Still unresolved to everyone’s satisfaction, the question of when life begins continues to occupy a prominent place in public discourse, especially in an election year. However, no less important and complex is the question of when life ends.
Veteran science journalist Dick Teresi tries to answer this deceptively simple question and to explore the whole issue of organ procurement for transplantation in his unsettling new book, “The Undead.’’
Teresi begins by offering a kind of history of death, specifically how people have defined the end of life through time and across cultures. He cites as a turning point the work of an influential Harvard group in the 1960s, which cited brain death as a major defining factor, and offers examples of how in his view those criteria have proven less than 100 percent reliable. He then goes on to discuss the rise in organ transplants and how it potentially creates a conflict of interest for doctors.
I should state at the outset that I neither perform organ transplants nor participate in the ongoing care of transplant patients on a regular basis. However, I have cared for patients in the end stages of cystic fibrosis whose death appeared imminent until the miraculous occurred, and they received a new pair of lungs, which provided them with additional years of life.
This is the reason I found “The Undead’’ so disturbing. Not because of the questions it raises about brain death and whether it is equivalent to death as commonly understood. These questions have obvious ethical and practical implications, and many continue to struggle with them, especially those who adhere to definitions of life and death that were arrived at before the technological advances of recent years.
Especially troubling is the way Teresi ascribes ulterior motives to the medical community’s acceptance of brain death as an irreversible state from which there is no recovery. This understanding has enabled physicians and families of brain-dead patients to make decisions about when to withdraw medical care that has become futile, allowing their lives to end with dignity. It has also had the secondary effect of making more organs available for transplant to those who would die without them.
When Teresi writes that the criteria formulated in 1968 by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, which “allows doctors to declare a person dead in less time than it takes to get a decent eye exam’’ it unfairly implies a cavalierness of physicians toward the dying whose organs they purportedly covet. In his view, the motivation for devising a definition of brain death was pure self-interest. “Disconnecting respirators would keep doctors from being arrested, and organs could then be gathered without violating the dead-donor rule.’’
Teresi notes that two of the 13 Harvard committee members were organ transplantation pioneers, including Joseph Murray, who would later win a Nobel Prize for his work in the area. He quotes Murray as having had two concerns: “First is the dying patient, and the second, distinct and unrelated, is the need for organs for transplantation.’’ Teresi writes sarcastically that describing the two issues as unrelated “is like a committee of foxes saying that it has two goals: (1) to make chicken coops with big holes in the sides, and (2) to meet the unrelated desire to eat more chickens.’’
Teresi’s view of organ transplantation is no less cynical, describing it as “a $20 billion per year business. . . . well ensconced in US medical and political arenas.’’ Writing that “[t]ransplant surgeons are near the top of the M.D. food chain. Earning $400,000 per year, they and their staffs often fly to harvests on private jets,’’ it comes across as though money, not saving lives, serves as the primary, nearly singular, motivation for performing transplants.
Although there is nothing wrong with raising the questions that Teresi does, the book is slanted in such a way as to bring the reader to a specific, predetermined conclusion. This is too bad, for while “The Undead’’ is certain to arouse controversy, had it presented the issues more objectively it might have served as a stepping off point for a larger conversation about this important topic.Dennis Rosen, a pediatric pulmonologist, can be reached at firstname.lastname@example.org.