll welcomes them - just as the Democrats have welcomed them as part of the party's emphasis on faith-based initiatives, broadening the party's tent, and appealing to moderates. He only notes that they should be focusing on other things.

In the Catholic - and evangelical - world view, hierarchy is supposed to be extreme, law-laying, and dictatorial. The job of church leaders is to set the rules and we parishioners are tasked with following them. (They don't call church doctrine and sermons "teachings" for nothing.) It's a partriarchal approach to the world that has been around since, well, forever.

This patriarchal structure of traditionally male leaders laying down the law for the rest of us is even the default from which our justice system works. Women are traditionally heavily sanctioned by such systems, treated to second-class status by male structures that profess to know what is best for them. Note the case of the Maine woman ordered by a judge to be on bed rest and confined to a hospital. In fact, looking recently at hospital mergers and the imposition of provider refusals (or "conscience clauses") over patients' rights, I see the medical industry is set to a "pro-life" default as well, with the implicit approval of our "justice for all" government.

The failure to protect women's reproductive rights in health care reform doesn't fall to a predictable, traditional, partriarchal church body, but to those in our government who failed to acknowledge that, while the church (and I'll include the evangelical church along with the Catholic here) may work to protect the "least of these," giving them deference in issues of policy-making will always mean sanctioning women's rights.

For more on this, don't miss the fantastic Sarah Posner who is blogging it well at ReligionDispatches.