Sunday

migczine
Page Three

inside:
page four-

Brashler
Alther
March 28, 1976

Number 21

FEATUR

ES

U'

Hoapiotal

pane:

Facing

questions

on

natent re anddeath

By STEPHEN HERSH
MARLA IS IN A COMA. Lying
motionless on a crisp sheet,
the 17 year-old resembles a dis-
heveled department store manne-
quin. The dull, artificial quality of
her arms and legs is accentuated
when the nurse by her bedside grips
the patient's forearm, lifts it up-
ward, and slides a hypodermic
needle into her flesh.
"No pain response," says Dr. Joel
Saper, standing at the foot of the
bed in the University Hospital's in-
tensive care ward.
As Saper approaches to take a
closer look at Marla, the nurse gen-
tly pulls out the hypodermic needle
and lowers Marla's arm to the bed.
It lies still, palm up, sallow.
Marla's jaw remains slack as Sa-
per lifts her eyelid and shines a
penlight at the pupil. He gingerly
touches her face to avoid knocking
the plastic tube running into her
nostril w h i c h maintains her
breathing. "The pupils don't con-
strict," he notes. He gently lets her
head go, and it rolls slightly on the
pillow.
Marla-not her real name-had
tried to kill herself with an over-
dose of sleeping pills. She was
rushed to the hospital, her stomach
pumped, and as her breathing slow-
ed to a halt, she was wheeled to in-
tensive care and attached to a res-
pirator.
'THREE SMALL television screens
a few feet from her bed moni-
tor her heart and breathing rates
and brain wave activity.
The pulse and respiration rate
show up as uniform, jagged lines on
the screens. But the brain activity
graph, or electroencephalograph
(EEG), is flat. No apparent brain
waves.
The reason that Marla's brain
activity is dormant may be only

that she has taken a drug overdose.
For up to two weeks after a person
has taken a large quantity of bar-
biturates, EEG activity can be tem-
porarily suppressed, only to start
up again when the drug is com-
pletely purged from the system. If
the barbiturate still in her blood-
stream is the cause of her flat EEG,
she could be on the road to recov-
ery.

'Whenever the plug is
pulled on a respirator, the
patient is already dead.
I've n e v e r seen a plug
pulled on a living patient.'
-Dr. Joel Saper

to transplant organs. As the de-
mand for organ donors increased,
doctors began to look for ways to
quickly determine whether coma-
tose patients are alive or dead.
Transplantable organs are often
needed in a hurry. And the longer
a patients stays in a coma, the
more the body deteriorates.
A team of doctors has been or-
ganized at University Hospital to
make fast decisions at any time of
the day or night on whether a co-
maose patient is alive. The group is
called the Cerebral Death Determ-
ination Committee.
"R. MARTHA WESTERBERG, a
neurologist and one of the six
physicians on the committee, ex-
plains that the group is "set up to
deal only with patients who are
to be used as donors.
"Others may ask our advice," she
says, "but that's rare. People die
everywhere in the hospital, and in
most cases that's the responsibility
of the doctor on duy."
The "brain death committee,"
Westerberg says, consists of a pair
of EEG experts, a pair of neurolo-
gists, and a pair of neurosurgeons.
Twenty-four hours a day, at least
one doctor from each pair is avail-
able to help decide whether a po-
tential donor is dead.
The doctor attending a comatose
patient will always be an EEG ex-
pert, a neurologist or a neurosur-
beon. In deciding a patient's sta-
tus, he or she will consult with two
brain death committee members,
one from each of the other two ca-
teiz-ories.
The committee uses a strict set
of criteria, dictated by state law,
for making its life or death judg-
ments. One of the tests is to study

Daily Photo by PAULINE LUBENS

Dr. Joel Saper

But things will not bode well for
Marla if after two weeks her EEG
remains flat. Even if the respirator
'- her breathing and her heart
continues beating, she may then be
legally dead.
* ~* *
A BOUT 15 YEARS AGO, respira-
tor machines caused a revolu-
tion in the medical profession's
" 'w of what constitutes death.
Until then, the fact that a person
was breathing and had a beating
heart was considered evidence of
life. But as the machine which
keeps Marla alive came into more
common use, it became clear that
a person's heart and lungs can be
made to work long after all other
sig'ns of life have evaporated for
good.
Ton of death was

