I remember when heart transplants were front-page international news, not local human interest stories: and when oral polio vaccine replaced injections. I really do not miss the 'good old days.' I remember them, and they weren't.
I also remember when cryonics was 'science fiction stuff,' not a highly-experimental and controversial medical procedure. I probably won't live long enough to see whether it works. But if you're young enough: you might.
- Heart Transplant: "a Rebirth of Sorts"
- Cryonics: Life, Health, and Decisions
Since I'll be talking about life, death, and medical practices, I'd better start by saying that I'm a Christian: a Catholic.
Like it says in the Apostles Creed, "I believe in ... the resurrection of the body, and the life everlasting." I'll be explaining why I don't see a conflict between that belief and trying to save lives.
I had more to say after discussing the 'cryonics' news item, so this post runs a bit long:
Decades later, I had both hip joints replaced; carpal tunnel surgery done on both wrists: and was in the operating room again when part of my lower digestive tract went bad.
I'd probably have died if the latter had happened in the 'good old days.'
Needing hip joint replacements wasn't a surprise.
I'd gradually learned that many folks transition into adolescence without having the light and color drained from their world: metaphorically speaking.
There wasn't much wrong with my vision, apart from extreme nearsightedness. I could still notice that beauty existed, and analyze the phenomenon: but the emotional responses were largely missing.
An array of powerful antidepressants and other pharmaceuticals have been changing that in recent years: which is a very nice change of pace.1
That brings up an interesting question: am I facing the wrath of God because I defied the Almighty by letting doctors keep me alive and somewhat healthy?
I don't think so.
Maybe that sounds like a daft question, or maybe not. I've run into a few excessively-sentimental 'lives of Saints' tales that focus on Saints who were very ill.
Saints are noteworthy for their heroic virtue and living in fidelity with God, not for being horribly sick, and that's another topic. (Catechism of the Catholic Church, 828)
Life and health are good things, "precious gifts entrusted to us by God:"
"Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good...."
Maintaining health and fitness is important: but it shouldn't be the most important thing in my life. Being healthy is okay, but it's wrong "...to sacrifice everything for it's sake, to idolize physical perfection and success at sports....." (Catechism, 2289)
That seems clear enough. Being healthy is okay. Staying healthy is okay: within reason.
It's okay to help sick people get better, too, and find new ways to cure disease. It's even okay to transplant organs, providing we don't kill or maim one person to help another. (Catechism, 2292-2296)
I occasionally run into news about someone who decides that getting medical treatment is immoral. If the person is Christian, the idea often seems to be that we can either use our brains or trust God: not both. Or maybe it's that being sick is divinely ordained punishment.
I trust God and use my brain, or try to; and don't think God gave me bad hips and glitchy neurochemistry as a punishment.
I'd better explain that, or try to.
Maybe life would be easier if God treated us like Pavlov's dogs, promptly smiting 'sinners' and rewarding good behavior with yummies. But that's not how it works:
"But I say to you, love your enemies, and pray for those who persecute you,
Then there was the way Israel treated his youngest son, Joseph, and Joseph's behavior, that got him sold as a slave and shipped to Egypt. A few years later, he was running the place: and a good thing, too, as it turned out. (Genesis 37:2-28; 45:5-8)
I accept the idea that my continuing existence depends on God. (Catechism, 301)
Thinking, making decisions based on reason, is part of being human. I can decide to let whim and emotion guide me, or use my brain. Thinking is an option, not a requirement. (Catechism, 154-159, 311, 1730, 1778, 1804, 2339)
(From James Gillray, H. Humphrey, Anti-Vaccine Society; via Wikimedia Commons; used w/o permission.)
"The Cow-Pock—or—the Wonderful Effects of the New Inoculation!"
(James Gillray's warning against the perils of preventing smallpox. (1802))
Concern, reasonable and otherwise, over new medical technology is nothing new.
For example, in 1802 James Gillray warned the British public against a controversial medical technology: inoculation. Meanwhile, the London Fever Hospital opened, "to the great horror of the neighbours." It was the first voluntary fever hospital, and that's yet another topic.
