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THURSDAY, JUNE 22, 2006


Session 2: Organ Transplantation and Procurement—Literary and
Philosophical-Anthropological Perspectives

Thomas Lynch, author of The Undertaking: Life Studies from the Dismal Trade and Bodies at Motion and at Rest

Stuart F. Spicker, Ph.D., Professor Emeritus, School of Medicine, University of Connecticut Health Center

CHAIRMAN PELLEGRINO:  Attention.  All right, thank you very much, those of you who are seated.  Thank you very much.  Thank you for reassembling, thank you very much, all the Council members. 

We move to the second session from the empirical data, the sociological and the numerical and clinical data, we move to another area from the literary and the anthropological and the philosophical sense, views of organ transplantation.  And I'd like to call on our first speaker for this next session, Mr. Thomas Lynch, the author of "The Undertaking, Life Studies from the Dismal Trade and Bodies at Motion and at Rest."  Mr. Lynch.

MR. LYNCH:  Well, thank you, Doctor, and thank you for the invitation to be here.  I want to thank Dr. Davis for that invitation and I was asked to hold court for about a half an hour and then there will be questions and answers.   I'll endeavor to hold court for a little bit and on the subject of questions and answers, I should say that I look forward to them so that we can go in the direction of your interests as well as mine.

I should also say that I cannot be offended. I've raised teenagers, so I'm thin-skinned, but amply padded so ask away.  (Laughter)  I embalm and do sonnets and I'm happy to entertain conversation between those subjects and if I don't have an answer, I'll make something up. 

But I thought I'd take advantage of the audience and start by reading a poem since we are considering literary aspects of organ procurement.  And some years ago I was asked to — as part of my indenture to a British publisher, to do a reading at Guy's Hospital in Central London in what was called the Old Operating Theater.  It was, I think an 18th Century amphitheatric room with, you know, few props.  The only thing that they had there was you know, a wooden table with some sawdust, a bucket and blades.  I think maybe this is familiar to the medicos among us but for me they thought it was particularly apropos, because I'm a funeral director, they thought I'd be really comfortable there.  Don't you just love them for those types of considerations.  So this is a piece called, "The Old Operating Theater, London, All Souls Night."  It's taken — there's a part of it taken from that lovely passage in Genesis where Abraham has that dream about becoming the father of a nation, you'll remember this.  There's the good news, A, he's going to be the father of a nation, and then the bad news, at least if you're one of his tribe's people, that everyone must be circumcised, at least the men.  And I always tried to imagine the number of them running off into the desert on that morning when he first announced this Old Testament to them.

"To rooms like this old resurrectionists return the bodies they had disinterred.  Fresh corpses so fledgling anatomists could study origin and insertion points of deltoids, pecs, trapezius and count the vertebrae, the ball and socket joints and learn the private parts and Latin names by which the heart become a myocardium, the high cheekbone a zygoma, the brain less prone to daydream is a cerebellum, and squirming in their stiff unflinching seats apprentice surgeons witnessed in the round new methods in advanced colostomy, the amputation of gangrenous limbs and watched as Viennese lobotomists  banished the ravings of a raving man but left him scarred and drooling in a way that made them wonder was he much improved.  But here the bloody masters taught dispassionate incisions, who to suture and remove.

In rooms like this the Greeks and Romans staged their early dramas.  Early Christians knelt and hummed their liturgies when it was held that prayers and penance were the only potions.  Ever since Abraham guided by God first told his tribesmen of the deal he'd made, their foreskins for that ancient covenant.  Good medicines meant letting human blood.  Good props include the table and the blade.  Good theater is knowing where to cut."

So I read that in part because it introduces us to this morning's considerations of bodies and body's parts, their uses and abuses, the issues of function and dysfunction, mortality and vitality, pathology and personhood, the living and the dead.  These are topics that have always interested me.  And the language of these issues, words like harvest, procurement, consent, donor, recipient and more lately, seller, buyer, agent, this is the language of the farm and market, of the foundation and institution and suggests a set of long established guiding principles or corporate policies and longstanding ethical standards. 

We talk now of future in the cadaveric tissue and organ markets as if we were talking about crude oil or soy bean futures, and suddenly we seem, we human beings, to quote from the songwriter Rufus Wainwright, "to be so many cubic feet of bone and blood and meat and nothing more."  My experience as a funeral director for the past 35 years, as the son of a funeral director for the years before that, as the brother and — brother of funeral directors and father of funeral directors now has taught me just the opposite.  That we are more than the sum of our parts.  And furthermore, our parts, our limbs and organs and remains represent more than remnant or accessory or fragment.  When speaking about human bodies the part is an essential portion, not an accessory, of the whole and it's precious to the owner whether the owner is the body in its current incarnation or the surviving bereaved family. 

My experience with bodies and the parts of bodies over the past 35 years has taught me that our dead are precious to us because ours is a species for better or for worse, that has learned to deal with death, the idea of the thing, by dealing with our dead, the thing itself.  I'm borrowing here, I think from Wallace Stevens who makes the distinction between the idea of the thing and the thing itself.  And it casts me back in imagination to, depending on what channel you're watching at night, 40 or 50,000 years ago when the first human widow awakened in that cave to the dead lump of protein next to her and said something on the order of, "My he's very quiet this morning," or words to that effect.

But depending on the season and the weather, sooner or later she would begin to sense, actually, she'd being to smel,l that this stillness was a different stillness than he or she had ever experienced before.  She knew she'd have to do something about it.  Ours is a species that deals with the idea of death by dealing with its dead.  She knew she'd have to leave the cave to him in which case, I suppose, it would become his tomb.  Or maybe she thought she'd drag him out by the ankles and kick his sorry self over the cliff, in which case we could call him "consigned to that oblivio" or maybe she'd build a fire and burn his body, or maybe she'd scratch a hole in the ground and tip him into it. 

Whatever she did, whatever oblivion she consigned him to 40 or 50,000 years ago, it was the questions that quickened in her looking into that void that became, I think, the signature of our species that separates us from rock bass and rhododendron and cocker spaniels and other living things that die.  As someone quite rightly pointed out and you can try this at home, the numbers are convincing on this, hovering as they do around 100 percent.  But that is a sadness, whether it's a crisis is for us to discuss.  But looking into whatever oblivion she consigned that first dead thing to, she asked the standard questions.  I hear them asked by widowed people today: "Is that all there is? Can it happen to me? Why is it cold? What comes next?" 

