Awake!, June 8, 1968

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JUNE 8,1968

THE REASON FOR THIS MAGAZINE

News sources that are able to keep you awake to the vital issues of our times must be unfeathered by censorship and selfish interests. "Awaken!" has no fatters. It recognizes the importance of being an independent voice. It is not censored by traditional creeds. This magazine keeps itself free, that it may speak freely to you. But it does not abuse its freedom. It maintains integrity to truth.

The viewpoint of "Awakel" is not narrow, but is international. "Awakel" has its own correspondents in scores of nations. Its articles are read in many lands, in many languages, by millions of persons.

In every issue "Awakel" presents viral talks on which you should be informed. It features penetrating articles on social conditions and offers sound counsel for meeting the problems of everyday life. Current news from every continent passes in quick review. Attention is focused on activities in the fields of government and commerce about which you should know. Straightforward discussions of religious issues alert you to matters of vital concern. Customs and people in many lands, the marries of creation, practical sciences and points of human interest are all embraced in its coverage. "Awakel" provides wholesome, instructive reading for every member of the family.

"Awake!" piedges to righteous principles, to exposing hidden foes and saddle dangers, to championing freedom for all, to comforting mourners and strengthening those disheartened by the failures of a deficient world, reflecting sure hope for the establishment of God's righteous new order in this generation.

Get acquainted with "Awake!" Keep awake by reading "Awake!"

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CONTENTS

Your Health—the Responsibility of More than One 3

Muse of Humans for Medical Experiments 4

What Kind of Doctor Treats You? 9

Experimenting with Transplants Not New 12

Heart Transplants Pose Staggering Problems 17

Professional Responsibility 22

Moses and Man's Life-Span 22

Using Good Sense in Caring

"Human Dignity and Moral Behavior" 25

God's Provisions to Heal Mankind 26

Your Health THE RESPONSIBILITY OF MORE THAN ONE

WHAT a blessing good health is! There is so much that can be accomplished, so much that can be achieved, so much that can be enjoyed when one is blessed with good health. However, sad to say, all too often good health is taken for granted until it has been lost or seriously endangered. Then it is but natural to hasten to the doctor for help.

But the matter of your health is not just the responsibility of your family doctor; it is your responsibility too. While heredity has a bearing on your health, even more so does environment, or how you conduct yourself. If you keep on violating the principles of good sense repeatedly and then go to your doctor for some pills, are you not asking for trouble sooner or later?

Besides, by doing so you may well be laying yourself open to be used as an object of medical experimentation, of which the press has had much to say. The manufacture of drugs is a commercial business, not an altruistic calling, and manufacturers are continually deluging the medical profession with new products. By your urging the doctor to give you a pill for fast relief, when what you need is sleep or

more moderate habits, you may well become a party to medical experimentation

After years of dependence upon pills you may next become the subject of surgical experimentation, which subject has arisen because of the recent heart transplants. According to Science News, March 9, 1968, the Board of Medicine of the National Academy of Sciences stated that even in the most extreme cases, when no other remedy is available, the procedure of heart transplants "must be viewed clearly for what it is, a scientific exploration of the unknown."

All of which underscores the responsibility the physician and the surgeon have by reason of their unique position of trust. People come to them in need of help and so are ready to put their trust in them. But these men are subject to the failings of mankind even as are others. What will they do? Will they put the interests of their patients first, or will they risk the patient's well-being for the sake of personal advantage, either in knowledge or of money?

What will govern their decisions?

Should it not be the "golden rule"? Surely! We cannot improve on the maxim: "Just as you want men to do to you, do the same way to them."

By heeding that rule, neither the patient nor the doctor is likely to have cause for complaint. But,

unfortunately, as is true of mankind in general, so too in these professions, not all are always governed by that rule, even as the following article shows. - Luke 6:31

Misuse of Humans for MEDICAL A BROOKLYN lawyer of int 际 national reputation was EXPERIMENTS

A BROOKLYN lawyer of international reputation was greatly disturbed. He had a philanthropic bent of mind and heart, as can be seen by his being one of the founders of the Jewish Chronic Disease Hospital of Brooklyn and for some thirty years one of its active directors. What had so greatly disturbed him? The resignation of three young doctors from this hospital. They had resigned rather than take part in certain cancer experiments that were to be made upon twenty-two aged and largely helpless invalids.

This director appealed to fellow members on the hospital board, but they turned a deaf car. It was necessary for him to carry his fight against stiff opposition all the way up to the Supreme Court of the State of New York for him to get the right to investigate the matter. Upon his gaining this victory others interested themselves in the case, including the Medical Grievance Committee of the New York State Board of Education, which deals with questions of professional standards such as those of doctors and lawyers. What did it find?

In brief, it found that one of the foremost leaders of cancer research in the United States, a doctor associated with a number of the country's most respected medical institutions, had arranged for live cancer cells to be implanted in twenty-two aged chronic invalids without their knowing what it was all about.

Previous research with prison volunteers had established that a healthy organism generally rejects these live cancer cells quite quickly; also that the bodies of cancer patients reject them much more slowly. Now Dr. Southam wanted to satisfy his curiosity as to whether the cancer patients rejected live cancer cells much more slowly than others because they had cancer or because their bodies had been weakened by cancer. So through a friend he arranged to make human guinea pigs of these twenty-two old folks, nineteen of whom were debilitated from causes other than cancer.

They were not told that what was being injected in them were live cancer cells. Some were deaf, or so far advanced in debility, or so suffering from nervous afflictions and senility that they could not possibly have understood what it was all about if they had been told the truth. It was also all done in a great hurry. A few months later one of these died from cancer of the bladder.

