Editorials

...The prognosis for infants with fatal heart defects, on the" other hand, has improved as pediatric surgeons have continued experimenting with heart transplants...

...He declared recently in Living Hungry in America (Macmillan, 1987), that "We have discovered an epidemic of hunger in the U.S...

...This effort points to one way of thinking about the issue...

...Lacking a skull covering and cerebral cortex, these newborns never become conscious...

...Declaring the anencephalic dead at birth assumes that they are not human persons who can claim the care and protection we normally extend to a dying person...

...Clearing up confusion is the main theme of the statement's several challengers...

...That statement alone is worth rereading...

...Hunger is now a domestic growth industry, even in America's breadbasket...

...Some moral theologians believe that anencephalics can therefore be baptized only conditionally...

...In Topeka, Kansas, a temporary project to aid those without food was initiated in 1982...

...From January to October 1986, "Help" distributed six thousand food baskets as well...

...Stiller put it, "I have been moved by the pleas of these mothers who want to redeem their pregnancies...

...born out of political ideology and government policy, a man-made disease caused by leaders who...

...THE TWENTY MILLION When the White House table welcomed the Gorbachevs last month-with a menu of Columbia River salmon, lobster medallions en gelee, loin of veal with wild mushrooms, tarragon tomatoes, corn turban, etc.-twenty million Americans would have appreciated being invited...

...But last year, 1987, it distributed twice that many during the same period...

...As Dr...

...In my judgment none of this is particularly controversial...

...Morality and mortality...

...What are these two permissible instances...

...The use of prenatal diagnosis along with opposition to abortion, as in the Winners' case, only increases the sorrow such parents must feel in knowing that, at best, their baby will be born dying...

...Then this strategy is mistaken...

...The answer devised by some ethicists and surgeons: periodically remove the anencephalic newborns from the respirator to see whether they continue to breathe on their own...

...Nor should we expect it to...

...Bailey and Dr...

...Was there not some way to make use of the organs of anencephalic newborns for whom medicine can do nothing...

...The figures deserve reflection: In the twenty-six cities the mayors surveyed, the demand for emergency food assistance has increased by 18 percent in the last year...

...There is a second way of thinking about the problem...

...Even if the administrative board miscalculated the "political repercussions" of not taking a head count of supporters within the entire conference before issuing the statement, it obviously intended its' statement to be clear about church teaching on sexuality...

...And in this case a necessary moral' responsibility...

...Catholic Conference) is that it is sorely needed, well-timed, and nearly perfect in tone, being both compassionate and realistic...

...The birth of an infant with anencephaly is heartbreaking and tragic...

...Nonetheless, the questions raised by the case remain unresolved...

...But it cannot fill the widening gap of hunger, American-style...

...Too often during a contretemps like this, the public takes sides or shrugs off the controversy without ever bothering to read the policy statement itself...

...Now there are almost five hundred, and they dispense 1.2 million meals each month...

...We fail to find any confusion in this...

...has recently risen to 6 percent, the highest percentage in the industrialized world-is-that this banquet in reverse has been accomplished by default...

...Archbishop Pilarczyk's succinct interpretation suffices: "What are we going to say when we talk about condoms and 'safe sex' practices...

...In the matter of providing medical treatment to anencephalic infants, Paul Ramsey, for example, has written,' 'Such infants demonstrate their status by dying, in all senses, rather quickly...

...However, the lack of donors is a severely limiting factor, and many infants die before a suitable organ-usually from an infant accident victim-becomes available...

...Whatever signs of life anencephalics show-respiration, heart beat, eye blinking-are reflex actions centered in the brain stem...

...they are living and human only in the sense that a human cell is, not in the sense of a human individual...

...so far as we know, they never see, smell, hear, or feel pain...

...To obtain these organs, it definitely bends the accepted proce-" dures for defining brain death...

...Some ethicists have argued that anencephalic infants lack a sufficient biological substratum to be considered protectable human life...

...The motive power for developing a strategy to use these infants as organ donors is said by the doctors to come from the parents themselves, who want to give this brief life some meaning...