So ours is a species that for better or for worse, while the dead do not care and you can try this at home, too.  I've spent a fair amount of time around cadavers, corpses, dead neighbors, dead friends and family and never once has one of them said anything like, "I want the blue pinstripe suit or the cherry casket or the mum plants, please in my behalf."  They say nothing.  They are mum on the subject.  The dead don't care, you can take that to the bank.  But the dead do matter.

They matter to the living in ways that we're only beginning to understand.  And so part of the considerations here as you discuss bodies and the parts of bodies, I would encourage you to take on more of the notion that whether we are talking about the parts of bodies of dead gangsters, buried maybe in Milford, Michigan, as we found out last month when they went digging for whatever is left of whatever remains, whatever might be there of Jimmy Hoffa, at Hidden Dreams Farms, or whether we are looking for our dead at fresh kill landfill site after their murder is commingled, their bodies are commingled with the act of their murderer on September 11th in our great cities, that the dead are with us.  We are all haunted — properly and happily in some cases — by not only their memories, but by their remnants.  I have seen this not only in consideration of organs transplanted or tissue donated, I have seen this in how we consider fetal deaths, expectancies, the whole notion that has fueled the... our concerns over the abortion and reproductive rights conflicts in this country over the past 30 years, just like the ones that are fueling the ones about so-called "assisted suicide," are based on the notion of when death happens and when life is.

And there is a difference, as one of your panel pointed out, between the notion of medical death, metabolic death and the notion of social death and spiritual death and actual death as far as your family is concerned, and those are the things this council must wrestle with when you seek to set forth useful policy.  I might know, for example, that at the end of a process with cremation, we end up with say 14 pounds of bone fragment and dessicated tissue that we can put in a box and hand to the family.  But when you see the elderly sister come to claim the ashes of a sister whose own children couldn't come and get her, when she bears that box like Viaticum, when she walks out the door, flips the button to open the trunk and then reconsiders and goes to the back door and opens it up and then thinks better of it and closes it again, when she goes to the passenger — front seat passenger door, opens it up, places the box on the front seat and then clicks a seatbelt around it, you can see that whether we are remnant or icon or relic is not up to you or me.  It's up to the living that bear us in their memory and in fact, that bear our mortality because we are mortals, we are humans.  We are tied to this humus, this layer of earth from which our monuments and our homes and our histories rise out of. 

The dead are everywhere.  When my father died in Florida many years ago, my brother and I got on plane to go down and prepare his body to bring him home to Michigan.  And I can remember thinking as we saw him laid out on the embalming table of the Myers — or the Anderson Funeral Home in Ft. Myers, Florida, thinking at first, "This is what my father will look like dead," and then, "This is my father dead," and then, "This is maybe what I'll look like when I'm dead," because we dispose of our dead and then become them. And we do not dispose of their parts easily. 

The market, the retail event involved in organ and tissue procurement is something that may have medical consequence but to most families it remains a mystery, tied up, as your Council has rightly put forth, in issues of personhood, not parts.  There's this "just a shell" theory of how we should relate to dead human bodies.  You hear a lot of it from young clergy and old family friends, well-intentioned in-laws, folks who are unsettled by the fresh grief of others.  You hear it when you bring a mother and a father in for the first sight of their dead daughter killed in a car wreck or left out to rot by some mannish violence.  It is proffered as a kind of comfort in the teeth of what is a comfortless situation, consolation to the inconsolable.  Right between the inhale and exhale of the bone-wracking sob such hurts produce, some frightened and well-meaning ignoramus is bound to give out with, "It's okay, it's not her.  That's just a shell." 

I once saw an Episcopalian deacon nearly decked by the swift slap of a mother of a teenager dead of leukemia to whom he had tendered this counsel.  "I'll tell you when it's just a shell," the woman said.  "For now and until I tell you otherwise, she's my daughter."  The woman was asserting the longstanding right of the living to declare the dead, dead.  Just as we declare the living alive through baptisms and lovers in love by nuptials, funerals are the way we close the gap between the death that happens and the death that matters.  It's how we assign meaning to our little remarkable histories.  And the rituals we devise to conduct the living and the beloved and the dead from one status to another have less to do with performance than they do with meaning.  In a world where dysfunction has become the operative adjective, a body that has ceased to work has, it would seem, few useful applications beyond those we are talking about here this morning.  It's dysfunction more manifest than the sexual and familial forms that fill our tabloids and talk shows but a body that doesn't work is, in the early going, the evidence we have of a person who has ceased to be and a person who has ceased to be is as compelling a prospect as it was when the neanderthal first dug holes for his dead and set our species apart from the others.

The bodies of the newly dead are, therefore, not debris or remnant, nor entirely icon or essence.  They are rather changeling, incubates, hatchlings of a new reality that bear our names and dates, our images and likenesses, as surely in the eyes and ears of our children and grandchildren as did words of our birth in the ears of our parents and their parents.  It is wise to treat such new things tenderly, carefully and with honor.

So I encourage the council as you go to work wrestling with these difficult issues, that you consider the traffic between the living and the dead  because in most of these situations, there is no medicine or math, no bottom line or Bible verse, that will explain the mystery that we behold when we behold someone we love dying or dead.  I know this for a fact, not only because of my professional and personal experience, because I sense it in the lives of people all around me. 

Today as we speak, my sons are conducting the funeral of a man who died on Sunday in a car wreck near Milford.   He has a son who is two years old and his wife is pregnant with their second son.  They have decided to name this new thing, this yet to be born son after his dead father.  Before he was brought to the funeral home, an OPO quite properly asked his family, his widow, his newly widowed wife if she would make what is called the gift of life.  She decided yes.  That would assist her.  The notion that he was ongoing there in the intensive care ward.  That he would want that, that he was always full of life and he would want life, such as he knew it, to be given to anybody else who could get it from him. 

So we don't have to wonder the comfort that that wife and family feels in knowing that somebody out of the sadness that has occurred to that family, will be saved or lengthened in their lifespan or returned to their family in a way this man will never be, but those are mysteries.  And when she holds her new son five months hence, named for the dead man he'd be named for, she'll know that mystery.  It's about living and dying and ceasing to be. 