Did the hospital director have good reason to be disturbed at what had taken place? He most certainly did, as can be seen by the statements of the officers investigating the case. Said one of the members of the three-man Medical Grievance Committee: "I am extremely concerned with the fact that these chronic, debilitated, sick patients were hurriedly and unexpectedly confronted with a verbal description of a technical procedure which, even to a normal, educated, intelligent, and healthy person, would have been inadequate and untruthful. This is fraud and deceit. I also believe that the omission from the hospital charts that these patients were injected with live cancer cells constitutes fraud and deceit. I further believe that the rights of these patients and their families were violated by the respondents . . . who resorted to trickery, false statements and deliberate deception."

The chairman of the committee stated: "Every human being has an inalienable right to determine what shall be done with his body. This without regard as to whether he be confined to a penal institution, or free, or whether he be healthy or debilitated or confined to an institution or a hospital." If the patient is physically or mentally unable to do this, his "nearest of kin must be accorded the right to make this decision."

The chairman of the New York State Board of Regents' Discipline Committee handling the matter, Dr. J. W. McGovern, ruled: "A patient has the right to know he is being asked to volunteer and to refuse to participate in an experiment for any reason, intelligent or otherwise, well-informed or prejudiced. A physician has no right to withhold from a prospective volunteer any fact which he knows may influence the decision. It's the volunteer's decision to make and the physician may not take it away from him by the manner in which he asks the question or explains or fails to explain the circumstances."

Seek to Justify Selves

How did these medical experimenters seek to justify themselves? By claiming that to tell these patients that they were being given live cancer cells would have needlessly alarmed them. Also, they contended that previous experiments with healthy subjects, as well as cancerous ones, had shown that the body rejects such cancer cells. The doctors further claimed that there was no likelihood of harm from these injections, although one of the patients did die later of cancer. However, since it could have been that the patient who died had cancer without its being known before he was injected with live cancer cells, the Grievance Committee made no issue of it.

Since the medical experimenters minimized the risk, Dr. Southam was asked whether he and his colleagues had ever injected live cancer cells into themselves. He replied that they had not because "there are relatively few skilled cancer researchers and it would be stupid to take even a little risk."2

That there is, indeed, risk is testified by authorities on cancer research. One of these has said: "The known hazards of such experiments include growth of nodules and tumors and may result in metastasis [spreading growths] of cancer if the patient does not reject the cells."*

'Almost Universal'

Dr. Southern and his colleagues could also have tried to justify themselves by stating that what they did was not entirely unusual. In this they would have been correct, for others in medical research are doing the same thing. Concerning this unethical experimentation on humans, Dr. Henry K. Beecher of the Harvard School of Medicine wrote: "What seem to be breaches of ethical conduct in experimentation are by no means rare, but are almost, one fears, universal." (By this he meant, as he himself later explained, that such experiments are taking place in all the various kinds of medical research, surgical, medicinal and psychiatric.) "Ethical errors are increasing, not only in numbers, but in variety, for example, in the recently added problems arising in transplantation of organs."

Previously Dr. Beecher told of fifty cases appearing in the medical press in which such breaches of medical ethics had been made over a period of years. He gave the details of only twenty-two of them because of the limits of space, it being at that a lengthy article. Among these were one in which twenty-five young soldiers needlessly acquired rheumatic fever and another in which twenty-three patients unnecessarily died of typhoid fever.*

How dangerous such experimentation can be is seen from the experiment made with twelve premature infants. Six of them were placed under high oxygen and six under low oxygen. All the infants placed under high oxygen became permanently blind. Was this necessary? Absolutely not, for "a series of reports from medical centers appearing in widely distributed medical journals called attention to the

apparent association between high oxygen exposure and the subsequent development of irreversible blindness in premature infants. The evidence was statistical but sufficient to cause those who made the observation to suggest that this kind of treatment should be avoided." Then was it necessary to blind six persons for life to verify this evidence? Where is the fellow feeling? Where is the empathy?

Speaking out against unethical experimentation in England is Dr. Pappworth. In his book Human Guinea Pigs (1967) he tells of the many experiments made on humans, to their great harm, often, as in the foregoing, simply to confirm what was already known. He cites instance after instance of experiments, without knowledge or consent, on infants and children, pregnant women, mental defectives, prison inmates, patients awaiting operations and on the old and dying.

The Attitude of the Profession

The New York State Board of Regents, in dealing with the cancer experiment case, stated that "some physicians believe . . . the patient's consent is an empty formality. With this we cannot agree." But this attitude is so widespread that one lawyer in the case asked: "If the whole profession is doing it, how can it be called 'unprofessional conduct'"[24] And according to Dr. Pappworth, "the vast majority of the medical profession are either genuinely ignorant of the immensity and complexity of the problem or wish to purposefully ignore the whole matter by sweeping it under the carpet." He also tells that Nazi doctors on trial at Nuremberg tried to justify their shocking experiments on Jews and others by citing examples of unethical American experiments. This, however, availed them nothing.

That the attitude of some in the medical profession is to ignore these abuses can also be seen by a directive issued by the United States Surgeon General Dr. William H.

Steward, February 1967. He found it necessary to order that "all institutions receiving grants from Public Health Service for clinical research must set up" panels to see to it that researchers do not conduct improper experiments. Many of these experiments subject the patient to "a risk-posing procedure that cannot conceivably benefit him." It is rare that doctors involved in such experiments are tried and found guilty. When they are, the penalties are often light. Thus Dr. Southam and his colleague were simply put on probation, for one year, for 'fraud, trickery and deceit.'

Disconcerting to many is what happens to those who dare speak out against such abuse. For daring to do so in connection with the experiments made at the hospital that he helped found and of which he was one of the directors, lawyer William A. Hyman was rewarded with loss of his position as one of its directors!

Scientific Knowledge or Compassion?