James Gillray probably realized that using cowpox inoculations to prevent smallpox wouldn't really make little tiny cows burst from the nose, face, and assorted other embarrassing spots. He was a cartoonist, satirist, caricaturist, and arguably invented the political/editorial cartoon.
Where was I? Smallpox, inoculations, tiny cows, idolatry. Right.
Vaccination against disease has a long history — I'm putting a resource link list near the end of this post4 — but in the 1700s it was still experimental medicine, and very dangerous.
We've lived with, and died from, smallpox for a long time: upwards of three millennia, most likely.
Smallpox wasn't always fatal. About two of every three who caught the worst sort didn't die: but were scarred for life.
One of the few advantages to surviving smallpox was that it didn't strike the same person twice. Somewhere along the line, folks also noticed that the disease wasn't as severe for those who caught it from a contaminated break in the skin.
That practical observation led to variolation, deliberately infecting someone so that their bout with smallpox was more survivable, which reduced the smallpox death toll. It was an early step on the road to contemporary medicine.
I don't recall anyone objecting when the United Nations declared that smallpox was extinct on May 8, 1980.
But in the "good old days" when folks like Edward Jenner were developing inoculations against smallpox, it was a different story. Vaccination experiments triggered strong reactions, sensible and otherwise:
"for a man to infect a family in the morning with smallpox and to pray to God in the evening against the disease is blasphemy; that the smallpox is a judgment of God on the sins of people, and that to avert it is but to provoke him more; that inoculation is an encroachment on the prerogatives of Jehovah, whose right it is to wound and smite."
(Contemporary reaction to inoculation experiments by American physician Dr. Zabdiel Boylston, circa 1720)
"Smallpox is a visitation from God; but the cowpox is produced by presumptuous man; the former was what Heaven ordained, the latter is, perhaps, a daring violation our of holy religion."
(A physician's reaction to Dr. Edward Jenner's experiments in developing a vaccine for smallpox, (1796) via Psychological Sciences, Vanderbilt University)
Let's see what other folks said about the newfangled sort of medicine:
"...In contrast, many village priests in Italy, Germany, Switzerland, and England not only urged parishioners to seek the preventative treatment, they became wholesale vaccinators themselves. Pastors in Bohemia charged parents with responsibility 'before God for neglecting the vaccination of their children.' In 1814, the Pope himself endorsed vaccination as 'a precious discovery which ought to be a new motive for human gratitude to Omnipotence.'..."
("Deliberate extinction: Whether to Destroy the Last Smallpox Virus," pp. 19-20, David A. Koplow, Georgetown University Law Center (2004))
That would have been Pius VII who said vaccination was "a precious discovery which ought to be a new motive for human gratitude to Omnipotence."
I'm inclined to think he was right.
"Heart transplant is a rebirth of sorts for Fort Wayne man"
WANE Staff Reports (April 25, 2016)
"Whether it’s taking a walk in the park, spending time with his grandson, and even performing household chores, Michael Steadman is cherishing every experience.
"Steadman’s heart began to fail three years ago. He got weak, could barely climb the stairs, and was exhausted all the time. Things gradually got worse, and last year doctors told him he’d need a transplant. He expected to be on the waiting list for months – maybe even years – but within 5 days he got the call.
"That was in July of 2015. He’s still on the road to recovery and doing everything he can to stay active and healthy...."
Open heart surgery was newsworthy when I was in high school: and Christiaan Barnard's successful human-to-human heart transplant in 1967 was a major international story. I trust that the donor really was "essentially brain dead" when the doctor cut her heart out.
Louis Washkansky survived the operation and lived for another 18 days: before dying of pneumonia.
I could claim that a wrathful God smote Mr. Washkansky something fearful for being a terrible sinner and mocking God by surviving the operation: but I won't.
I think he caught pneumonia and died because immumosuppresive drugs had shut down his immune system.
I could also denounce WANE, the transplant team at Lutheran Hospital, and Mr Steadman, for their "encroachment on the prerogatives of Jehovah," as Dr. Zabdiel Boylston put it in the 1700s. But I won't.
I see the WANE headline,"Heart transplant is a rebirth of sorts for Fort Wayne man," as a mildly-poetic way of expressing the idea that getting a new heart restored at least a porton of Mr. Steadman's health.