Let me close with one more poem so that you can tell your adult children or teenagers tonight that you, among other things, went to a poetry reading.  It's like being the President of the Rotary Club, you only have to do it once and it goes in your obituary, so (laughter) once you've heard this, you are a raconteur of literary events.  I give it as thanks, in part, for your listening to our conversation.  To have a room full of experts and studious people consider these things, is like going to the shrink and not getting a bill for it, so I'm very grateful.  (Laughter)

A Death, it's called, I mean, it's an occupational hazard for the likes of me.  In the end you want the clean dimensions of it mentioned, to know the thing adverbially while asleep after long illness, tragically in a blaze as you would the word of any local weather where it gathered, when it got here, how it kept the traffic at a standstill, slowed the pace, closed the terminals.

Lineage and issue, names and dates, the facts you gain more confidence in facing, histories and habitats and whereabouts.   Speak of it, if you speak of it at all in parts.  The CVA or insufficiency or growth that grew indifferent to prayer or medication, better a tidy science for a heart that stops than the round and witless horror of someone who on a dry night in perfect humor, ceases measurably to be.  Thank you, God bless.

(Applause)

CHAIRMAN PELLEGRINO:  Thank you very much, Mr. Lynch.  We will proceed —

DR. FOSTER:  Mr. Chairman, point of interruption for a second.  I wonder if you would ask that the little poem be printed out for us as a gift for your very gifting speech.

CHAIRMAN PELLEGRINO:  Thank you very much.  We will do as we did this morning and have our second speaker, Dr. Stuart Spicker and then a member of the council will open the discussion of both papers.  Dr. Spicker is Professor Emeritus of Bioethics, Philosophy, at the University of Connecticut.  Stuart?

DR. SPICKER:  That cliche about a hard act to follow, A, it's not an act and it was wonderful that you preceded me because you said so many things, the shortness of time wouldn't even let me introduce, never mind develop.  So out of the blue, we're kindred spirits and we have never met and perhaps, not read much of one another either.  Who would have presumed that?

On May 14th, 1964, I met Dr. Edmund Pellegrino for the first time at the VA Hospital in Lexington, Kentucky.  As coincidence would have it, I turned, oh, dear, 27 that day.  We were both attending the opening session of the Second Lexington Conference on pure and applied phenomenology. I promised I wouldn't use that word much with the Council, which was the second of five Lexington conferences all organized and their proceedings published by Dr. Erwin Strauss, eminent psychiatrist, philosopher and gentleman.  Indeed, the Lexington conferences were the  true birthplace of what later became the trans-disciplinary symposia on philosophy and medicine and the subsequent book series "Philosophy and Medicine," which continues today under the competent authorship and editorship of my close lifetime friend Dr. H. Tristram Engelhardt, Jr. of Rice University, Texas.

Having formally studied in — with Hans Jonas at the New School for Social Research in New York City from 1959 to `62, I came to appreciate the work of one of his disciples, Dr. Leon Kass, whose "Teleology and Darwin's The Origin of Species: Beyond Chance and Necessity?" Do you remember that Leon? (It) was published in the Festschrift honoring the 75th birthday of Hans Jonas in 1978 on May 10th and that became Philosophy and Medicine Number 7, and a joy to do. 

Today, therefore, is not only a personal honor, but also a very special occasion for me, to be reunited with these distinguished two gentlemen and you the other learned members of the President's Council on Bioethics.  I come here as disciple, therefore, having followed the paths first pressed down by my predecessors, principally philosophers and physicians.  I recall, as you students may, and you should, that the philosopher, John Dewey had published a book and that book was titled "Experience and Nature."  He provides there in the opening section, precisely such an image.  As humanity walks the earth everywhere making new paths, nature becomes transformed into experience.  It's a wonderful idea and hence, his metaphysics.  That's what this book is.

Well, today it's time to begin another, though surely shorter, Dr. Pellegrino is in the chair, a shorter walk, this time to transform better to, may I say, incorporate one man's experience, not mine, as patient and research subject during the years leading up to his receiving a heart transplant from a young woman donor.  That is I'm coopting this man, Mr. Ed Linz into the philosophy of medicine as well as philosophy in medicine, that's bioethics, to borrow a distinction made salient by Dr. Pellegrino some  years ago.

I have to apologize to the audience, not to the Council because the paper is not distributed for you to read ahead of time as it was for the Council since it's pretty dense and probably would serve more to embarrass me than to get my ideas across, so we've all agreed, I would not read it and it's readable, I hope and it's only a draft still, nothing ever is finished.  And so it should be online.  I've been promised that as with all the proceedings and transcripts and so on, so if you're interested, it can be read at some later time when the staff is prepared to put that out online.  And I thank you and the staff for all that work.

The title of the presentation I gave is "A Transplant Recipient as Patient and Research Subject," subtitle, "Exploring the Zones of Corporeality Between Leib and Körper."  I purposely used the German words "Leib" and "Körper" because the English, soul sometimes and body, are nothing but misleading, confusion as prevalent all the time and what I'm about to say, I hope will begin to clarify some of this Cartesianism which is still with us in everyday speech.  With respect to my deep respect for American jazz, may I say that my favorite jazz tune is still "Body and Soul," but by the time I'm done, soul will be like "it" in "it is raining."  It will refer to nothing. 

So for the moment, let's do a little slow reading in my case of the German from Nietzche.  I want this quotation right up front today.  I'll translate it only because my German is weak and I must be clear about what I am saying.  Many of you know many languages but the German is important because of Leib and Kopor and the fact that Körper is not used in this quotation from Thus Spach Zarathustra penned by Nietzche or published by Nietzche in 1891. 

In fact, the first part of that work is called "On the Despisers of the Body."  We'll get to that in greater detail.  So it goes like this in German, (Speaks in German).  Translation: "Body am I and soul," thus speaks the child. And why should one not speak like children? But the awakened and knowing say, "Body am I entirely, and nothing else and soul is only a word for something about the body."  At this point, may I say, and this is important, staying with the Germans for the moment, who've given us through Wittgenstein another insight, he defined philosophy as the overcoming of the bewitchment of our intelligence by means of language.  Isn't that wonderful? 

I think of the toolkit.  You build something with it and when it breaks down all you have are the tools that helped you build it.  So we are in a paradoxical situation of finding that we abuse and confuse our intelligence because of the use of language, and we can only save ourselves from that abuse by the use of language in the creation of neologisms and all the rest that goes with using a language. Typical Wittgenstein, but terse and to the point, but signals a tremendous obligation and danger, since only language can help us clarify what we muddle up in intelligence.  It all began with language, even Zoleta Tas Kint (phonetic) even the language especially of the child and we still speak like children, how else can we speak.