One of America's leading psychiatrists once stated that the kind of a man a psychiatrist was was more important than what he had stored up in his head. No question about it, for the average patient compassion on the part of his physician is as desirable as scientific knowledge. "What he is affects the patient more than what he does." The Nuremberg Court decreed death sentences for seven Nazi physicians and prison sentences for nine others who had experimented upon humans. Included among these doctors were "outstanding men of science, distinguished for their scientific ability in Germany and abroad, . . . exemplifying in their training and practice alike, the highest traditions of German medicine."

The result of these trials was the Nuremberg Code, consisting of ten rules. First and most important was the rule that only those who were volunteers in the fullest sense of the word, and who were fully informed, could be used for human experiments. Secondly, that only such experiments as held promise of benefits not obtainable in any other way were to be performed on humans. Thirdly, it ruled that all experimentation on humans must first be preceded by experiments on animals. (Hitler had banned animal experimentation but had no objection to the shocking experiments that Nazi doctors performed on the Jews and other concentration-camp inmates.) Among other rules was the one that all unnecessary suffering was to be avoided.

Discussing this subject in the Journal of the American Medical Association, Dr. H. K. Beecher wrote: "It is clear that many published studies should never have been undertaken in the first place. . . A particular pernicious myth is the one that depends upon the view that the end justifies the means. A study is ethical or not at its inception. It does not become ethical merely because it turned up valuable data. Sometimes such a view is rationalized by the investigator as having produced the most good for the most people. That is blatant statism. Whoever gave the investigator the godlike right of choosing martyrs?" He concluded by observing that the patient's "great safeguard in experimentation as in therapy is the presence of the skillful, informed, intelligent, honest, responsible, compassionate physician. And one hopes and believes these are in the majority."11

In regard to medical ethics Dr. Irvine H. Page, Director, Research Division, Cleveland, Ohio, Clinic, and editor of Modern Medicine, had an interesting observation to make. Among other things, he stated that medical ethics "depend importantly upon the starting point, whether it is religious, existentialist or materialist .

. . If there is an expert on medical ethics, we need him badly, but I suspect he is nonexistent." But he is not nonexistent. Jesus

Christ, who was raised from the dead, even as testified by many eyewitnesses, is the expert on all ethics, medical, legal, political, economic, social and

ARTICLES IN THE NEXT ISSUE

The Quiila Board—Harmless Amusement or Deadly Threatt

Summer Is Year's Happy Time!

Be My Guest for a Day at Gilead,

So You're Going to Movel

Similarly the physiologist wife of Dr. Fritz Fuchs, of New York, learned from experiments that alcohol given to animals intravenously off the hormone that causes the labor contractions that result in birth. So when she found herself having premature labor contractions during

domestic. He summed up ethics in what is generally called the "golden rule": "Just as you, want men to do to you, do the same to them."—Luke 6:31.

The Golden Rule

This is not just a layman's view. Dr. Beecher said that what was needed was "a firm application of the Golden Rule."¹² And Professor of Medicine at the Oxford Medical School, London, Sir George Pickney stated: "the experimenter has one golden rule to guide him as to whether the experiment is justifiable. Is he prepared to submit to the procedure? If he is, and the experiment is actually carried out on himself, then it probably is justifiable. If he is not, then the experiment should not be done."¹³

This suggestion is not at all as radical as some might think. There was professor of surgery, Dr. Werner Forssmann, of Duesseldorf, Germany, who was presented with the Noble Prize for Medicine in 1956, for the method of heart catheterization that he had discovered or invented in 1929. Against the strenuous objections of his superiors, he used his catheter method of heart diagnosis first upon himself, it requiring the feeding of a long tube from the elbow into the heart.[14]

her fourth pregnancy, she used this method on herself. She thus became the first human on which this was tried. It worked and now is recognized standard

procedure in a number of hospitals, although the method has yet to win general acceptance. 15

Of course, this does not mean that just because a doctor is willing to experiment on himself such experiment should be performed on someone else.

No question about it, important as scientific knowledge is, human compassion is even more important. Application of scientific knowledge without human compassion calls to mind the poet's words: "Grace abused brings forth the foulest deeds; just as the richest soil, the most luxurious weeds." Bible principles are not only just, but they are wise and loving. Those who live by them are not only happy but also spread happiness to others!

REFERENCES

1 Saturday Review, February 5. 1966.

3 Saturday Review, July 2, 1966.

What Kind of Treats You?

WHAT kind of doctor do you like to think that your doctor is? One who is greedy for selfish gain? One who is more interested in research than in people? Hardly! Rather, you would like to think that your doctor is a man of principle, who believes in doing to others as he would have them do to him; one who gets satisfaction out of helping people; in short, a doctor who is compassionate.

Compassion has been defined as "a feeling for the sufferings of others" together "with the urgent desire to aid." Surely it should be a basic requisite of all who would alleviate the sufferings of humanity, be they general practitioners, surgeons, specialists, chiropractors or psychiatrists.

The greatest Teacher and Healer ever to walk the earth, Jesus Christ, the Son of God, was truly compassionate. Concerning him the Bible says that "when he saw the crowds, he had compassion for them, because they were harassed and helpless, like sheep without a

so touched that he himself "gave way to tears." No question about it, he had empathy; he was able to enter into the spirit and feeling of people around him. He was compassionate, keenly desirous of helping them. What he himself preached, he practiced. "All things, therefore, that you want men to do to you, you also must likewise do to them."—John 11:35; Matt. 7:12.

Is He Greedy for Selfish Gain?

Probably the greater part of those in the healing professions manifest to an extent the fine qualities of doing to others as they would have others do to them and of showing compassion. However, even as some who were supposed to look after the people's welfare in the first century were greedy for selfish gain, so today. (Luke 16:14) There is, of course, nothing wrong with earning a comfortable living while bringing relief to ailing humans. But it is something else for anyone to exploit the suffering and misery of others for the sake of selfish gain, as when an unnecessary operation is recommended or performed, or a very simple operation is presented as having been a very complex and serious one.

