Correspondence
ORMSBY, ELIZABETH F. & CALOGERO, STEPHEN & Caplan, Arthur L.
CORRESPONDENCE Top-down view Homewood, 111. To the Editors: Bravo David R. Carlin, Jr., in "A Shortsighted Vision" [November 6, 1987]. After working in public schools for more years than I care...
...No attempt is made to hasten or facilitate the dying process by those seeking organs...
...By setting a time limit, those seeking organs assure that a decent level of respect is shown for the sensibilities of parents and for the humanity of the infant...
...And it would be undignified to maintain a baby's vital functions indefinitely, solely to obtain organs and tissues for others...
...After working in public schools for more years than I care to remember, I must say that in my opinion Carlin's concept of many top administrators in education is pretty much on target...
...Nothing is done to add burden to lives of either the infants dying of anencephaly or their parents...
...As our globe grows smaller and the chances for conflict greater, so grows our need for accommodation, cooperation, and common ground...
...STEPHEN CALOGERO Standards of death Minneapolis, Minn...
...Where children dying for want of a brain are concerned, other tests of death must and can be found...
...I will grant that the public may find many more pleasant matters to contemplate than the gruesome and tragic choices posed by anencephaly...
...To the Editors: David Carlin's article, "This, Too, Shall Pass" [January 15], concludes in a tone of cynicism unbecoming to the pages of Commonweal...
...The thorny matter seized upon in the editorial as the reason for forbearance is: what evidence should be used to make a diagnosis of death...
...ARTHUR L. CAPLAN Center for Biomedical Ethicsnter for Biomedical Ethics...
...The latter is only a reason for clarity about what is being done and why...
...Insist on inapplicable standards for the determination of death and forgo possible donations of life-saving organs, or recast the tests of death to see whether (Continued on page 223) CORRESPONDENCE (Continued from page 194) a determination of death can be made that permits donation...
...ELIZABETH F. ORMSBY Hobbled by Hobbes Chicago, 111...
...Carlin's tone is that of the so-called realist, resisting the temptation to dream of Utopia...
...But is it really true that the American public can't absorb the distinction between taking organs from a baby without a brain who has been pronounced dead and one who is not dead, merely brainless...
...Current attempts-at Loma Linda University Medical Center, in California and in other medical centers in Canada, Japan, and Western Europe-to use anencephalic infants as organ sources respect the boundary between life and death...
...The prospect of swapping imperfect lives for those that would otherwise be doomed due to the congenital failure of a heart, liver, or kidney is seen as ghastly to the point where it would be too much for the American public to bear...
...It is true that the only reason to pursue new standards of death in anencephalic babies is to allow them to be used as organ or tissue donors for other infants in need...
...And if we await the stoppage of the heart and lungs no organ source will exist...
...It is becoming increasingly clear that the viewpoint of a Hobbes will not provide the means even for this, his minimal goal...
...In the editorial, "Manipulating Death" [January 15], arguments concerning the use of infants dying of anencephaly as sources of organs are reviewed, pondered, analyzed, and found wanting...
...The former is a reason which calls for moral commendation rather than opprobrium...
...I suppose it is always prudent to maintain a "show-me" attitude in political affairs, but cynicism plays dangerously into the logic of the Hobbesian analysis Carlin examines...
...However, the issue is not Utopia but survival...
...Since in the "real world" the lion does not lie down with the lamb, nor the eagle with the bear, does it follow that periods of detente are nothing but aberrations from the inevitable norm of conflict...
...But this horrible fact ought not to lead us to the perverse conclusion that such babies cannot die...
...And no steps are taken to obtain organs or tissues until death has been pronounced...
...Matters might be different if the children were to be kept on artificial life support until a recipient had been identified-a time that could extend to weeks or even months...
...But the efforts of Loma Linda and other transplant centers to redeem something of value from a tragedy such as anencephaly are not as far beyond the pale of emotional and rational acceptance on the part of the average medical spectator as your editorial would suggest...
...But there would seem to be little that is disrespectful or dehumanizing about such an act...
...No one can measure electrical activity where no brain exists...
...The absence of spontaneous respiration, reflexes, and eye movement are reasonable substitutes where no other indices of brain activity are available...
...It is true that anencephalic infants whose parents desire organ donation are placed on respirators at birth...
...Admittedly, existing criteria of brain death cannot be applied to an infant who lacks most of his or her brain...
...Rather it ought to lead us to rethink the evidence, the criteria, the data that must be sought to determine death's presence where infants with anencephaly are concerned...
...But parents need time to grieve...
...What should be done...
...Organ procurement does not commence without the voluntary consent of the infant's parents...
...Not in a calculus of egos, but in a realistic search for a common humanity lies our hope for the future...
...Neither consideration is a sufficient reason to call for a moratorium on organ procurement from anencephalic infants...
...If we continue to assume that the Soviet Union is at its core the societal analogue of the Hobbesian ego, we will continue dutifully to play its counterpart, and our assumptions will remain self-affirming: International politics will remain the clearest evidence of Hobbes's state of nature...
...It is also true that the public demands certainty where matters of life and death are concerned...
Vol. 115 • April 1988 • No. 7