Now, just a few words about these words.  Talk about what I saw in the literature some time ago, that famous F word, since it's polite to use that expression.  Well we've got some beautiful four-letter F words, body and mind for example and soul another F word.  We're being forewarned, I think, of what's coming, namely I hope in the remaining time I can talk about three things at once, so to speak without being too confusing.  We have one man who's both a patient for a long time, and he still is, and a research subject. 

Secondly, we have to tiptoe in and out of the philosophy of the body for lack of a better phrase in English and finally, I have a little to say, not very much, about organ transplantation, since Dr. Pellegrino gave me the assignment to, perhaps, mention what I saw as one, perhaps, two but only one issue of bioethics as I see it in the context of organ transplantation if time permits, because that, indeed, is the next session and it would be at least a transition.

So let me proceed with these three general themes coming in and out of them, especially the first two, as I proceed without reading you this paper.  First, this word in English, "subject," is, to say the least, ambiguous.  We use it when we're serious as the center of what it means to be human as the being who's the source of his or her moral choices.  This however, is not quite what became the meaning of the word as we began to use human beings as research subjects.  We kind of threw them under, yes?  That is, we have to look at them, if you're the researcher now from your perspective, how do you see these people you're trying to co-op into with informed consent and the rest to be subjects for your — participants in your study.

I should tell you that due, I think, to political correctness, even at the Hastings Center, the subtitle of IRB, their Journal, changed from "subject" to "participant."  I caught that, I was looking more carefully one day.  And so it's not an accident, the idea being it looks too dehumanized, sounds too dehumanized.  Participant, I'm almost consenting already, it's in the word, but it's hard to talk about this one man, Mr. Linz, who's his own research — well, what is he?  Is he a participant?  Well, he's not in a study.  He's participating in his heart transplant situation and we will see when eventually  you read this, as some of you of course have, you'll see that — I like this expression — this man, lo and behold, this man went through the entire American armamentarium of medicine if it was a medicine cabinet that's in there.  You name it, he had it from the very beginning of the diagnosis to finally that heart transplant of the young lady.  There is nothing virtually that didn't happen, and that will include, as I hope to get to briefly, all kinds of prosthesis, not to mention the drugs.  They have to somehow be incorporated. 

By the way, by the way, this is very, very important.  Allow me, because I can't help it, I'm going to speak like a child, too, and you can catch me every time and you'll be really sharp because I'm going to slip into Cartesian language when I don't intend to, when I reject it, I'm going to do it all the time.  It's that powerful, it takes hold of you.  It's impossible to avoid it.  For example, embody, that doesn't sound like one entity, it sounds to me like two.  Embodiment, a word Dr. Zaner used in his work and so on, embodiment, is that speaking with forked tongue when I talk about soul doesn't refer to anything, but there's only body? But don't think you know what I mean, when I talk about body because I'm going to mean something much broader than what your anatomists mean or certainly your brain surgeons mean or certainly your neuro-scientists mean by "brain" or "body."  In any event, you can feel the worry about language, that's what maybe all we philosophers have to contribute if anything, and Wittgenstein knew it and when we get it straight, we can throw away the ladder because we've clarified how language is constantly bewitching us but you can never let your guard down. 

Now, from subjective and objective and then objective science, that is mathematicize whatever it  is you're working on that comes out of the Galilean tradition as far back as Pythagoras, all of you know the  history of science and quantification.  So we take our move now to the other words.  The term "human body," "physical body," for those who have studied enough Decartes, at least got into the Meditations at least got to read Meditation 1 and 2, you've gone far enough.   That is to say, well, because he's so powerful he'll just overwhelm you and you'll wind up like the rest of us.  Maybe you can avoid it.  It's so powerful and such a genius. 

Let me digress, I'm backing away.  Again, don't confuse Cartesianism with Descartes' philosophy.  The man is not the followers of the man.  This was a very special time.  I looked this up to get the exact date.  Galileo's trial, and you know the tribulations and trial and the recent book, Galileo's Daughters, wonderful book, 1633, the trial, 1633, Descartes' Meditations in another country, he's in France, 1641.  That's not very much time, even then.  So I maintain when Descartes writes in his notebooks, Larvatus Prodeo, "I come forward in a mask," in quick form, ladies and gentlemen, I've always held and still hold and I have people who join me, like La Mettrie he was not being straightforward.  He was disingenuous in the Meditations and Descartes is not a Cartesian.

He does not hold to the strict form of his own res extensa, res cognans distinction but it's fantastic.  However, Princess Elizabeth of Bohemia, it takes a woman to found him out, and not let go and she doesn't let go.  Well, Descartes, how is it possible that these two entirely different substances could possibly come together to make one unified human being if we are both of two totally different substances?  Answer, Galileans are already smart, they know their anatomy, in the pineal gland.  Well, wait a minute Descartes, that's material.  So, I'm back to my first question, sir.  And answer, well, God must intervene there and God intervenes in the pineal gland and that's where you become a unified person until you have some brain pathology and you guys all know the rest.  The rest of that trip is the history of science.

So I just wanted that little interlude.  I didn't want to fail to mention it.  It gives me a little confidence that this ruse that's coming forward as an amass, we've inherited that.  I call that Cartesianism rather that Descartes because I think Descartes knew exactly and precisely what he was, so to speak, putting forward in his historical moment.  Well, then we have the res extensa famous example, I don't have to teach Descartes here to you today to you eminent folks, but he gets pure body out of that.  And that, no matter how a block of wax needed changes, one thing doesn't change, it is the same wax, he says, when melted down and cooled as what we started with. So we've got physical universe, everything, including the human body, okay, that's what that looks like.  And then secondly, of course, his argument in the first Meditations that the mind or soul or psyche exists.  He proves that by his immediate connection to cogitations as he calls them.  Enough of the history of philosophy.

What now has to happen to come forward to the 19th, 20th Century is to see the transition by those eminent psychiatrist philosophers, Binswanger and many, many others we could name and Erwin Straus, namely the Leib-Körper distinction that I already have mentioned and why the German is better than the English, it helps us to do it.  A fast footnote here, Körper is not corpse.  It's not the dead body for autopsy.  We will see it as an extreme condition of still unanimated human.  I'm going to use that word.  And Leib, to give you this other extreme, my favorite example is playing the piano after some years without the sheet music.  You really aren't mistaken to say the body knows how to play the piano if it's the piano.  You call it memorize but the fingers seem to know it too.  There's a strong sense in which the fingers know and the hands know and the whole being knows that work that you're playing.  Or the athletes, since we have always references to sports and other teams, these people are purely fully-lived bodies in their activities of their sport.  They don't think about their illness at the time or whatever they're undergoing.  They are immediately and totally fulfilling and living through the moment and the motion and the self-motility and the uprightness and all the things that go with the current philosophy of the body of those psychiatrists I mentioned.