Doctors who do these things might rationalize their course by noting that ever so many people today are motivated by greed for selfish gain, and in a way this may largely be true. But is it doing to others as one would have them do to one? Far from being compassionate, is it not betraying a patient's trust?

That such men are not as rare as one could wish is apparent from the fact that repeatedly men in the medical profession itself feel the need to speak out against such abuses. For example, there are the books The Interns (1965), Deplorable Doctors (1965) and The Healers (1967). In the latter book the author, a gynecologist of long standing in United States medical circles, gives many instances of the greed of some of the men in the medical profession.

The latter two books are to be found in the library of the New York Academy of Medicine, which is careful of the kind of books it supplies to its members. And what is even more disturbing about these books is the fact that their authors feared to identify themselves. The books were written either under admitted anonymity, such as by "Dr. Anonymous" or under a pseudonym, that is, a fictitious or pen name. Regarding the revelations contained in the book The Healers, it was reported that "many doctors would like to speak out against had practices but none felt able to do so without fatally compromising his career with the medical establishment."

No question about it, in the healing profession, whether orthodox or unorthodox, there are those whose chief concern is, not helping people get well, but selfish gain.

Is He Too Much Fascinated by Research?

Also lacking in empathy and compassion, though undoubtedly less censureable than the foregoing, are those doctors with whom their practice is more a matter of the mind than of the heart. These are the healers who are overly fascinated by the scientific search for knowledge. For them this quest seems to be an end, rather than a means to the end of bringing relief to suffering humanity. These men become more fascinated by theories and experiments than by the prospects of doing good. It might be said that these men belong more in the scientific laboratory than in a hospital or doctor's office or at a patient's bedside.

Concerning this tendency among some modern doctors, the British physician Pappworth says in his book, Human Guinea Pigs: "The degree to which antihumanism dominates modern medicine can be judged by the significant fact that in most medical reports of patients having been submitted to experimentation, the patients themselves are collectively described as 'the material.'"

No doubt adding to the fascination of research for some is its rewards. Thus Dr. H. K. Beecher urged that experiments that violated patients' rights be denied publication in medical journals. Why? To discourage overager young researchers out to make a quick name for themselves. "Every young man knows that he will never be promoted to . . . a professorship in a major medical school unless he has proved himself as an investigator."—New York Times Magazine, July 2, 1967.

A typical case of this appeared in the press as recently as March 20, 1968. Mr. Richard Doyle, a special agent for the New York State Investigation Commission reported: "I found that there were five [research] projects at Coney Island Hospital that did not have the necessary approval of the Commissioner of Hospitals.

They all involved patients." He also found that "a chief of service at Coney Island spent 100 percent of his time on research, according to grant applications filed by the physicians. Another physician spent 80 percent of his time on research. Both physicians are required by their city contracts to supervise their departments."—New York Times.

The Compassionate Physician

How different from the foregoing is the doctor who is compassionate! He does not let the desire for selfish gain interfere with his ministering to his patients. He does not view his patients as objects for experimentation. Instead, he has empathy, he is able to put himself in the place of his patients and to think and feel as they do. He therefore gives to his patients the impression that he truly does care, and he does care. He will take the time needed to get an adequate case history, will take time to listen to his patient's complaints, will do his best to explain to his patient how he sees the problem and what he recommends and why. He will see his patient as a whole and not merely view him as a case of this illness or that. He is not reluctant to make a house call if need be, knowing it may well help him to understand his patient better. In times past this type of doctor was far more often to be seen than now.

That there is a tendency for some young physicians to veer away from this role of being a compassionate friend is recognized by the "old-timers" in the profession. Both in private and in the medical press they speak out against it. Thus Medical Economics, said by some to be the medical journal having the highest circulation, in

its issue of November 1966, carried an article entitled "Can We Teach New Doctors Compassion?" Then later it stressed the point again with a reproving title, a statement made by a patient who had lost her husband: "The Doctor Just Didn't Seem to Care!" Among the points made by the veteran practitioner were: "Compassion, I like to think, has helped many of my patients in their bouts with sickness." Often a sick patient needs emotional companionship.

This type of doctor is ready to cooperate with the Christian witnesses of Jehovah in their scruples against taking blood transfusions because of the Scriptural injunction: "Keep yourselves free from . . . blood." (Acts 15:29) Concerning this problem, Inside Baylor Medicine, No. 2, 1968, had, among other things, the following to say: "The challenge of religion versus medicine has been well met, and much has been gained. Doctors have learned that they may be called upon to modify their management of a patient's illness when there are factors more important to the patient than his own health or even his life. The patient's ideals and honor must be respected. Sometimes, as in the case of surgery for Jehovah's Witnesses, the modified procedures developed can be of wide benefit to other patients."

The great Teacher who commanded that we do to others as we would have them do to us, also wisely observed: "There is more happiness in giving than there is in receiving." All doctors who show empathy and compassion, as did the open-heart surgeons at the Baylor University School of Medicine, can hope, in one way or another, to realize the truth of that principle.—Acts 20:35.

Experimenting with Transplants NOT NEW

TRANSPLANTS are not new. For about a hundred years now surgeons have been experimenting with them. Not even heart transplants are new. What is new is experimenting with transplants of hearts from one human to another.

A now-growing number of patients have received "new" hearts. On December 3, 1967, at the Groote Schuur (the name means "Big Barn") Hospital in Cape Town, South Africa, two surgical teams performed the first experimental human heart transplant. They took the heart of dying Miss Denise Darvall, who had been fatally injured in an auto accident, and transplanted it into heart patient Louis Washkansky, a grocery fifty-five years old. First reports were optimistic, but Washkansky died after eighteen days.

