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Stanley Reiser edited the first major bioethics anthology, Ethics in Medicine.

In 1970 as an instructor just starting out at Harvard Medical School I came into contact with William Curran, who was then the professor of legal medicine at Harvard, and Arthur Dyck, who was the professor of population ethics. Together we decided that medical ethics had become significant and that Harvard should begin to study it.

A very important member of our team was Milton Levine, a pediatrician at Children's Hospital in Boston, who was involved in an interesting event that took place in that first program year, possibly the first case round in medical ethics. It was a word-of-mouth event, held in a small room at the Children's Hospital behind closed doors with about twelve clinicians and us. A memorable question kept coming up as we considered the complicated case of the treatment of a child and the views of the family. I never thought as a physician that I'd ever ask this question: Who is the patient? We went around and around on that one. And we recognized, therefore, that the essential nature of medical ethics is to challenge basic categories and beliefs.

In the 1940s we believed that penicillin would be the symbol of the future generations of technology. We were wrong. The real symbol that would emerge in the early 1950s had little in common with the wonder drug; in fact, its effects were just the opposite.

The forerunner of this technology was introduced in 1952 in Copenhagen during the polio epidemic that was, as many of you remember, spreading throughout the world in those days. A Danish clinician, seeing a large number of children brought to his ward and certain they would be dead in several days, called the anesthesiologist down to the ward. The anesthesiologist introduced the technique of positive pressure breathing, essentially using air bags to pump air into the lungs of these patients. It worked. However, it was recognized that the air bag had to be continuously pumped, one couldn't stop. So all of the medical students of this Copenhagen medical school and all of the nurses of the hospital spent a week pumping air into these patients and saved many of them.

It was recognized that this innovation was useful, but not in the form it was currently fashioned. And so, by attaching a pump to the air bag instead of a student, we created the artificial respirator.

This technology diffused quickly throughout Europe and the United States in the mid-1950s so that virtually every hospital had one. It was a miraculous machine in that patients coming into hospitals with acute respiratory failure, stroke from drug overdose, or in diabetic coma could be treated in the hope that the natural breathing mechanism would be restored and the technology could be removed.

It was in this spirit that a Viennese anesthesiologist, Dr. Bruno Haid, who was the chief of the emergency room of his hospital, used the artificial respirator. However, he, like others, came to see the dark side of this technology. For they saw that while many of the patients they treated indeed survived because of this machine, not all of them survived to become functional in the way they had been before being overtaken by illness. A number of them were not dead, but in some ways they did not seem to be alive. They lingered, lingered in this never-never land between functioning life and death. And as weeks and even months went by and some of his patients remained in this state, Haid came to face dilemmas to which he had no solution.

He saw the problem of first deciding if it was ethically correct to remove the machine he himself had initiated. He was perplexed about how this decision should be made and who should make it. And in an extraordinary letter to Pope Pius XII he wrote that the moral problems of using this technology were more troublesome, more complicated than the technical problems of using the machine. He sought the Pope's help to deal with these dilemmas.

The Pope wrote back an extraordinary letter published in the journal The Pope Speaks. In his reply, the Pope acknowledged the great difficulties of answering the questions the doctor posed, and indeed expressed pessimism that he could give satisfactory answers.

As several of my colleagues have related, there are a number of points that could be said to have been significant in initiating the bioethics movement. But the moment when both the physician and the Pope acknowledged that a problem was beyond them is perhaps as good a time as any to take as the beginning of the modern biomedical ethics movement.

There are many things to be said on how we should view technology, how we should embrace it, how we should introduce it, how we should use it. But there's one thing we shouldn't do. We should not judge whether a technology should be introduced into our own lives or into the lives of our medical institutions by the characteristics of the technology itself.

No, that is not the way to view or adopt technology. The preferable way is to seek deeply what the goals and values of the institutions that we have are, and to see whether the technology's capabilities further those values. In that way we direct the technology rather than the technology directing us.
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Title Annotation:Three Views of History
Author:Reiser, Stanley J.
Publication:The Hastings Center Report
Date:Nov 1, 1993
Previous Article:View the second.
Next Article:What bioethics brought to the public.

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