So what I've tried to say that's different in this paper than my older papers and other older papers, is I think we can distinguish certain and slightly different, I'm calling them zones of coporeality for lack of a better way to put it.  The first is "Leib," the fully lived personal being in action.  The second is "Leib-Körper," a lived thing body. The third is "Körper-Leib" and "Körper-Leib" is sort of what happens, you're experience as you're quite ill.  I find it's almost paradoxical.  I think that's the Cartesian distinction almost, because I don't buy that he bought either.   But that's getting close.  Your body is just the burden, the attachment.  

In fact in asomatoagnosia as you may know this case the psychiatrists often deal with, in asomatoagnosia the doctor has his hand on the table on the patient and the patient says that this arm, the doctor points to the patient's arm says, "That's not my arm, that's yours, doctor," and he means it.  It's not duplicity, fabrication.  It's not lying, it's not self-deception.  It's really this doesn't belong to me, yet it's fully attached.  You know, interesting disturbance and it probably has, it usually always has some neuro-correlate which is something is awry and that's so the specialist, we philosophers don't argue with the scientists with good science and with good neuro-science.  There's no grounds for that.  It's just — it's not the whole story. 

If we could just get these people in this field to understand, I say this.  It sounds like such arrogance, I know, but it just came, you want to shake them up, the Churchlands, with all due respect and the others.  You know the brain and central nervous system are the necessary conditions for certain, perhaps all kinds of experience, but they aren't the sufficient condition to unravel what that experience means.  And I believe members of the Council, I know Dr. Kass has spoken to that, I think, in response I'm trying to tie this back into your meeting with Dr. Churchland at the time, which he did not — as I reread the transcript could not answer the question because the intellectual position on it is just indefensible, but enough of that.

I just wanted to tell you as an aside that this is so stressing and distressing to continue to see all of this going on today in the 20th century.  I was telling Dr. McHugh I have this kind of simple-minded theory, Dr. Pellegrino will remember when he taught this in medicine and he taught that in many other things, when surgery — the surgeon using the hands, these are menial.  No status in that, they are your earth and mud and knife and blood and all the rest, and now brain surgeons get the highest pay in medicine, I think so.  I think they're the highest paid certainly in surgery.  Okay, that's happened.  Is it an accident historical that we are now in a situation where philosophers like Professors Churchland and many others are themselves sort have been totally taken over — have taken over the neuro-science.  They review neuro-scientists' books.  What's happening here?  Is it purely accidental?  How did the kind of brain get back into philosophy?  It's kind of weird question to put it that way because I don't think philosophy is based on brains. 

It's based on brains being a condition for anything human but no more philosophy than walking, that crawling.  Well, in any event, it's for me a fascinating time to see really this rise and the way this has all happened within philosophy and philosophy departments, which it wasn't like that when I began my own studies.  Well, I don't have time to take you through — I wrote here page 17 for the sake of the council members where I do quote the — I do quote Mr. Linz.  Fortunately, Mr. Linz wrote a book about his entire experience and he calls it "Life Row."  Isn't that a great title, trying to stay alive till he got that heart transplanted in him at the very end and he's alive and well, by the way, and lives in Virginia.  And he was a — just for the sake for a moment, out of respect to him, he was a commander at the Rickover of a nuclear submarine and he got out of the Navy, he got enough and he's teaching high school and he was a coach, math teacher, and he's doing okay.  I called him a few weeks ago and said, "I'm going to the President's Council and you're the star, so I want you to know I'm using your name one more time."

He actually corrected this paper for me in places, the one the Council has because there were certain quotations and things about his experience.  Well, they're wonderful.  Maybe I can just — I see I have a few minutes, don't I?  We can go to — the Council and I, at least, can go to page 17.  Just take these, some of it may not be quite right.  I'm still working on this.  It's when he's in Leib mode, Leib zone, okay, he's not an athlete at this point, Leib.  "I feel lousy, not so hot."  The surgeon told Linz, "You won't even know that it's here, there.  It's the ICD," the implanted cardio defibrilators. "My donor's heart is part of me," you get the picture, fully incorporated, living a life, doesn't think about it any more.  Now and then he may, but he's doing what we all do with our hearts up and running as they are. 

This is Leib, now Leib-Körper: "I felt no sensation from the actual high frequency sound waves that were mapping my heart, my heart," do you hear the distancing about his own internal organ?  Let's see, "mapping my heart.  It was never the physical pain, but the immediate fear that my heart would not respond to the shock and I would die immediately."  There's a kind of detachment going on is what I would claim.  Now, Körper-Leib, "The right ventricle of my heart was not working well and both my right atrium and right ventricle were enlarged due to the sarcoidosis that  started all of this, but the sarcoidosis did not spread throughout my body.  I now had two metal encased computer systems inside my body keeping me alive."  I'm calling that a description under Körper-Leib.  Do you see he's getting more Bionic Man-like in the language.  Do you see what I'm driving at?  A show of hands, class.  That's the routine and maybe I didn't say it well.

            And here's Körper, remember it's not corpse, "The doctor" he said, he gets a female doctor, this is great.  "The doctor, she said, might stick fingers in various embarrassing places in my body.  I was repaired by a laptop," he said later.  "I could lift virtually nothing.  Getting up from a chair was always an adventure."  What I'm trying to say there is, I'm taking those as descriptive of being much more thing like than living thing like.  Do you see my drive?  I could be a bit wrong on that last one.  But do you get this picture? 

Here's this male going to a female doctor and you kind of have your eyes closed.  What are you hoping?  I mean, I've been there.  What are you hoping?  Geez, will I not, first of all, get off on this, think of the transcript.  You know, I'm not supposed to get excited from this.  This is just, you know, I've got to objectify this.  I don't know what else to say, right?  She's got to do it, I have to go through it, I want this over with.  I'm going to thingify (sic) myself.  Have we all been there?  Do you know what I mean?  I'm going to thingify myself, hopefully for as short as possible.  And you cannot live in the body.  It's very hard to do but we do it better — that's not the best example, but you know, we can do it.  And I have it in the paper for the Council which I will get to in my time.