On December 6 Dr. Adrian Kantrowitz at the Malmionides Hospital, Brooklyn, New York, replaced the fatally defective heart of a two-a-and-a-half-week-old baby boy with the heart of a three-day-old baby boy who had been born with a fatal brain defect. "All vital signs appeared favorable. But inexplicably, 6 and 1/4 hours after closure, the transplanted heart ceased to beat."

On January 2, 1968, Dr. C. Barnard, in South Africa, performed his second heart transplant. He gave a fifty-eight-year-old

retired dentist, Dr. Philip Blaiberg, the heart of a "colored" (racially mixed) man, Clive Haupt, who was dying of a brain hemorrhage. Blaiberg was dismissed from the Groote Schuur Hospital two and a half months after the operation and at latest reports is writing a book about his experience.

On January 7 Dr. N. E. Shumway at Stanford, California, transplanted the heart of Mrs. V. White, who died of a massive brain hemorrhage, into Mike Kasperak, aged fifty-four, who was seriously ill with a very faulty heart. He survived two weeks and then died of a series of complications.

On January 16 Dr. Kantwritz performed his second heart transplant, a nine-hour operation, taking the heart of Miss Helen Kouch and transplanting it into Louis Block, a heart patient. "The donated heart was too small to handle Block's circulation and Block died hours after surgery."2

The sixth heart-transplant operation took place in Bombay, India, on February 16, 1968, when Dr. P. K. Sen and his forty-five-man surgical team took the heart of a nineteen-year-old woman who was scarcely alive after a fall and transplanted it into a farmer suffering from a fatal heart malady. Dr. Sen said "the operation was technically successful, but death came three hours later from a lung infection."29

On April 28 at the Hospital de la Pitie, Paris, a team of surgeons performed the seventh heart-transplant operation. They took the heart of accident victim, 23-year-old Michael Gyppaz and transplanted it into retired 66-year-old Clovis Roblain. He died 51 hours later, not having regained consciousness.

Since then, reports of more of these operations have continued to be made.

Fires Imagination of Public-But

The first heart transplant (from human to human), performed by Dr. C. Barnard, was hailed in the press as "The Heart: Miracle in Cape Town." It was further described as "opening a new era in medicine." Doctor and patient alike, it was said, "have been catapulted irreovocably into a new transplant age by the Cape Town operation."

On the basis of his apparently successful operations, Dr. C. Barnard became an international celebrity overnight. He visited the United States and its president and appeared on TV. Later he took a tour in Europe. Two colleagues accompanied him, and he took along a Cape Town fashion photographer to make pictures for his coming autobiography. During his interview with Pope Paul VI, Dr. Barnard expressed concern about the moral aspects of heart transplants. The pope, however, assured him, saying: "I bless your achievement, and I invite you to proceed along the same road, as you have until now."

Sensational as this news seemed to be, it was by no means met with equal enthusiasm by leaders in the medical profession. For one thing, many were highly

critical of the publicity connected with it. Thus Dr. P. M. Spear, Director of Medicine of a leading New York City medical institution, complained:

"It is indeed unfortunate that my surgical colleagues in South Africa, Stanford and Brooklyn have succumbed to the blandishments of publicity. Neither the interests of medicine nor of the public are served. . . Such premature reports of medical research can only serve to raise false hopes in thousands of victims of intractable heart disease. It would be closer to the highest scientific traditions of the medical profession to . . . refrain from making grandstand plays to the public until there is more solid accomplishment upon which action can be based."

Even stronger criticism was voiced by many, especially heart surgeons, on the basis that heart-transplant operations at this time were altogether premature. Thus Dr. J. Ankeney, surgeon at the Western Reserve University School of Medicine in Cleveland, stated: "Tremendous interest has been built up in something that hasn't been proven. . . . I think there are many physicians in the country that are disturbed by what's going on." Dr. C. P. Bailey, one of America's foremost open-heart surgeons, stated that heart-transplant operations were at least a decade premature. And one of Canada's leading heart surgeons, Dr. Jacob Horowitz, said: "I don't think it is moral to experiment on humans . . . I don't think they will last. . . . There are just too many tissues that can reject the heart. Transplants have never really been successful on animals. Why should doctors try the same thing on humans?"

In a similar vein are the observations of Dr. G. E. Burch, president elect of an American association of heart surgeons: "I would not select any patient for a cardiac transplant, because once you take his own heart out, you know he's going to die." And said Dr. Werner Forssmann, one of Germany's leading heart surgeons and a Nobel Prize winner, regarding heart transplants: "Unethical.

Medically unsound. Criminal." Many voices have also been raised against heart transplants in Great Britain, and the medical profession in Russia has so far refused to have anything to do with human heart transplanting.

Experimenting with Transplants

Why have so many voices been raised, not only objecting to the undue publicity, but also stressing that heart transplants are premature? Because the problem is not primarily technical but biological. What does that mean? In brief, it is easier by far to transplant a heart than it is to keep the patient alive for any length of time after the "technically successful" operation.

Thirty-eight years ago a leading Canadian heart surgeon, Dr. J. Markowitz, performed a successful heart transplant from one dog to another. The dog that received the heart transplant remained alive for six days. In the past three years Dr. Barnard performed this operation on fifty dogs, so as to perfect his technique. Yes, "long before they operated, the surgeons who have performed heart transplants knew that the actual surgery, though tedious and difficult, would be the easy part."*

Then why wait so long? Why did not Dr. J. Markowitz at once proceed to transplant hearts from one human to another? Because of what has been termed the "double-edged threat of rejection and infection." As another leading United States heart surgeon put it: "Until we overcome the fantastic problem of immunity, we'll have a tremendous mortality rate from transplants. So, until we improve the state of the art, I say the risk is too great." And while Dr. C. Barnard gave a lecture at

the meeting of the American College of Cardiology insisting that his operations were not premature, the fact remained that all the dogs on which he performed heart transplants died within a year.