As I said earlier, organ transplants are okay: providing we don't kill or maim one person to help another. (Catechism, 2296)
That 'rebirth' headline is mild, compared to its 'dead patient returns to life' counterparts I remember from the late 1960s.
They were almost accurate, since a common way to tell if someone was still alive was to check for a pulse.
Surgeons couldn't operate on a beating heart, so the organ had to be stopped — and the patient was "dead." At least in the pulse = life sense.
I'll get back to that.
Oddly enough, I don't remember a rash of horror-heart-transplant movies in the wake of Dr. Barnard's accomplishment.
Maybe studios figured folks had had their fill of Frankenstein spinoffs5 by then, or maybe I didn't notice 'I Have an Ax-Killer's Heart' titles.
Anyway, that's movies; and heart transplants are now so routine that they're generally human-interest local stories.
My guess is that someone, somewhere, is preaching that the road to Hell is paved with transplanted hearts. That's a disturbing image, now that I think about it. Never mind.
"If cryonics suddenly worked, we'd need to face the fallout"
Rachel Nuwer, BBC Future (April 25, 2016)
"Right now, in three facilities in the US and Russia, there are around 300 people teetering on the cusp of oblivion. They exist in a state of deep cooling called cryopreservation, and entered their chilly slumber after their hearts had stopped beating. Before undergoing true cell death, the tissues of their brains were suspended using an ice-free process called vitrification. All are legally deceased, but if they could they speak, they would likely argue that their remains do not constitute dead bodies at all. Instead, in a sense, they are just unconscious.
"No-one knows if it's possible to revive these people, but more and more of the living seem to believe that uncertainty is better than the alternative. Around 1,250 people who are still legally alive are on cryonics waiting lists, and new facilities are opening in Oregon, Australia and Europe soon.
" 'We have a saying in cryonics: being frozen is the second worst thing that can happen to you,' says Dennis Kowalski, president of the Cryonics Institute in Michigan, the largest cryonics organization in the world. 'There's no guarantee you'll be able to be brought back, but there is a guarantee that if you get buried or cremated, you'll never find out.'..."
I'd have a problem with cryonics, heart surgery, and emergency rooms, if I thought being very sick or seriously injured was the same as being dead — or that folks who aren't healthy are better off dead. I don't.
Recapping what I said earlier, I see life and health as gifts from God. Taking reasonable care of them is a responsibility. (Catechism, 2288)
That's reasonable care. "Over-zealous" treatment isn't required. Common sense is:
"Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of 'over-zealous' treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected. "
"...To the uninitiated, cryonics might seem the stuff of 'Vanilla Sky,' 'Demolition Man,' and other purely science fiction works. But many researchers believe that it is a credible field of inquiry, and cryobiologists are slowly chipping away at the possibility of revival. Most recently, a team succeeded at thawing a previously vitrified rabbit brain. Even after several weeks of storage, the synapses that are thought to be crucial for brain function were intact. The rabbit was still dead, though – the researchers did not attempt to resuscitate the animal afterwards.
"While a thawed out rabbit brain does not a fully revitalised person make, some believe that cryogenic revival might someday be as commonplace as treating a case of the flu or mending a broken arm. 'This is really not so earth-shattering or philosophically weird as you might think,' says Aubrey de Grey, co-founder and chief science officer at the Sens Research Foundation in California, a non-profit organisation dedicated to changing the way we research and treat age-related ill health. 'It's just medicine – another form of healthcare that helps people who are seriously sick. Once you get your head around that, it's much less scary.'..."
(Rachel NuwerRachel Nuwer, BBC)
Cryonics "is not part of normal medical practice," as a Wikipedia page put it.
Quite a few scientists are skeptical about whether or not 'reviving' someone who has been frozen is possible. They've got a point.
We don't know for sure whether the human brain has to be continually active to preserve memory. If it does: getting stored at around -196°C would pretty well erase the person's memories. I wouldn't like that.
The last I heard, someone must be legally dead to be frozen. That makes sense from a criminal-liability viewpoint: but means that if and when folks get taken out of cold storage, medicos will have a really sick patient on their hands.