I have the Weltanschauung where it's Plotinus and maybe with the time I have, not to — not to fail to mention this, I think I have to now that I've set you all up, I have to find that on page — if someone would help me, the Plotinus, 19, thank you.  I think I almost have it.  Well, 19 and 20, let me find 19.  I hope I can in the time I've got.  Well, if I can't someone else — I've got these pages all mixed up here.  Oh, 19, having said about this detachment, and making — putting aside, okay, putting aside body, okay, just putting it aside, here it comes right from Plotinus himself from the fourth Ennead, the soul's descent into the body and so on.  Listen to this theological experience, not a medical exam.  "Many times it has happened lifted out of the body into myself."  We've got a soul and body here, this is clear dualism, Plato, right? 

"Becoming external to all other things and self-encentered, beholding a marvelous beauty, then more than ever assured of community with the loftiest order.  Enacting the noblest life, acquiring identity with the divine," after all this is third century A.D.  "Stationing within it by having attained that activity, poised above whatever within the intellectual is less than the supreme, yet there comes the moment of descent from intellection to reasoning and after the sojourn in the divine, I ask myself how it happens that I can now be descending and how did the soul ever enter into my body, the soul which even within the body is the high thing it has shown itself to be. Plotinus' account of his soul's assent from and descent into the body reflects not only his disdain for matter," and in our context it's the thing body is limiting case, Körper, "but an ontology or world view that is throughout sternly non-worldly.  Indeed, even the zone of corporeality, Leib, is nothing more for Plotinus than a prison and all the heavenly bodies, the cosmos, nothing more than a denigrated "evil empire." This is pre-President Bush. 

"Everywhere we hear of it, the human soul is in bitter and miserable endurance in body.  A victim of troubles and desires and fears and all forms of evil, the body, its prison or its tomb, the cosmos its cave or cavern."  Furthermore, as matter is absolutely evil, absolute deficiency of good, and vice and body are one, he adds," and I'll close with this, "for weakness in the body is not like that in the soul.  The weakness be in the fallen souls, neither cleanse nor clean and in them the weakness will not be in any privation but in some hostile presence like that of phlegm or bile in the organs of the body. 

"This is the fall of the soul, the entry into matter.  Thence, it's weakness, thus the cause once of the weakness of the soul and of all its evil is matter.  The soul would never have approached matter but that the presence of matter is the occasion of its earth life."  So the human body, its earth life is like dirt or mud, whereas the soul, the high thing, is like a perfect, I hate to say diamond, that's material but you get the idea by metaphor. 

So we have it, I think, but there is another Weltanschauungen that stands this third century Platonism on its head and that's the one where soul, Nietzche and others is just another name for the body, that's not Plutonus, that's not the Cartesians, and may not even be Descartes, if pushed.  It's in Wittgenstein one more time and I don't know if I can find that page, but (speaks German), the human — now that's Wittgenstein using Körper not Leib unfortunately.  The human body is the best picture of the human soul.  Well, that's I think — except for my concluding word, that is all I would have time for today except to signal to you just that one little problem in bioethics that maybe needs consideration when looked at from the point of view of the Council on transplantation, organ transplantation, to be specific.  Let me see if I can locate that. 

But I know the problem so I'll just say it in the few minutes I have left.  And it goes like this: Ed Linz and thousands more if we consider all organ transplantations of all types of organs including intestines which I tend to fail to mention some time and of course, livers and the rest, if we consider all of these organs, these people who receive them are on immuno-suppressants and they're on them forever.  They're very expensive, someone is paying, insurance or the individuals or what have you.  Question or point of fact, they're beginning to organize, these people, and they're making a certain claim.   The American pharmaceutical companies and industry have an obligation to do research and to find ways that we can be taken off these immuno-suppressants, for this reason.  We are far more prone to cancer and infection and early death once again, because the immuno-suppressive drugs, you know the general biochemistry and the pharmacology, because we have been saved and now we have another risk not of the organ rejection but of dying or acquiring and dying of cancer and other infections like, of course, the AIDS patients and so on or people who acquire these diseases. 

So the question I think the Council might consider and I'll give you one answer some people are giving, they say, no, no, this is not the obligation of the pharmaceutical industry.  But maybe it is the obligation of NIH researchers.  I haven't thought this one through myself at this point.  You know, I believe in China and you can check this and we should check it, the staff, if you wouldn't mind.  That's the only thing I'm requesting.  I haven't found it.  You can save someone's life, then you must continue to save it, if it's in jeopardy.  They don't owe you.  You continue to owe them.  It sounds a little like that.  Here are the people who have been saved through the organ transplantations and the immuno-suppressive drugs saying there's a societal obligation to find new ways to take them off these drugs because they're more prone to cancer and other infectious diseases. 

Question, is there such a societal obligation and if so, how do we fulfill it.  Another expansive demand.  Now another answer is, well, let the drug companies get ahold of this who don't make immuno-suppressants, right, and let them compete and put those other guys out of business because they'll find what's cheaper and what will get you off those drugs and these will not have the same side effects and make you — have you in greater danger of acquiring and dying from cancer and other infectious diseases.  I'm just beginning to think about this problem. 

I defer to the Council.  I don't know if you've taken this one up.  I haven't read all your transcripts.  Have you actually dealt with this particular problem?  Okay, well, I thought I would end with just this one concern that's arisen.  I first heard about it some months ago and heard about it again when I spoke to Ed Linz, who is a member of such a group and so I thank you for the time and look forward to the question period as my colleague does.

(Applause)

CHAIRMAN PELLEGRINO:  Thank you very much, Dr. Spicker.  I've asked Dr. Meilaender if he'd be good enough to open up the discussion on both of these papers, Gil?

PROFESSOR MEILAENDER:  Yes, thanks to each of you.  There's an awful lot more in not only what you had to say here but also in the written materials we got from you in advance than I can possibly pull together here.  But I want to make my way toward a question, a separate question for each of you.

Professor Spicker is interested in the lived body, sort of a complicated concept that he has there, that can move through these various zones in which it become progressively more a thing and although it never is corpse as lived body, I mean, the corpse would, in a sense be the limiting case when it would cease to be that and then it would be what Mr. Lynch deals in at that point.  Now, we're interested in thinking about taking organs for transplant from living bodies and also from corpses.  I mean, both of these are done.  And what I'd like to see is whether I can get each of you to help us think from your own particular angle the sorts of things that you've taken up, about that question. 