What is this 'fantastic problem of immunity', this 'double-edged threat of rejection-infection'? Simply this, that the Creator endowed the body with various powers to protect itself from invasion by foreign bodies. Among these are the phagocytes, white corpuscles in the blood that devour harmful bacteria. Another is the formation of antibodies by which the body rejects all foreign tissues, known as the principle of immunology. The forces of immunology or rejection can be weakened by means of certain drugs, but it appears to be impossible to weaken the forces of rejection without also weakening the body's defense system against invading bacteria. It appears that Dr. C. Barnard has had a measure of success in balancing these opposing forces, as is apparent by his second patient's being alive after several months.

This problem has been plaguing surgeons ever since they began, in the latter part of the nineteenth century, to graft skin from other persons onto patients who had been badly burned. It was found that while the patient's own skin or that of an identical twin "took," the skin came from some other person the body sooner or later rejected it. By the time of World War I these facts had been firmly established, but it was first thirty years later that it was learned why the body rejects foreign tissue, because of the principle of immunity, a defensive process.

With skin grafts this has not been too great a problem for two reasons. The body usually tolerates the longer than other grafts. And then, too, their need is generally only temporary, until the body again grows its own skin. Also in a slightly more favorable position than other kinds of transplants are those of the cornea, the outer shell of the eye, as it were.

It is reported that about 3,000 of such corneal transplants are performed each year in the United States alone. These are taken from deceased persons and must be removed within three hours after death and utilized within twenty-four hours. It is said that the measure of success they have enjoyed has been largely due to the fact that the cornea has no blood vessels—or

tin of the glands. As of this writing three baby girls, two years old or less, have transplanted livers, one as long as nine months.

Far more frequent have been kidney transplants. Throughout the world a total of 1,200 of these have been performed, and it is estimated that between 600 and 700 of these are still alive. But here again there is a sobering side to the story. According to a late report, the kidney transplant 'immediate' remains experimental.

the pupil could not have unobstructed vision through it. The oxygen and nutrition the cornea needs are absorbed from adjoining tissues or membranes.

Even though thousands of corneal transplants may be performed each year, the results still leave much to be desired, even as can be seen from the following sobering report: "Poor Ratio of Success in Eye Transplants. Much excitement surrounds the successful transplant of an eye cornea and the restoration of human vision. But the actual is coldum told. Party

plant procedure remains experimental, with less than a 50-50 chance of functioning more than a year if a related donor is used." Actually 43 percent of kidneys taken from close blood relatives are functioning after one year, but only 19 percent of kidneys taken from unrelated persons and only 10 percent of kidneys taken from persons having just died. (Miss Denise Darvall furnished not only a heart for Louis Washkansky but also a kidney for a ten-year-old boy.)

Because of the high risks involved one

sion. But the sequel is seldom told. Forty percent of corneal transplants do not remain transparent and thus are eventually unsuccessful." Regarding this factor the report quoted Dr. David Patton, associate professor of ophthalmology at Johns Hopkins University School of Medicine, as saying: "The relative few dramatic successes with graft and prostheses [artificial grafts] overshadow the deficiencies in grafting techniques and the dearth of knowledge as to how foreign tissues and substances can be made to form a com

of the leading kidney transplanters in the United States, Hume, for the past three years has refused to transplant any kidneys from unrelated donors. And Science News, July 15, 1967, told that the nurses at Aarhus Hospital, the only one in the Netherlands where kidney transplants are made, have refused to give any further assistance in kidney-transplant operations. Among the reasons the nurses gave was that "they feared transplant operations involved interference with bodies before they could be considered dead according

patible union with the cells of the patient's eyes."10

Among other kinds of transplants surgeons have been experimenting with are those of the organs of the body. There have been several transplants of lungs; in one the patient, lived for eighteen days, in another, for seven days. There have also been transplants of the spleen and of cer JUNE 8, 1968

to internationally accepted criteria."

Transplant Complications

In view of the foregoing transplant record it is not at all difficult to understand why so many heart surgeons, in particular, have expressed serious doubts regarding heart transplants. The main problem, that of the body's tendency to reject foreign bodies, has not been solved.

It simply is not possible, under the present state of knowledge, to weaken the body's immunological defenses without making it extremely susceptible to infection. Dr. Barnard's first patient died after eighteen days from double pneumonia. The British Medical News (January 5, 1968) quoted him as saying that his patient died because the drugs given him to combat rejection, so weakened him that he was unable to fight off the pneumonia.

Among other complications that result from organ transplants is what is known as "transplant lung." It appears that the drugs used to combat the body's efforts to reject a foreign kidney may cause the body to try to reject its own lungs. Because of this it is necessary to watch patients very carefully so as to detect this condition as soon as possible and then remedy it by cutting down on the amount of drugs given, "because many of these patients develop secondary infections and die."11

Still another transplantation hazard just recently noted in the effect of immunosuppressive drugs, as they are called, is their tendency to play havoc with the bones. Thus one report told that of twenty-seven patients that had received kidney transplants "ten developed debilitating changes in the hip, shoulder or knee . . . Nine patients were left limping. The transplant has prolonged these patients' lives, but they are no longer able to hold jobs. This complication suggests the need to reevaluate postoperative management."

Are There Alternatives?

Even if heart transplants were biologically successful and morally and religiously acceptable to all persons, which they are not, their conditions make them available for but a tiny fraction of the world's

millions of heart sufferers. The problems of heart transplanting have been well stated by the British Medical Journal, January 13, 1988:

"The recipient must have a mortal affliction, in order to be a candidate for transplantation and the donor must be dead before the organ is removed. The conditions of the transplantable disequilibrium of organization of the surgeons. It is necessary to perfuse and remove the organ to be transplanted within minutes of death to prevent the organ from deteriorating while the recipient is being operated on. This requires a large team of skilled surgeons, expensive equipment, and the presence of a suitable recipient, at a time which cannot be delayed. The organ is also available. The complications that follow organ transplantation and immunosuppressive therapy are numerous and often grievous."