I'm not convinced that cryonics works, or that it doesn't. I'll get back to why I don't see an ethical problem if it does. Practical issues, yes: ethical, not so much. I'll get back to that, too, in this post's Afterword.
I am convinced that "legally dead" or "medically dead" and "dead" are not the same thing.
If having a pulse meant being alive, and not having a pulse meant being dead, all recovering heart transplant patients are walking corpses that had no heart at all, let alone a pulse, for several minutes.
I think Mr. Steadman would not agree, and I think he's right.
I'll admit to having a personal bias about hasty assessments of death.
My father's father was on a construction site when a crane collapsed, killing many of the workers: including, apparently, my grandfather. An alert medic noticed that one of the mangled "corpses" was bleeding, which saved my grandfather's life.
His days as a construction worker were over, but he developed other skills, and that's yet again another topic.
I'd like to think that most folks buried these days were dead before getting embalmed/cremated and interred.
Which reminds me: I've heard that cremation was on the 'don't do this' list for Catholics. The rule wasn't as random as in might seem, and reasons for the prohibition are implicit in the Catechism's discussion of options:
"Autopsies can be morally permitted for legal inquests or scientific research. The free gift of organs after death is legitimate and can be meritorious.
"The Church permits cremation, provided that it does not demonstrate a denial of faith in the resurrection of the body.93"
I'm forgetting something. Safety coffins: that's it.
I'd like to think that what's euphemistically called "unintentional live burial doesn't happen: but in 2005 funeral director John Matarese noticed that the "corpse" in a body bag wasn't quite dead yet, and called paramedics. Dashed thoughtful of him, I think.
Quite a few patents for safety coffins date from the 18th and 19th century.
Cholera epidemics — I've mentioned how much I don't miss the 'good old days' — and a natural skittishness about examining possibly-contagious corpses encouraged not-unreasonable fears of waking up in a cozy little coffin.
A recovery team pulled a limp, obviously-lifeless body out of the Red River in Fargo, North Dakota, back in 1987. Young Alvaro Garza Jr. was limp as a noodle when a recovery team fished him out from a hole in the ice.
He had no pulse, and was quite obviously "dead." That's what happens when you spend 45 minutes under the river's surface.
His core body temperature went down to 77 degrees Fahrenheit — which probably saved his life. That, the mammalian diving reflex, having a hospital with a heart-lung machine nearby, and a family who wanted him to be alive. My opinion.
Folks at St. Luke's hooked Alvaro Garza Jr. into the machine, which let them "take his blood and warm it up and put it right back in his body," as St. Luke's/MeritCare's Roberta Young, RN, put it. 20 years later, Mr. Garza had four kids of his own: and a healthy respect for water.
- "11-year-old-boy who nearly drowned in icy river released from hospital"
Spartanburg Herald-Journal; via Associated Press, Google News (December 22, 1987)
- "Boy, 11, Who 'Died' in Icy River Leaves Hospital"
LA Times, via Associated Press (December 22, 1987)
- "20 years later, Christmas 'miracle' is remembered"
(December 4, 2007)
As I said last month, I follow the Man who is God: who died in my place; descended to the abode of the dead; rose from the tomb; and lives today and forever. (Matthew 28:1-10; Mark 16:1-11; 1 Peter 4:6; Catechism, 631-635, 638-655)
Jesus died. Our Lord had been killed by an execution squad which included Roman soldiers. They surely knew the difference between a dead body and someone who had fainted, or was pretending to be dead.
About three decades back, JAMA (The Journal of the American Medical Association, a peer-reviewed medical journal covering all aspects of the biomedical sciences) published an analysis of what our Lord went through.
It isn't an easy read, but worth the effort. My opinion:
- "On the Physical Death of Jesus Christ"
William D. Edwards, MD; Wesley J. Gabel, MDiv; Floyd E. Hosmer, MS, AMI — JAMA, Vol 255, No. 11 (March 21, 1986)
via associationofcatholicwomenbloggers.blogspot.com/2015/04/good-friday-physical-death-of-jesus.html (April 4, 2015))
I've been over that before. (April 5, 2015)
I am quite sure she did not do that because she denied the Resurrection, or wanted to encroach "on the prerogatives of Jehovah, whose right it is to wound and smite," as Dr. Zabdiel Boylston put it.