So for Mr. Lynch, I'd ask you to respond to something like this; you said in your talk and it's a refrain in one of the pieces of yours that we had to read, "ours is the species that keeps track of our dead," that's very nice.  I like that a lot.  You never precisely tell us why and that may be okay.  I don't say that as a criticism at all but what I'm wondering is this; if we — if we begin to manage death in such as way as to make organs more available for transplant, if that becomes the primary structuring — the primary concern that helps us to structure dying, or if we ask families as they are in the process of letting go of a dying loved one to consider consenting to organ donation, or if, perhaps, we even offer them some kind of financial incentive to listen more receptively to our request, are we doing anything that in anyway undermines our ability to be the species that keeps track of our dead or if we're not, say a little bit about why you think we're not?  That would be the question for you. 

And for Professor Spicker, you deal primarily in thinking about these zones of corporeality with the transplant recipient, that's your example of Mr. Linz.  I'd like to get you to think a little bit about the donor.  Although it's sort of complicated on your understanding and I may not even have it fully sorted out, which is okay, though, I think since you said you didn't have it fully figured out either.  You do say that sort of in terms of this process of being sort of pure — in which we experience ourselves as just lived body to increasingly thingafied in some ways that you say that the sicker we are, the more likely we are — you hypothesize, the sicker we are the more likely we are to be willing to think of ourselves in more and more thing-like ways and that on the other hand, the sort of healthier we are, the more we're just pure Leib and little or no Körper, the less we're going to do that.

What I'd be interested in hearing you respond to is whether there's any reason why a healthy person, when I'm experiencing myself as Leib in your strong sense, whether there's any reason that such a person should or should not donate an organ, should, in a sense move into — move into and through that increasingly thingafying process that I think would be required in order to do that.  You know, is there some reason that that would be appropriate for one who is Leib or inappropriate.  I'd like you to think about that.  So from those two perspectives, I'd be interested in listening a little bit to what you say about donation.

CHAIRMAN PELLEGRINO:  Mr. Lynch, please.

MR. LYNCH:  Thank you, Doctor.  I don't see this as an either/or, either we take care of the needs of people in need of organs or we downsize the honors or obsequies done for our dead or the record we keep for them.  I don't think that a concern for the living  needs to be trumped by honors or things done for the dead.  I see this as a constant traffic because as more than a few of us have pointed out, every one who is living is going to be dead and everyone dead was formerly living.  So this is a human condition, not a medical condition, not a retail event, not — it's an existential problem and our culture is, as we might have guessed, at odds in this.  We do things that are — well, for example, we spend a fortune on bringing our dead home, recovering our dead from hurricanes and tsunamis and wars and other acts of God and human nature, and yet, we are part of a species, part of a culture that often times wants to look the other way.  We don't see our dead coming home from war.  We are prevented from it.  We don't watch executions.  We are — I see often times people who constantly are in the market for what they — you know, for a commemorative event at which, you know, the finger food is good, the talk is uplifting, the music is life affirming, someone can be counted on to declare closure, usually just before the merlot runs out, and everyone is welcome but the corpse. 

The corpse has been dispatched, downsized, disappeared by usually someone like me who is called in the middle of the night with a, you know, cell phone and a Gold Card and disappeared.  We live in a culture where in the space of a generation we have gone from two or three percent cremation to 40 — well, 30 or 40 percent cremation and all to the good because we are not, like our grandparents, grounded geographically or parochially to a place.  We are more divided and a bit more scattered.  So cremation suits us.  And yet nobody sees cremation, nobody wants to.

Everybody is in favor of cremation but nobody is in favor of crematories.   We don't like the burning part.  And more and more people will say, for example, speaking of their own deaths, "When I'm dead, just cremate me," and the operative word in that is not "cremate," it's "just."  And the emphasis is on the minimalization of bother and in many ways minimalization of the body in such a context.   The uses of the body become almost entirely a matter of performance, extra parts.  We become, you know, the rag and bone shop of the heart as Yates called it.  We become just the parts.

I think the fully engaged — to take Dr. Spicker's metaphor, the fully engaged species does both.  They respond not only to the apparent need, the manifest need for more donors, but they respond to the — you know, to the human need to keep track of our dead, to give them their due. 

DR. SPICKER:  I'm not sure I have the question clear.  Were you asking me about — first you distinguished corpses and living bodies as the sources of the donation, so we can leave out corpses because I thought you were asking me about the timing.  Was that the force of your question?  That is, what — the zone of corporeality one is in would this effect the timing of when you would more likely get a yes than a no for donation or did I miss your question?

PROFESSOR MEILAENDER:  No, I don't think that's what I was asking.  What I want to know is, is there anything troubling or inappropriate or problematic about a person who is experiencing himself as Leib in your sense, farthest removed from pure body or thing or something like that, is there anything inappropriate about such a person deciding to donate an organ in the process of which he will inevitably have to come to think of himself largely as thing?  Is there any reason we shouldn't do that or is that perfectly compatible with your understanding of these zones?

DR. SPICKER:  Well, I'm glad you — zones, right.  I also tried — I didn't have the time to do what I did in the paper, I was also signaling almost you could jump zones and you could go in the reverse direction.  There was no intrinsically logical order to this business about one zone to another.   I was just trying to give a — let me call it a crude of the patient, the kind of crude phenomenological description through his English account of his various moments in his illness and when he's feeling better, both of those, I was just trying to give sort of what I call idea types of statements to capture and help me see the differences between these different zones.  So there's no logical distinction in a sense, between them. 

So I don't quite see — I think I understand your question better, that you — in consideration that you would be treating yourself as some contributor of part, but this kind of comes back to how I wish to construe this and I think it's something even Leon pointed out in some other context, and I can view — I can become such that I can — and that's the worry we have, that we will, indeed view ourselves as just replaceable — German has Teil and Stuck you know, just the replaceable Stuck are pieces of cake as opposed to integrated where I give you four matches and it's a Gestalt okay.  You can't help but see the square.  You can't help it.  You can't see it as four matches. You can try to cover your — do what you can do.  It's so demanding.  Do you see what I'm getting at?  It's another — it's the way we want to normally see ourselves as a totality.

But we can certainly do all the breakdown and there's even a modern word for going the other way to the gestalt, called emergence.  That's a word that's kind of the opposite of reductionism.  You could also use that word for me and what I'm talking about, reductionism but I avoid it for obvious reasons.  No, I guess my answer to your concern is I'm not so sure — let me put it another way; I think I can by persuasion and the language I use effect the way someone is going to view himself or herself as a donor of a particular organ of their body, whatever that organ is.   Quite different when it's one organ, which you could conceivably spare, certainly not the heart, or where you have two as in the case of the kidney or one where you're going to lose part — or give up part of your liver where there's only one liver.  You can tell a different — Wittgenstein I think would say, you can draw the picture you want to the other two to adopt.  You can — it's like when we get informed consent in the West, we can write that up a certain way.  We could write it up another way and what we're looking for is some understanding of approval of participation and, of course, the legal worry we have about not having such a signed document, all of that.