EEG readings taken 24 hours apart.
The patient is considered to be
alive, Westerberg notes, if the
graphs are not flat. But flat graphs
are not considered evidence of
death if the person has taken de-
pressant drugs or has an abnorm-
ally low body temperature.
rFHE COMMITTEE ALSO consid-
ers these characteristics, de-
termined by clinical tests, to be evi-
dence that a patient is dead:
-- contracted pupils which do
not respond to light;
- no response to pain or other
stimulation;
- absence of all other than spin-
al reflexes; and
-inability to breathe or sustain
circulation of the blood without ar-
tificial support.
Doctors on the wards treating
comatose patients who are not to
be organ donors use the same cri-
teria for death but do not make
decisions as quickly.
When a patient is judged to be
"brain dead," the respirator ma-
chine keeping him or her alive can

be disconnected. Neurologist Joel
Saper, the physician who treated
Marla, explains that even on the
wards, the decision that a patient
is dead is made by a group of doc-
tors.
"WHEN THE PLUG is pulled on a
patient determined to be
dead," he says, "it isn't an indivi-
dual decision. Several doctors get
together and all say, 'the person is
dead'. So the respirator goes off."
Is the plug ever pulled at 'U'
Hospital on a patient who doesn't
fill all the criteria for death?
"No. Even if a patient was in so
much pain that he wanted to be
killed," Saper says, "under the law
it's murder if the doctor pulls the
plug on him or gives him a fatal
shot of morphine. Personally, I
wouldn't kill a patient even if it
were legal.
"Whenever the plug is pulled on
a respirator, the patient is already
dead. I've never seen a plug pulled
on a living patient, and I've never
seen a patient neglected."
Leaning back in his chair in his
small office at University Hospital,

Saper tamps down a fresh tuft of
tobacco in his pipe, lights it, and
puffs, wrinkling his eyebrows. He
brushes a morsel of tobacco from
his white smock, and strokes his
beard.
"I'VE READ SOME charges that
euthanasia is practised in some
hospitals in the country, and I
don't know if it's true," he re-
marks. "But if it happened here,
I'm pretty sure I would know about
it. At teaching hospitals like this
one, people know about what ev-
eryone else is doing."
"Sometimes, with certain pa-
tients," he continues, "we think
that because they'll be in pain or
because their chances of making it
are very small that maybe we
shouldn't attach machines at all.
We doctors might discuss that over
coffee, but I don't know of anybody
who doesn't try to keep that pa-
tient alive when a life is actually
on the line."
See LIFE, Page 5

Sti, hheu
Dire'cior.

Hersh is"The Daily's Editorial

erward, surgeons began

Recombinant DNA research: Gold
or destruction at rainbow's end?

By JEFF RISTINE
'HE QUESTION of whether sci-
ence will serve the world or
rear back and become its Franken-
stein monster was graphically il-
lustrated on a fateful day in Au-
gust, 1945. The awesome destruc-
tion wreaked on Hiroshima dem-
onstrated convincingly that the
ability to destroy the world was
locked up in the atom. But, as
time has shown, unleashing the
armageddon-like forces of the atom
has proved far easier than chan-
nelling its terrifying energy into
peaceful purposes.
The power to destroy the world
in a few, fiery hours provoked a
spate of moral and philosophical
questions. And not until recently,
with the new DNA technology, has
any scientific research provoked
such intense debate. When recom-
binant DNA research was unveiled
about five years ago, scientists
opened the door to an issue which
has since become a national con-
troversy.
At one end of the DNA de-
bate are certain scientists and an
assemblage of optimistic support-
ers who believe that this new re-
search may help rid the world of
numerous diseases, provide defense
against allergies, vastly increase
agricultural yields, and offer a

less desirable consequences. The
most extreme opponents warn of
a genetic apocalypse - of a sud-
den, unpredictable and irreversi-
ble new disease which may kill
human life and vegetation. While
university researchers may have
only the best intentions, some of
the critics say, the ends toward
which government or industry may
work could be far less desirable.
They urge that all risks be identi-
fied and calculated before sci-
entists ever tinker with the mi-
croscopic gene.
However, the potential dangers
and benefits probably lie some-
where between the scenarios paint-
ed by the doomsayers and the rosy
pictures offered by the scientists.
The concerned layperson, who can
now only guess at DNA's impact,
is faced with a battery of statis-
tics, probabilities, and promises of
good faith on the one hand, and
counterstatistics, skepticism, and
pleas for caution on the other.
And if the two sides share any
thought about the research, it is
the unsettling fear that there may
never be a way to decide - to the
satisfaction of all - who is right.
THE QUESTION is difficult, be-
cause it involves a substantial
dose of highly technical issues,

DNA, deoxyribonucleic acid, is
a type of molecule found in the
nucleus of virtually every cell in
every organism. DNA molecules,
which consist of two strands wound
into parallel spirals (the double
helix), are an important part of
the study of biology because they
form the basic units of heredity
for the cells-genes. Therefore, if
two organisms have different
genetic material, it is because the
bases (also called nucleotides) in'
their DNA molecules are arranged
differently, which means the genes
will carry different "information."
Recombinant DNA research is
a broad term referring to a rela-
tively new way to experiment with
DNA molecules. Only a fraction of
the experiments are considered
risky at all, and a few of them
have been banned by the scien-
tists themselves.
Recombinant DNA experiments
essentially involve the transplant
of genetic material from one cell
into cells of a wholly different
species - an action that never
occurs in nature. Microbiologists
remove tiny, circular DNA mole-
cules called plasmids from the bac-
terium of one species, split them
open chemically, and attach new
genes from a different species to
the gap in the DNA plasmid.

'I have tried to look into
the faces of those who might

be immediately helped

by

this research, but also.into
the faces of those who might

-~ -.,~