I am reasonably confident that her goal was what it appeared to be: restoring my health.
Getting back to the cryonics, ethics, assumptions, and all that — I very strongly suspect that whether or not getting put in cold storage is right depends at least in part on a person's motive.
If the individual thinks surviving until a cure for some disease is developed will prove that God doesn't exist — don't laugh, I've heard goofier arguments on several issues. I also don't see that as a good reason.
Someone wanting to survive until a cure for some disease is developed: that, to me, seems reasonable. I suppose someone out there thinks we're supposed to sit on our hands and let God smite us something fierce, but I'm not of that opinion.
Basically, I don't see cryonics as wrong, ethically.
If it works, it's simply another method for stabilizing a patient until adequate medical care is available. If I'm going to denounce cryonics on ethical grounds, I might as well denounce ambulances: because they defy God by getting folks to a hospital while they're still alive.
We may learn that cryonics doesn't work, and that folks who signed up to be frozen are really dead: as well as legally deceased. But right now, we do not know. I'm inclined to see it as a highly experimental medical procedure: dangerous, but potentially life-saving.
I think what Dr. Barnard wrote about Mr. Washkansky, the first heart transplant patient to survive more than two weeks after the operation, is relevant to questions about cryonics:
"...Washkansky could either wait for certain death or risk transplant surgery with an 80 percent chance of surviving. He chose the surgery. As Barnard later wrote, 'For a dying man it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion.'..."
(Christiaan Barnard, People and Discoveries, A Science Odyssey; NPR)
Lal Bihari was dead, officially, from 1975 to 1994. His uncle had bribed an official to register Bihari's death: putting the uncle in line to inherit some land.
Bihari eventually sorted the legal mess out, learned that at least a hundred other "dead" folks were in his position, and formed the Uttar Pradesh Association of Dead People.
Lal Biharie and his fellow-dead-people were victims of fraud: and in danger of being really, as well as legally, dead if they made too much of a fuss. I hope folks in that part of the world sort the mess out, but I won't claim that 'it can't happen here.'
"Brain death," the complete cessation of brain activity, might be a useful definition of death: if it was consistently applied.
It's not, so "brain death" in one place can mean that the whole brain, right down to the brainstem, has shut down.
Somewhere else, a patient with an active brainstem can be breathing on his or her own — and be "brain dead" because at least part of the higher brain functions are offline at the moment.
I don't think it helps that in my country organ harvesting can't start, legally, until a doctor signs off on "brain death." Cheerful thought.
I've seen that silly optimism change to what I think is an equally-silly fear that the future will be just simply awful: and then we'll all die.
The World Health Organization released a Global Polio Eradication Initiative Strategic Plan progress report in 2012. This will take time, but I think we can end polio, too.
About adjusting to 'the future,' it helps that I didn't expect the world I am growing old in to be exactly like the world my grandfather lived in. I lived through the intervening years, learning new skills as needed: and enjoy learning about new technology.
If I'd — this couldn't have happened, we didn't have the technology, and still don't — been frozen in my mid-20s, and taken out of storage this year: that would be a different experience. I wouldn't mind learning that the Cold War was over: and wouldn't miss disco.
My guess is that I'd learn how to use today's information technology differently: most likely skipping right past learning how to use BASIC, QBasic, and DOS. Also, I wouldn't have gotten practice being patient while a dial-up modem made connections.
What sort of job I'd be qualified for: that, I'm not at all sure about.
The biggest adjustment, I think, would be getting used to a world without my parents. I would have missed the last few decades of their lives. On the whole, I'm glad to have experienced that.
Something that I'd wonder about, if I signed up for being frozen, is who would pay the bill if I survived the process. Cryonics organizations charge for their services up front, including storage and maintenance costs: so that's not an issue. Not in the short run, at least.
But let's assume that I was dying of something, arranged to be frozen, and woke up in the 31st century. Any financial arrangements I'd made could easily have failed in the millennium that passed.