It would seem, therefore, that more attention should be given to alternatives that may be less glamorous but are more practical and widely applicable. There are such, and it is indeed unfortunate that the sensational heart transplants have resulted in drawing attention away from them. For example, for some thirty years now Lr. C. S. Beck, a Cleveland surgeon, has mended hearts suffering from deficient blood supply simply by opening the heart sac and scratching the surface of the heart, which in self-defense builds up an increased blood supply.

Another technique has been developed by Dr. A. Vineberg, a Montreal surgeon. He frees certain minor arteries of the chest and implants them in the heart muscle. This type of operation, with variations, is among the most common types of corrective heart surgery being performed in the United States and Canada. Each year some 2,000 of such operations are being done on adults.

Then, again, another team of doctors had been able, with use of recently improved X-ray techniques, to cut out the damaged part of heart arteries and to replace them with parts of veins taken from the patient's own thigh.

Of fifty-one performed so far, forty-nine have proved successful, supplying the heart with needed blood. Of course, one reason for these being so successful is their being autografts. The grafts coming from the patient's own body, there is no problem of rejection or infection and so no need to use dangerous immunosuppressive drugs.

And let it be noted that all such alternatives, and others that might be mentioned, have a still more powerful reason to be preferred to heart transplants. And

what may that be? They do not raise the ethical, moral and religious problems that heart transplantation does, not to say anything of the abuses that it makes possible. Just what these are will be considered in the next article.

REFERENCES

1 Medical World News, January 12, 1968.

2 Science News, January 20, 1968.

3 Science News, March 2, 1968.

a Newsweek, December 18, 1967.

5 Time, February 9, 1965.

8 New York Times, January 16, 1968.

7 The National Observer, January 22, 1968.

8 Toronto, Canada. Daily Star, January 11, 1968.

Science News, March 16, 1968.

10 Chicago Daily News, December 12, 1967.

11 Medical World News, February 16, 1968.

Heart Transplants

IT IS difficult to portray accurately all the moral and legal implications of heart transplants. For example, there is the question of who is qualified to perform the operation. Thus one press dispatch told that, "fearing a mass rush to the operating table by unqualified surgeons who want to join the heart transplant club, the American College of Cardiology urged today that doctors take a go-slow attitude toward the procedure."

This "College," which consists of America's foremost heart surgeons, announced that it would be setting guidelines as to who is qualified to transplant hearts. Skill no doubt had something to do with the measure of success that Dr. C. Barnard had. He not only received much training in the United States in transplanting hearts but also, in South Africa, made fifty transplants on dogs in the past three years. However, let it be noted that fortuitous circumstance also entered into the

matter, for example, the fact that Clive Haupt's blood and tissue matched Philip Blaiberg's.

Then there is also the question: Who is to benefit from the available heart? Will it be the most urgent heart case, or the one of greatest value to the community, or the one with the most dependents, or the one with the most money? On this matter Dr. A.

Semning, professor of surgery, University Hospital, Zurich, and an outstanding surgeon, stated: "We are afraid of doing a transplantation. Where would you stop once you started? There are so many people with damaged hearts. To whom would you give the one available heart? To someone who would pay a million dollars?"

There is also the human element to consider. On this aspect of the matter the remarks of one of America's leading openheart surgeons, Dr. E. M. DeBakey, are apropos: "The surgeon must scrupulously guard against taking inadvertent advantage, for purely experimental purposes, of the eagerness of a desperately ill patient to consent to almost any procedure suggested. The surgeon must be certain that the proposed transplantation" has possibilities of success and for improving the patient's condition and chances for life. This sets up an exceedingly high standard. Who would be charged with the responsibility of seeing to it that doctors meet it?

Dr. C. Barnard, it is reported, claims that 'the authority to decide legal and ethical implications in cardiac transplant rests with the medical profession alone.' But not so! In the Jewish Chronic Disease Hospital case, although three doctors resigned in protest, it was a lawyer who forced the issue, with the result that two highly reputed doctors were found guilty of 'fraud and deceit.' By the very nature of their profession some surgeons are likely to become limited in their view of the issues.

If this were not so it would be impossible to explain the facts that came to light at the Nuremberg Medical Trials. Among those sentenced to death for their experiments on humans—none of which resulted in any benefit to medicine—was Dr. Karl Gebhardt, a professor of medicine, head physician of the Hohenlychen

Sanitarium and president of the German Red Cross. Though some of these experiments were reported in the medical press, the profession by and large remained silent, even as it greeted with silence the book that catalogued them: Doctors of Infamy (1949), a revised edition appearing in 1662 under the name The Death Doctors. However, the World Health Organization highly praised the authors of these books, Dr. Mitscherlich and F. Mielke, for bringing these facts to the attention of the German medical profession.

When Does Death Take Place?

But perhaps the most staggering question or problem facing the heart-transplant surgeon is. When does death take place? Yes, just what is death, medically speaking? According to one dictionary, death is "the total and permanent cessation of all the vital functions of an animal or plant." But it has been averred that there is no legal definition of death. Thus Dr. N. Bricker, a pioneer in kidney transplants, observed: "An acceptable, legal, medical and moral definition of death is needed." Yes, just when does the dying patient, the potential donor, become a corpse whose organs can be used? These are among the most disturbing questions that the spate of modern heart transplants has raised.

Up until now doctors had their greatest tension when trying to decide whether a person should be kept alive artificially or allowed to die peacefully. It was also held that a doctor should do all in his power to restore the heartbeat to the patient, as by artificial respiration, by heart massage, or by other methods. All this was well and good, the only question involved being the life of the dying man. But with heart transplants this question has become highly charged with tension, for now the life of one patient is pitted against the life of another!

A truly terrible predicament for the doctor to face!