...It is no.t hard to hear in the Winners' plea the hope that their tragedy will give life to another infant...

...Those not born dead, die soon after...

...They are the twenty million who go hungry part of each month in the U. S., according to the October report of the Harvard Physician Task Force on Hunger in the United States...

...each year...

...The Winners have not been the first to plead with doctors to draw some meaning from their tragedy by allowing another infant to benefit from an organ donation...

...Second, measuring brain activity is very difficult in their case-as it is with other infants...

...The second point is that the bulk of its worthwhile message has already been overlooked in the intra-episcopal quarreling that broke out the same day the statement was issued...

...It is to no one's benefit, especially those in need of organs, that transplant specialists appear to be manipulating brain death criteria in order to secure a steadier supply of infant organs...

...In this country,'' according to Arthur Simon, executive director of Bread for the World, "both the number and the percentage of hungry people have increased in the last decade...

...Preserving and harvesting organs is the sole purpose for this use of life-sustaining medical technology...

...If no suitable organ recipient is found after an agreed upon period of time, the newborns would be removed from the respirator...

...Indeed, the physicians who opposed the California legislation because they found it repugnant to remove the heart of a still-breathing baby would seem to share with the ordinary citizen a basic perception that this is a dying baby rather than an entity with a needed organ...

...Connect the anencephalic to a respirator at birth and provide life-sustaining measures, such as antibiotics and nourishment...

...But is this a real solution or a form of medical manipulation that not only allows the treatment of one infant to be manipulated in order to benefit another, but also tailors the definition of death to the requirements of obtaining transplant organs...

...Should the anencephalic be killed in order that its heart be transplanted...

...Don't...

...Search for a suitable recipient and when the newborn dies the organs become available for transplant...

...AIDS is fatal...

...We are going to say that they are in disaccord with Christian morality and that they are not totally effective anyway...

...That would be particularly unfortunate given the breadth and balance of this document...

...These questions need a larger public, and perhaps legislative, discussion than so far has taken place...

...Leonard Bailey, who made headlines in 1984 when he transplanted the heart of a baboon into a dying infant, is a pediatric transplant surgeon at the hospital...

...Conference of Mayors has weighed in with its own figures on hunger in this land of plenty...

...For the record, the document states over and over that the church must offer a clear presentation of Catholic moral teaching on human intimacy and sexuality...

...Then the anomalous, non-human status of anencephalics must be established legally on grounds having to do with the nature of anencephalics themselves-and not because of any need for their organs...

...Once again the challenges of medicine at the cutting edge are presenting us with faits accomplis that threaten to undermine the basic prinicples of human morality...

...According to Arthur Simon, the single most important thing needed to overcome hunger in this country is convincing people they can help change national policies on hunger...

...First, their brain stem is not dead...

...If they do not breathe within three minutes, they would be presumed dead and their organs available for transplant...

...In this process, their organs gradually deteriorate and become unusable for transplants...

...And it includes a capsule-sized rendition of that teaching, to which it refers several times...

...Now it serves more than three hundred meals a day...

...Called "Let's Help," it has now become a permanent institution in the Kansas capital, and presently serves more than six hundred meals a day...

...That seems to be the document's strength and, to its critics, the tension point...

...And it very much looks like medical flim-flamming, a thinly veiled way of "trading-off' one life for another...

...Their plea deserves our attention and our sympathy, but it cannot be the basis for medical policymaking...

...Many people may find this a shocking view, but it is one with a real basis in traditional thinking...

...In Brooklyn, New York, "Neighbors Together" served seventy-five meals a week when it opened its storefront doors in 1982...

...Should the heart of the Tanencephalic be transplanted to save the life of the infant with the heart defect...

...The document insists that AIDS prevention programs should include an authentic understanding of human intimacy, but recognizes that such programs should also reflect' 'an understanding of the pluralism of values and attitudes in our society'' as well...

...stood firmly at the helm and purposely dismantled programs that had been successful at preventing widespread hunger in our nation for years...

...Second, in Catholic hospitals and health-care institutions during professional counseling with a patient at risk or who has been exposed, "if it is obvious that the person will not act without bringing harm to others...

