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Thursday, November 26, 2009

'Bioethics' and the Houben Case

'Bioethics' and the Houben Case ... and asking the deeper question: "Is the 'harvesting' of vital organs for transplant morally permissible ... or is this 'harvesting' tantamount to murder?"

I presume that Gentle Reader has at least heard of the Rom Houben case, that of a (now 46-year-old) Belgian man who, until about three years ago, had been diagnosed for the previous 23 years as being in a "persistent vegetative state" but is said by some to have been conscious the whole time, and in an apparent "medical miracle" is now able to communicate via technology and the help of a caretaker.

And, perhaps Gentle Reader is also aware that "the usual suspects" in "the bioethics community" -- one is featured prominently in the AP/Yahoo news item I linked -- are pooh-poohing this apparent "medical miracle" as merely an example of "facilitated communication" -- which is controversial ... and perhaps as disreputable as the "recovered memories" craze of several years back.

Now, I'm all for a proper skepticism about any claim. But there is such a thing as improper "hyper-skepticism;" there is such a thing as *refusing* to admit the truth which is right in front of your face. And I think that an improper hyper-skepticism is exactly what is going on here with the 'ethicists' (*).

The blogger "Neo-neocon" has a post in which she lays out some thoughtful skepticism about some of the claims being made about Mr Houben's recovery, specifically about whether he really is communicating.

And -- being that I am inherently a highly skeptical person -- I would tend to agree with her on the "facilitated communication" angle. At the same time, one of Neo-neocon's commenters has provided a link to a First Things-hosted
blog post by Wesley J. Smith in which he points out that one of the AP news stories about Mr Houben's apparent recovery answers that very question:
One of the checks Laureys applied to verify Houben was really communicating was to send the speech therapist away before showing his patient different objects. When the aide came back and Houben was asked to say what he saw, that same hand held by the aide punched in the right information, he said.
So: are Dr Laureys and the others directly involved in Mr Houben's case lying, or are the 'bioethicists' engaging in an improper hyper-skepticism?

And, if the 'bioethicists' are engaging in an improper hyper-skepticism -- which is to say, intellectual dishonestly -- what might be the reason for that?

Further, there is nothing in principle to invalidate "facilitated communication" as a concept -- does not the famous scientist Stephen Hawking communicate via "facilitated communication?" Does it matter, in principle, that Hawking's facilitator is a machine, whereas Houben's facilitator is a (presumably) highly-trained human being?
The therapist, Linda Wouters, told APTN that she can feel Houben guiding her hand with gentle pressure from his fingers, and that she feels him objecting when she moves his hand toward an incorrect letter.
Is she mistaken, being mislead by false hope? Does she desire so much to help him communicate that she sees what isn't there? Or, worse, is she lying?

Or do some 'bioethicists' have a vested interest in dismissing (without good reason) the claims being made about Mr Houben's recovery and his after-three-years-of-therapy ability to communicate via "facilitated communication" that they will not see what is in front of their faces?

Is there any rational, non-question-begging, reason to believe that Linda Wouters is mistaken (or worse, lying) about her ability or skill helping Mr Houben communicate? One of the commentors on the Wesley J Smith blog-item raises the objection that Miss Wouters, and no one else, is able to "facilitate" Mr Houben's communication. This sounds like it might be a reasonable objection ... but I don't believe it is. Consider: is it not reasonable to believe that over a long period of therapy, Mr Houben and Miss Wouters have both trained one another such that they are able to cooperate to get his thoughts out? How is it surprising that someone who has not spent so much time working with him may not be able to perceive the queues he makes?

When Anne Sullivan taught Helen Keller to communicate, was *everyone* at once able to communicate with her, or did those who wished to communicate with her directly, without going through Anne Sullivan, have to learn how to do so? Mr Houben's disability is far greater than Helen Keller's was; does it not stand to reason that if he is indeed communicating that it will take great patience and skill-learned-over-time to effectively communicate with him?

And that brings me to another, and critical, point -- the apparent "medical miracle" here is not really that Mr Houben may be able to communicate via "facilitated communication," but rather that he is not, in fact, a "vegetable" after all. Look, at the two pictures which accompany the two AP articles I've linked: Mr Houben certainly *seems* to be consciously attending what his "facilitator" is doing with his hand. Are these photos (unintentionally) misleading? Are they intentionally deceptive? Or, do they show what they appear to show -- a disabled, but conscious, man?

