ETHICS

A life-giving death

NORA UNDERWOOD November 2 1987
ETHICS

A life-giving death

NORA UNDERWOOD November 2 1987

A life-giving death

ETHICS

For the parents of a newborn baby girl who had no chance of surviving, the decision was agonizing. But according to the Orillia, Ont., couple—identified only as Karen and Fred—donating their infant daughter’s heart so that another baby could live has helped to comfort them after their own child died. Karen gave birth on Oct. 12 to six-pound, three-ounce Gabriel, who had been diagnosed in the womb as anencephalic—without a brain. Two days later doctors declared Gabriel, who had been baptized Roman Catholic, to be clinically brain-dead, and nearly 41 hours after that another newborn, Paul Hole of Surrey, B.C., received her heart in a pioneering operation in California—becoming the youngest heart transplant patient ever. At week’s end, the official report on Baby Paul, born on Oct. 16, had improved; previously listed as serious but stable, his condition was changed to fair in Loma Linda University Medical Center, 95 km east of Los Angeles. But the procedure that saved the life of the six-pound, six-ounce boy born with a fatal heart deformity has sparked an ethical debate about keeping infants alive artificially so that their organs can be used for others.

Throughout North America, doctors are required to comply with standards set by a single definition of what constitutes clinical brain death. Under that definition, doctors must deem all brain activity to have ceased irreversibly—most notably, the breathing function. For 12 hours after her birth in Orillia, Gabriel breathed on her own. Then doctors transferred her to the Children’s Hospital of Western Ontario in London and placed her on a respirator to ensure that her organs stayed healthy. It was not until 30 hours after she had been on the respirator that a team of London doctors determined that the baby was unable to breathe on her own and pronounced her dead. Gabriel was then transferred to Loma Linda on a chartered jet. Technically and legally, according to Edward Keyserlingk, a member of the McGill Centre for Medicine, Ethics and Law in Montreal, the child was dead at the point when she could no longer breathe on her own. Still, some observers have argued that doctors have no way of knowing exactly how long an anencephalic child could survive on life-support systems.

But some critics said that even though doctors technically followed

the rules, they still tampered with life. Reform Rabbi Gunther Plaut of Toronto’s Holy Blossom Temple, for one, acknowledged his own conflicting opinions. “I’m glad another life was given a chance,” declared Plaut. “But the question is, at what cost?” And Dr. Timo-

thy Frewen, director of pediatric critical care at Children’s Hospital, said that he “went through a lot of mental difficulty” about the procedure.

But Frewen also said that keeping an anencephalic patient’s organs alive and transplanting them has set an important precedent at a time when organs are in short supply for children under, the age of 2. Indeed, according to Dr. Calvin Stiller, chief of organ transplants at London’s University Hospital, from 40 to 70 per cent of infants who could be saved by transplants die before organs can be found for them. For his - part, ^ev' ^°^n. ^a^‘

» ^ v JSftfe /12 Centre of Bioethics in

Toronto, said that there

was no reason to object

to keeping Gabriel alive long enough to help Paul. “If it is done with adults,” said the priest, “I don’t see why it should not be done to babies as long as it is not an assault on their dignity.”

NORA UNDERWOOD in Toronto