...The board advocates the former, and thereby safeguards against the latter...

...As long as cases like that at Loma Linda appear to the public as simply taking one doomed life to benefit another potentially fuller one, the course of action should be clear...

...As appalling as these facts and their long-term consequences-the number of infants born with a lower-than-recommended birth weight in the U.S...

...Even if only for the crumbs...

...First of all, life-sustaining measures, such as respirators, antibiotics, and nutrition will not benefit anencephalics, neither ameliorating their condition nor making them more comfortable...

...As it turned out, the Winner baby was born dead some weeks later and its organs could not be used...

...Furthermore, it seems to create a special category for declaring anencephalics dead by trying to establish the cessation of heart-lung function while using the respirator to preserve transplantable organs...

...This strategy seems to avoid two problems: The anencephalic is not directly killed and organs are preserved for transplant...

...So an anencephalic baby, it could be argued, no more enters the human community to claim our care and protection than a patient remains in the human community when his brain death (and consequent heart death and lung death) is only disguised behind a heart-lung machine...

...First, if preventive programs are addressed to a wide audience wherein some people likely "will not refrain from the type of sexual or drug abuse behavior which can transmit AIDS...

...If anencephalic newborns are killed in the very act of recovering their organs for transplant, the public is likely to understand this as justified because of the pressing need for organs and not because of a principled understanding of what does and does not constitute protectable human life...

...The primary concern of our observations is people's moral and physical well-being, not their condemnation, however much we might disagree with their actions," the authors say early on...

...95 percent are dead within a week of birth...

...Larry Brown, head of the Harvard Task Force on Hunger, goes further...

...There were thirty such private organizations in New York City in 1982...

...Perhaps the vast majority of dying anencephalics are dead if they do not breathe within three minutes, but perhaps some are not...

...The standard medical response has been to do nothing and let them die...

...That recognition of pluralism led the drafters to permit-not to insist, encourage, advocate, or promote-the giving of information about prophylactics (they never mention "condoms") in two specific instances, but only after the health risks and moral problems with the "safe sex" practices are presented, and the authentic meaning and purpose of human sexuality is explained...

...Two to three thousand anencephalic infants are born in the U.S...

...Early in December, Loma Linda Medical Center in California agreed to the persistent requests of Brenda and Michael Winner to transplant the organs of their infant diagnosed before birth with anencephalia...

...So has the voluntary response...

...It has been advanced by transplant physicians, such as Dr...

...Not because the board waffled on church teaching, but because they juxtaposed church teaching with another, particularly prickly idea...

...The problem, however, is not likely to be generally understood in this way...

...Calvin Stiller of University Hospital in London, Ontario...

...most of them die of infection...

...GETTING THE POINT The first point to note about the recent document,' 'The Many Faces of AIDS: A Gospel Response," (issued by the administrative board of the U.S...

...This strategy gives the benefit of the doubt to the need for organs, not to the infant...

...Are anencephalics humans who deserve the protection and respect we extend to the dying...

...Since the Washington summit, the U.S...

...AIDS is incurable...

...It is simply good sense...

...What is needed is not an insufficient distribution of the crumbs, but a pounding on the table with the national silver...

...Are anencephalics anomalies, whose condition excludes them from the human community and who legitimately can be used to provide a supply of transplantable organs...

...But when does the anencephalic die...

...Moral and physical, they said...

...Ramsey would probably oppose the California legislation but the point to be acknowledged here is that, quite apart from the issue of organ donation, there may be serious grounds for recognizing anencephalics as not possessing the status of human beings...

...The major problem, however, remains the question of establishing death...

...Several families tried unsuccessfully to have California's brain death law amended to define anencephalic infants as dead at birth...

...Anencephalics do not fall within the criteria generally accepted for establishing brain death...

...And information that may save lives when sexual teaching has fallen on deaf ears does not constitute anything other than the traditional Catholic concept of' 'avoiding greater, harm," a standard moral principle...

...However, they apparently failed, at least with some of their fellow bishops...