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

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 . . .