One of my top concerns would be learning how I'd be expected to compensate folks for keeping me alive.
In a way, I'd probably rather wake up after several thousand years. That way my memories and experiences might be a mildly-valuable resource for antiquarian scholars.
And now for something completely different.
That's Rudolf Selnikov in the jar: what's left of him, that is. He was "in need of medical attention" — it's quite complicated, actually, like most of the Girl Genius comic series, and mostly irrelevant to this post.6
Selnikov looks happy in that panel because he's realized that being (officially) "dead" frees him from political infighting; and, as he put it, "...twisted and ruthless as you people are, throwing in with you is a step up."
Several panels back, Selnikov asked why he was "still alive." Given the willing suspension of disbelief required for the story — that question makes sense.
He'd been seriously injured, but "dead" only in a legal sense. His head was essentially intact, so his medical status in the story was a bit like an accident victim who was unconscious when taken to the emergency room.
We can't grow a new body for someone. Today, that sort of medical technology does not exist: although scientists have successfully grown a mouse thymus, and a few other non-human spare parts. (August 29, 2014)
Interestingly, I don't remember folks going ballistic over the first heart transplants. Maybe that's because I'd stopped listening to radio preachers by then, or maybe they were too busy having conniptions over just about everything else going on during the '60s.
By now, swapping out someone's heart is still a major medical procedure: but I think most folks have gotten used to the idea that not having a pulse does not necessarily mean being dead.
I also think the Sens Research Foundation's Aubrey de Grey, quoted in that BBC Future article, made sense, talking about cryonics:
"...'It's just medicine – another form of healthcare that helps people who are seriously sick. Once you get your head around that, it's much less scary.'..."
(Rachel NuwerRachel Nuwer, BBC)
More, mostly about faith and reason, science and religion:
- "Synthetic Life, DNA Profiles"
(April 1, 2016)
- "March 29, 2015 Humility, Science, and Accepting Reality"
(November 27, 2015)
- "Pig Organs, Ancient Immigrants"
(October 16, 2015)
- "Kidneys, Experiments, and Ethics"
(September 25, 2015)
- "Regeneration: Getting Closer to Growing Lost Organs"
(August 29, 2014)
- Growing a Thymus from Scratch
- Replacement Parts, Grown to Order: Bladders Today; Hands — Eventually, Maybe
- Brand-New Tech, Same Old Challenges
- Positive Law, Isus Positum: Human-Made Rules
- Natural Law, Lex Naturalis: Universal Principles, Changing Applications
- Living in 'The Future'
1 I've been over this before:
- "About Me and This Blog"
- "Humility, Science, and Accepting Reality"
(March 29, 2015)
- "Joy and Standing Orders"
(October 5, 2014)
2 I've talked about God, love, anger, and getting a grip, before:
- "Life, Death, and Love"
(November 1, 2015)
- "Fire, Brimstone, and Lollipop Faith"
(March 15, 2015)
- "Vengeance, Anger, and Looking Ahead"
(July 13, 2014)
3 I don't hope to convince zealots — but owning pictures and carvings isn't "idolatry," and the Catholic Church says to worship only God:
- "Precision-Grip Thumbs and a 'New' Archosaur"
(January 30, 2015)
- "Gideon, Gabriel, Mary, and Guts"
(December 21, 2014)
4 Life, death, and medicine; background:
- Cardiac surgery
- Cardiopulmonary bypass
- Cardiopulmonary resuscitation
- History of Smallpox
- Transplant rejection
- Organ transplantation
- "Why Hospitals And Families Still Struggle To Define Death"
Maanvi Singh, NPR (January 10, 2014)
5 Just when you thought it was safe to go back to the movies:
- Bride of Frankenstein
- Son of Frankenstein
- The Ghost of Frankenstein
- Frankenstein Meets the Wolf Man
- Abbott and Costello Meet Frankenstein
- I Was a Teenage Frankenstein
- Frankenstein Meets the Space Monster
- More Frankenstein films
- Still more Frankenstein films
6 Selnikov is a minor character in the Girl Genius comic series.
- May 28, 2008
(in need of medical attention)
- February 2-February 7, 2011
(adjusting to being (officially) dead)