The "miracle" is being misframed. And I believe that most 'bioethicists' have no incentive nor inclination to notice, much less correct, that error.

I am reminded of the videos that Terri Schiavo's family made public when they were trying to save her life from the horrible death-by-dehydration which we, as a society, allowed to be inflicted upon her by her husband and the anti-life and anti-morality 'bioethicists.' In those videos, I saw a severely disabled, but conscious, woman, not a "vegetable."

Gentle Reader may recall that I'd once linked to some interesting comments and moral assertions about my character, which were made in reference to a skunk, a mere animal, about which (until I screwed up my courage to get close enough to it to shoot it) I saw no option but to let it die in exactly the same manner that Terri Schiavo was murdered. Interestingly enough, *most* of those persons, so "morally" concerned about a mere and verminous animal, didn't, and don't, give a damn that an actual human being was judicially murdered in a horrific manner.

And now the deeper question: "Is the 'harvesting' of vital organs for transplant morally permissible ... or is this 'harvesting' tantamount to murder?"

I present two cases which occurred in 2008, one from France and one from the US, which ought to lead to serious reconsideration about the morality of "organ harvesting" in all morally serious persons.

First, the French case (as reported in the UK press, for instance: 'Dead' patient comes around as organs are about to be removed [there were other UK news articles at the time, which I've been unable to find now, which went into more detail about some aspects of this; for instance, more detail about the rule change and comparison to the rules in teh UK] ) -- A "dead" man lives!

The incident happened in January of 2008, but wasn't reported to the public until about six months later: a 45-yead-old man collapsed of a heart attack, was eventually pronounced dead -- and "woke up" as so-called doctors were about to remove his organs for transplant (and, as of that article in June of 2008, the man himself hadn't yet been informed how close he came to being junked for parts).

Apparently, this particular man's life was spared due to the inefficiencies of socialized medicine. There wasn't a (so-called) doctor available at the time he was pronounced "dead" who was qualified to remove his organs; had they gotten to him at once, he likely wouldn't have awakened. OR, had they injected him with certain anesthetic drugs, as is sometimes done (even in the US) for the express, though unadmitted, purpose of preventing things like this occurring, then barring an act of God, he certainly would not have awakened.

At the same time, the fact that he was slated for organ harvesting in the first place is also due to socialized medicine, and the moral laxity which must eventually accompany any form of socialism -- the "determination" that he was "dead" was made pursuant to new guidelines (i.e. a more lax “definition” of when death occurs) which the French government and medical establishments had put in place for the express purpose of procuring an increased supply of vital organs for transplant.

Here are the last three paragraphs of that article --
Other doctors have seen similar incidents, according to the ethics committee report. "During the meeting, other reanimators ... spoke of situations in which a person whom everyone was sure had died in fact survived after reanimation efforts that went on much longer than usual," the report said. "Participants conceded that these were exceptional cases, but ones that were nevertheless seen in the course of a career."

Le Monde said doctors had feared the new transplant rules would confront them with cases of this kind. They believe the existing rules are imprecise and could undermine public support for the removal of organs for transplant. They are pushing for the issue to be discussed as part of a consultation next year on a proposed, new law on medical ethics.

Professor Alain Tenaillon, the organ transplant specialist at the French government's agency of bio-medicine, told Le Monde: "All the specialist literature suggests that anyone whose heart has stopped and has been massaged correctly for more than 30 minutes, is probably brain dead. But we have to accept that there are exceptions.... There are no absolute rules in this area."
Note that bureaucratic non-concern with the actual morality involved. Note that it's more important to keep the public on-board with respect to organ harvesting than it is to get the morality right. Note that bureaucratic CYA by reference to the "suggestions" of "all the specialist literature."

Note that frank admission that "There are no absolute rules in this area" -- which, in context, translated, means, "We don't really have a good and objective metric for determining when a heart-stop patient really is "brain dead," so we're just going to treat those who have not revived after 30 minutes of correct heart-massage as though we know they are dead. Besides, think of all other the lives we can save be pretending we know that this one is lost!" And, after all, the longer the (so-called) doctors wait to begin chopping up the erstwhile "patient" for parts, the greater the probability that his organs will begin to suffer oxygen deprivation, and thus cellular damage.