In fact, this is one of the reasons why Russian doctors have not yet proceeded with heart transplants. As an American doctor who recently worked with them reported: "When is the patient dead? When should heart or kidney be removed from a patient? These two questions are as unsettling in the U.S.S.R. as they are elsewhere. The Soviet scientists I worked with were reluctant to accept the proposals put forth in other parts of the world for using 'death of brain' as the moment of death rather than 'death of heart.' They are troubled by their experience with the famous physicist Dr. Lev Landau, whom they succeeded in rescuing from 'clinical death.' A doctor working to save a life until all hope is gone now passes well beyond the point in time at which organs are salvageable for transplantation. He experiences severe tensions when he decides to abandon his efforts. The Soviets believe that these tensions will become nearly unbearable if, as he fights to save a patient's life, he must consider surrendering early enough to salvage a transplantable heart." Yes, deciding how long he should try to save a dying man is enough of a burden for the doctor without having the added responsibility of making a choice between two lives!

The "Dead" Brought to Life Again

to remove his heart can be seen from the following further examples.

How great the danger is of deciding too soon that a person is dead and proceeding

The New York Times, March 12, 1968, stated that heart surgery restored a marine officer who had been hit in the heart, face and legs and who "died real fast. His heart stopped. So did his breathing." Clinically he was dead, but still he was brought to life again.

Thus also a recent London medical report showed that, of 102 patients who were unconscious for more than a month because of brain injuries, 62 survived. Of these, 19 returned to their former jobs and 29 others returned home to lead useful lives. Along the same line, Professor W. Forssmann, German heart specialist, told of an American corporal who, on July 16, 1967, was the victim of a mine explosion. After doctors tried in vain for forty-five minutes to revive him through heart massage and artificial respiration, they sent him to the morgue. A few hours later, as he was to be embalmed, it was noted that he had a weak pulse, although the electrocardiogram showed no heartbeat. After three weeks of deep unconsciousness, this apparently dead man fully regained his mental faculties.

No question about it, heart transplantation poses staggering problems. As one British woman expressed it: "How can I ever be certain that doctors would do everything to save my life if I had a nasty accident, or a terrible disease, that they would not be influenced by what I could contribute to another person?" Apparently some doctors would have all patients entering hospitals sign statements that, in the event of death, surgeons would have the right to take any organs they chose for transplanting them into another patient!

No wonder that some of the more humane, more compassionate specialists are greatly concerned lest a doctor "pull the plug" on a dying patient in order to get a needed organ.

To this end they urge that the transplanting surgeon not be the one attending the dying potential donor. Thus the British Medical Journal, in discussing such problems as "when to resuscitate a patient and when to stop resuscitation once it has been started," stated: "These problems are especially acute when the patient is a potential donor of a vital organ . . . There is much to be said for the entire care of the potential donor being in the hands of doctors other than the transplant team until death has been finally diagnosed."

In the same vein Dr. DeBakey said: "The surgeon must be certain, beyond any conceivable doubts, that nothing further can be done to save the donor's life. This judgment should be made independently, by physicians who are not members of the transplant team. . . The legal, moral and theological aspects of this problem are formidable."12 Yet is not the likelihood of a dying patient's having a doctor solely concerned with his well-being diminished at a hospital where every member of the staff is infected with the heart-transplantation fever, as apparently was the case at the Groole Schuur Hospital?

In the first heart-transplant case it was the transplant surgeons who ministered to the dying heart donor. Just what took place appears to be dubious. According to Science News, Dr. Barnard proceeded to remove Miss Darvall's heart when the last brain wave was seen on the encephalograph. However, according to Time magazine, he waited until the heart stopped beating. But when a reporter for Newsweek inquired as to whether Miss Darvall was taken off the resuscitation machine before her heart stopped beating, he was told: "That is an impertinent question," and so did not get a direct answer. But it was a most pertinent question to

everyone who may someday become a heart-transplant donor due to the assent of close relatives.

Dr. Barnard testified: "A doctor has one duty and one duty only, and that is to treat his patient until he has no means left. If we feel a heart transplant is a method for helping a patient, we must do it." But what if that 'feeling' is not based on accurate knowledge? What if helping one patient means taking the life of another? There is much discussion as to the condition of Clive Haupt, whose heart was given to Dr. P. Blalberg. According to Boris Petrovsky, Soviet health minister, "not everything is clear in the Cape Town experiment. Many things show that a beating heart was removed for the transplant." It might be said that such is implied in that we are told that the doctors "said that when they determined he could not survive, the decision was made to attempt the transplant."

Have not patients time and again been restored to life after their hearts stopped beating? Dr. Lev Landau's heart stopped four times. And as for using 'death of brain' to determine death, patients have been restored to life after not having shown any brain activity for two hours. Particularly bothersome is the question: "If a body is all but dead, technically alive only because an artificial respiration maintains heartbeat, it is homicide to take out the heart or kidney before pulling the plug?" In one case in England a man who was declared dead after an accident was put on a resuscitation machine just long enough to take out his kidney and then left to die the second time.

Nor is that all. The potential of making heart transplants could be exploited by selfish, ruthless men to a shocking degree. The possibilities for abuse are so vicious that they might be likened to the unforeseen consequences of the discovery of atomic power.

Thus Dr. Forssmann envisions criminals sentenced to death being kept alive until their organs are needed for transplant; then they would be executed by heart-transplant surgeons. Concentration camps would be filled with undesirables who live only until their hearts or kidneys are needed for transplant operations. He is deeply concerned lest "the doctor would finally be degraded to a hangman, a Lucifer, a fallen angel." According to Dr. Mitscherlich, that is the very use doctors were put to during the Nazi regime. They were employed to get rid of undesirables by injections of various things, such as gasoline or tubercule bacilli; in particular, were physicians on submarines used to get rid of troublemakers in this way.

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