podesta-emails

podesta_email_20771.txt

podesta-emails 1,432 words email
P17 V11 D6 V16 P22
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hope you can all use this recent article from the Economist showing that economists favor Obama by a large margin. See this article with graphics and related items at http://www.economist.com/science/displaystory.cfm?story_id=12332939 O DEATH, WHEN IS THY STING? Oct 2nd 2008 Some bioethicists reckon that the definition of death is starting to embrace the living. Indeed, some reckon that it should IN THE summer of 1968, while youth was redefining itself in Paris, San Francisco and elsewhere, a committee at the Harvard Medical School was busy redefining the end of life. Following its recommendations, almost all rich countries adopted a definition of death based on the extinction of activity in the brain, rather than in the heart or any other organ. In some places, notably America, that means monitoring the brain's electrical chatter to make sure the whole organ has died. In others, such as Britain, the brain's stem is regarded as the crucial part. In this case simpler tests can be applied, such as whether a patient's pupils react to light. Either criterion, however, seems more reasonable than just registering a pulse, since it is the brain, not the heart, that makes the individual. At the time, there were some objections to the change on religious grounds. But the western world's most organised religion, the Catholic church, did not object. It asked only for moral certainty that death applied to the whole being, and left the judgment of when that happened to the experts with the encephalograms. Forty years on, however, those experts are divided, and the church is under growing pressure to reject criteria based on brain death, and return to the alleged unambiguity of permanent cardiac arrest. The debate has flared up ahead of a conference on organ donation that will be held in the Vatican in November. One of the triggers was an article in the Vatican's newspaper, L'OSSERVATORE ROMANO, by Lucetta Scaraffia, a religious historian at La Sapienza University in Rome and a member of Italy's National Bioethics Committee. What worries Dr Scaraffia is that, as the demand for organs rises, doctors are under pressure to shift the line that divides life from death, so that they can get hold of organs for transplant at a time when they are more likely to be in a healthy condition. One of the aims of the organisers of the conference, who include the Pontifical Academy for Life, which ponders these matters on behalf of the world's Catholics, is to discuss "the importance of spreading the culture of organ donation". Dr Scaraffia, however, believes the church is jumping the gun. First, she says, it must address the more difficult question of when a person can really be said to be dead. And other doctors, though not necessarily opposed to moving the line, agree the matter needs to be cleared up. I'M NOT DEAD YET! In August, for example, Robert Truog of the Harvard Medical School and Franklin Miller of America's National Institutes of Health, bioethicists both, published a paper in the NEW ENGLAND JOURNAL OF MEDICINE describing a recent trend to revert to using cardiac death as the critical marker. But that is not good news for Dr Scaraffia and her followers for, according to Dr Truog and Dr Miller, the definition of cardiac death has changed over the years in just the sort of way that Dr Scaraffia predicted that it might. Dr Truog and Dr Miller posit the example of a patient who has given informed consent to the withdrawal of life support in the case of his suffering devastating brain injury. The doctors respect his wishes and his heart stops beating. So far, so ethical. But instead of waiting a few minutes for his brain to die as well, they anticipate this inevitability and declare him dead immediately, so that they can hurry along with the business of removing his organs. Death in such cases is therefore based on a decision not to resuscitate, not the impossibility of resuscitation. And their hypothetical case does seem to be happening more frequently in reality. In America, data from the Organ Procurement and Transplantation Network, an organisation that matches donors to recipients, show that those classified as cardiac-dead but not brain-dead represent the fastest growing proportion of donors, having risen from zero ten years ago to 7% in 2006. Dr Truog and Dr Miller reckon this gerrymandering of the division between life and death will continue as long as doctors have to abide by the dead-donor rule--that although a living person can consent to have a non-vital organ removed for transplant (a single kidney, for example) vital organs can be removed only from dead bodies. Instead, they propose that someone whose brain is devastatingly and irreversibly damaged, and who has previously given his informed consent, should be able to donate vital organs while still alive. In practice, says Dr Truog, this would not differ much from what happens now, except that doctors would be released from the temptation to fudge the definition of death, or to accelerate it by, for example, withdrawing life-sustaining treatment. Indeed, the British government is considering changing the regulations in a way that would allow just that to happen. The prospect of having their vital organs removed while they are still alive might put some people off carrying donor cards altogether, Dr Truog admits, so the plan would have to be accompanied by a public-education programme about what irreversible brain injury means. Nevertheless, his views have alarmed some people, including delegates to the forthcoming Vatican debate. Antonio Spagnolo, a bioethicist at the University of Macerata, Italy, and an expert on the Catholic view of death, says that to violate the dead-donor rule would be to violate the primary duty of a doctor, which is not to inflict harm. The definition of death may have to evolve as science advances, Dr Spagnolo says, but doctors must continue to declare it based on "humanly reasonable certitude", and with no ulterior motive--a task, it may be noted, that once went to the priests. See this article with graphics and related items at http://www.economist.com/science/displaystory.cfm?story_id=12332939 Go to http://www.economist.com for more global news, views and analysis from the Economist Group. - ABOUT ECONOMIST.COM - Economist.com is the online version of The Economist newspaper, an independent weekly international news and business publication offering clear reporting, commentary and analysis on world politics, business, finance, science & technology, culture, society and the arts. Economist.com also offers exclusive content online, including additional articles throughout the week. - SUBSCRIBE NOW AND SAVE 25% - Click here: http://www.economist.com/subscriptions/offer.cfm?campaign=168-XLMT Subscribe now with 25% off and receive full access to: * all the articles published in The Economist newspaper * the online archive - allowing you to search and retrieve over 33,000 articles published in The Economist since 1997 * The World in - The Economist's outlook on the year * Business encyclopedia - allows you to find a definition and explanation for any business term - ABOUT THIS E-MAIL - This e-mail was sent to you by the person at the e-mail address listed above through a link found on Economist.com. We will not send you any future messages as a result of your being the recipient of this e-mail. - COPYRIGHT - This e-mail message and Economist articles linked from it are copyright (c) 2008 The Economist Newspaper Group Limited. All rights reserved. http://www.economist.com/help/copy_general.cfm Economist.com privacy policy: http://www.economist.com/about/privacy.cfm The Economist, Economist.com and CFO Europe are trading names of: The Economist Newspaper Limited Registered in England and Wales. No.236383 VAT no: GB 340 436 876 Registered office: 25 St James's Street, London, SW1A 1HG -- Michael Stebbins, Ph.D. SEA Action Fund 703-625-1512 http://www.SEforA.org Join Scientists and Engineers for America today! --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to the "big campaign" group. To post to this group, send to [email protected] To unsubscribe, send email to [email protected] E-mail [email protected] with questions or concerns This is a list of individuals. It is not affiliated with any group or organization. -~----------~----~----~----~------~----~------~--~---
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