Under the rule change, even more so than previously, the "medical professionals" in France are working under a perverse incentive to give up on their actual patient and send him to the chop-shop while he's still "fresh" ... all for the greater good of mankind, of course!

Allow me to state this bluntly: If the doctors do not *know* that a person is dead, then it is immoral -- it is wicked -- to "harvest" his organs. It does not matter in the least that a cute little child will certainly die unless "we" take the vital organs of this "dead" adult to transplant into the child. It does not matter in the least that ten, or even one thousand, other persons may benefit if "we" take the vital organs of this one "dead" person -- if "we" do not know that he is, in fact, dead, then we are murdering him if we take his organs.

Reason is not soft-and-fuzzy; reason does not bow to sentimentality: reason does not fudge truth -- and there is always a horrendous social (and personal) price to pay for fudging such an important truth as the one above.

Now, the American case ( Woman Wakes Up After Family Says Goodbye, Tubes Pulled and 'Dead' woman returns to life ) -- A dead (or "dead") woman lives!

Val Thomas, a 59-year-old West Virginia woman, had died (or "died") of a heart attack, and subsequently had been "clinically brain-dead" for 17 hours, in May of 2008 -- except that she didn't stay dead (or hadn't actually died). She "woke up" as the nurses were disconnecting her "corpse" from the life-support machinery -- to which she'd been hooked up that long only in order to keep her organs "fresh" until her family could be convinced that she was dead so that they would authorize organ harvesting.

Now, either she really was dead -- in which case the fact that she came back to life is a very important thing -- OR she was not really dead -- in which case we have no objective way to know that the persons whose organs are being harvested are really dead ... which means that the harvesting of vital organs for transplant is always immoral.

In the US, we supposedly use the more objective and measurable "brain-death" metric to determine that a person has indeed died. This is in contrast to France (with the newly relaxed rules), and much of Europe, were "brain-death" is assumed ... but, apparently, not generally verified.

So, was Val Thomas really dead? Or are the US "medical professionals" behaving as perversely and as immorally as those in France?

But, even if Val Thomas was not really dead, there goes materialism/naturalism, don't you think? Materialism/naturalism posits (for it must) that the human mind is "just a buzz in the brain" ... yet, for seventeen hours, there was no buzz in Val Thomas' brain. Yet, there she is.

(*) 'Ethicists,' especially 'bioethicists,' seem frequently to be more concerned with explaining away moral obligations -- with justifying rank immorality -- than with helping us, as a society, to think properly and more clearly about 'ethics.'


Foxfier said...

I tend to class the bio-ethicists into ethicists and utilitarians. Sadly, the ethicists are usually religious and thus easy for the "let's harvest the disabled" folks to dismiss on those grounds.

Ilíon said...

Hello Foxfier.

I'm still composing (and undating) this post. I hope you'll manage to read it after I've completed it.

Foxfier said...

Will do!

Lippard said...

The check Laureys says he did is a single-blinded test--that's not sufficient to exclude unconscious cuing by the experimenter. A controlled test would be better.

But the actual footage looks very bad--you can't accurately direct a facilitator's finger to a key if you aren't looking at the keyboard, and worse yet if your eyes are closed. See the Belgian TV footage in particular, which gives a lot more continuous footage than aired in the U.S.

This doesn't mean he's not locked-in, and Laureys work in general does look to be serious evidence for misdiagnosis of persistent vegetative state (PVS) for people in a minimally conscious state (MCS).

Laureys' paper that included Houben as a patient diagnoses him as MCS, which is not the same as "almost completely normal."

I've blogged about this at some length, with references to the relevant scientific literature, including Laureys' most recent paper and an article in _Nature_ where he was quoted regarding a different patient.

BTW, none of this provides any evidence that Terri Schiavo was MCS rather than PVS--while it would have been nice to subject her to PET scans (or today, fMRI), the CT evidence was itself enough to show she had virtually no cerebral cortex, and her behavior in medical tests showed nothing but reflex behavior.

Foxfier said...

I blind-type all the time-- it's called touch-typing when it's taught at school. My hands are too small to touch exactly right, though-- yet I can type without looking, and it took a lot less time than three years to learn it.

All of that assuming that the video wasn't staged.
(Most of the TV spots I've seen made have been staged by the news folks to "look good"-- I can still remember rigging up three different models of o-scopes and a couple of wave generators for the Navy News photographer guys, because actual calibration didn't look impressive enough.)

As for Mrs. Schiavo supposedly not being conscious because she didn't have much brain-matter, might want to look up the french gov't worker that found out he was missing most of his brain when he went in as an adult for leg weakness.

James Nicholas said...

BTW, none of this provides any evidence that Terri Schiavo was MCS rather than PVS

Anyways, the husband wanted her gone. It took a couple of weeks, but its done.

No use talking about it now.

Anybody catch the Lions game?

Ilíon said...

That's a very good point, Nicholas.

Ilíon said...

OK, I think I've said what I intend to say. Any changes ought to be minor, and more in the way of correcting typos or firming up the grammar.

James Nicholas said...

Well, it was a little flippant and provocative.

I am sure that Mr. Lippard has given this topic a considerabloe amount of thought. All the same the Schiavo case ended up with her mother and father watching their daughter slowly die because she could no longer drink or feed herself. A feeding tube can hardly be considered 'heroic measures'.

To be sure, there is a rational for discontiuing life support measures to those that are no longer truly with us. But there were clear issues of secondary gain on the part of her husband, making the steps taken morally suspect. The parents wanted to try to help her. The husband could have divorced her and moved on with his life. For a father or mother to have to watch their child die because we wouldn't feed her or give her water is deeply offensive, regardless of the EEG results.

I am fairly confident that any thought process we produce, when taken too far, becomes hideous.

Foxfier said...

Huh, I read it as a gallow's humor/irony sort of way of saying "her husband murdered her."
'Net is bad for tone.

(I do wonder what it would have taken for her husband to lose control of her-- multiple illegitimate children with his mistress, a pile of money and implications he was abusive weren't enough!)

For the "dead" woman who was nearly harvested-- let's just say I'd want to see how much tail-covering went on!

I sure can't support taking organs from someone still breathing.

James Nicholas said...

"Huh, I read it as a gallow's humor/irony sort of way of saying "her husband murdered her."

No, you were quite right. It was ironic gallows humor. But then when Ilion replied, 'That's a good point!' (and nothing more) I was left with the quandry of wondering what point it was that he was commending.

Mr. Lippard is looking at the problem rationally. In my opinion, his analysis fails him in the Schiavo case.

Ilíon said...

Commending the irony. Commending the summation of the perverse logic.

But, Mr Lippard is not looking at the case rationally, for rationality also encompasses morality.

kh123 said...

"When Anne Sullivan taught Helen Keller to communicate, was *everyone* at once able to communicate with her, or did those who wished to communicate with her directly, without going through Anne Sullivan, have to learn how to do so? Mr Houben's disability is far greater than Helen Keller's was; does it not stand to reason that if he is indeed communicating that it will take great patience and skill-learned-over-time to effectively communicate with him?"

See, the great thing about the Completely Happy And Ordered Society is that we won't have to bother with patiently trying to communicate with invalids or trying to discern where there may be intelligence or a spark of the spirit - besides, we've already thrown those concepts out of biology thanks to Darwin!...

Since we'll be in such a rush to implement social justice and politically correct harmony, and since people are just random allocations of matter anyway, we'll simply take the useless ones (who can't defend themselves of course) and throw them away.

Into big piles.

Much like how the National Socialists and Bolsheviks did.

But of course, what those politically incorrect regimes did was... well, not evil, since we can't entertain objective definitions that smack of theism... but it was just... well, it doesn't make us feel good about ourselves. So, we'll just have to dispose of those who don't fit into the Completely Happy And Ordered Society... discretely.

You know, as in: Behind closed doors. In clinics.

This will have apply to all of those annoying other people - the rest of the world - who are taking up too much space as is. They'll just have to be trimmed back a notch or two to give us a little more Lebensraum to enjoy. (Have you seen the traffic in Los Angeles lately?! You can't find parking at the downtown Mall anymore)...

Of course, naturally, we ourselves and our loved ones will be exempt from being held to the same standards and requirements of Eugeni.... uh, I mean, our right to choose.

Happy days indeed! (except for invalids and the unborn - but hey, they wouldn't have been happy anyway, right?)

Lippard said...

Dr. Laureys performed additional tests with Houben and the facilitator and found that, in fact, the communications were coming from the facilitator, not Houben:

Ilíon said...

Here's a relatively recent news item relevant to the *actual* issue: Patients in 'vegetative' state can think and communicate