I don't know if I'm answering this very well.  I'm sorry.  I just see a lot more arbitrariness in this than anything rigorous from what I said.

CHAIRMAN PELLEGRINO:  Dr. Kass?

DR. KASS:  Thank you very much.  I think the theme of this session, at least I would like to think that the theme of this session is absolutely - might seem remote from the questions of organ transplantation.  I would like to think that Council members would share my sense of the primacy of these anthropological reflections before one takes up either the ethical questions or the particular policy proposals.  We get sort of two different approaches to this anthropological question; one from the side of the corpse, the other an argument for renewed — a different understanding of what the living body is and the strong emphasis on the notion of Leib.   And I'm not — my own inclination is somehow to think that it is with the latter that we get the greatest kind of mileage and sort of thinking about what the living human person is, though Mr. Lynch, I was just very deeply moved both by what you've submitted and the way in which you spoke.

So my question is actually really for you.  You say that the dead don't care.  And there's a certain sense in which that is obviously right, yet you say also that the newly dead are somehow changeling and I think you mean that they are somehow changeling for us more than they are in themselves.  And yet, I wonder whether it's — this has some bearing on the question of how we think even about extracting organs from cadavers which is not the heart of the matter for the current discussion. 

I'm not sure I — I want to press you on the suggestion that they cannot be harmed in any way.  There's a certain sense in which they obviously can't be harmed.  They're beyond feeling and so on.  On the other hand, a corpse can be disgraced.  The beginning of the Iliad makes that very clear.  "The wrath of Achilles sent the strong souls of heros to Hades but left themselves to be the delicate feasting of the birds and dogs."

And therefore, I guess the question is, how do we have to think about even the newly dead human body in such a way that we overcome the sense that even the removal of the organs from such a body for wonderful human good isn't somehow a violation?  Because I think we need to sort of deal with those intuitions before we can talk about going further down this road or introducing incentives and I wondered if you'd comment to that.

MR. LYNCH:  Well, thank you for the question because I think it goes to the heart of this matter or to the liver or to the kidney or to the face or whatever else we endeavor to retain and we don't have to go to third — you know, to ancient Greeks for what can be done to bodies.  We can go to the daily news and the current war to find out how abhorrent it is.  We can take a death count but the bodies would be brutalized, beheaded, undone in this way is despicable in a way that is hard for us to articulate although we all sense and you are absolutely right to understand that while the dead don't feel it, the living who are in custody of the dead, either by kinship or by legal responsibility or by neighborliness or by nuptials, whatever it is, the one who is responsible feels custodial about the body and we ought to. 

So I have seen for years as a funeral director in a small town, I have seen how the body changes, how the dead change to the living.  And one of the reasons why wakes and funerals and their cross-cultural variance throughout our history work is because it gives time for the living to take on board what has happened to the dead.  So that you see, for example, on the first day when a family comes into the funeral home to pay their, as we call them, final respects and say their goodbyes or whatever we call that confrontation between the living and the dead, the dead are still often spoken of in the present tense.  They are said to have the wrong hairdo as if it mattered to them.  Or they don't look exactly like themself and the stillness is absolutely unnatural because there is no stillness in life that is anything like the stillness of death.  Anybody who sees dead bodies knows this. 

And a day later or two days later or three days later, when we place that body in a hole in the ground or in a fire, you have to take on board that that body has changed for the living.  It hasn't changed for the dead.  There are some post-mortem changes but they are a matter of boredom to everybody.  But for the living, what has changed is that it has ceased to be, so that you can put this loved thing in the ground or in the fire.  And we have to understand that one of the reasons — I mean, one of the things that the OPOs, if that's what we're going to call them, they have to find some framework in which in the setting, the medical or bioethical setting, that they are giving people the same time to connect those dots so that they can say when it's okay for the organ to be taken, when it's all right, when there's enough death resonant, when the change is sufficient that that difference can be done.   And if we don't take that onboard, I think we do so at our peril and we can keep looking at these low rates of authorizing the donation. 

It is not mystery why few people in this culture witness cremation.  If you're body is burned in Calcutta or Bombay, it is done publicly and ritually and the retort is open 24 hours a day and the fire that lights the body's toe is brought from the home fire by the first born and the whole thing is given a religious and spiritual and cultural surround.  And then the ashes are placed in the river and the geography and metaphors and everything works together.

But here we don't see fire as purifying.  We don't see fire as releasing.  Here we don't — we see fire in the Western World as punitive and wasteful because when you're in trouble with God, you go to hell where you're not freeze-dried, by the way, you burn.  That's what we were brought up with and so people have this problem with fire, which is why everybody wants to be cremated, they just don't want to see a body burn.  But it's the same fire, which is why we don't watch executions.  We're all in favor of whether it's justice or revenge or come-upins, whatever it is, we want it, we just don't want to see it because of the changes we might witness.

But take onboard the fact that for the living in care of a dead body they are already thinking those things, they are already thinking, can they feel it?  They're still worried about can they feel the fire that — that's why they don't go. 

DR. GAZZANIGA:  Follow-up question; your colleagues in the pet cemetery business, do they speak of similar mental reactions?  I'm trying to get to the fundamental mental mechanisms here.  Do they speak of similar kinds of grief and transcendent ideas when they're dog dies and they go through this process?

MR. LYNCH:  I haven't — I don't know much about the pet cemetery business but love hurts, I think it was Bodolu Bryant wrote for Roy Oribison to sing, famously, love hurts.  Who was it that wrote those three items on attachment, separation and loss that we all stopped our doors with in undergraduate school?  If you boil them all down, love hurts is what he was trying to say.  So whether you love your AKC registered pain in the ass Burmese Mountain Dog or your grandmother, or your spouse, love hurts.

CHAIRMAN PELLEGRINO:  Dr. Hurlbut and Dr. Lawler.

DR. HURLBUT:  Basically what I want to ask but I want to frame it other words is, which zone are we in when we make a donation or receive a donation and a live donation, but I want to premise it by asking something a little deeper.  You spoke in both your presentation and in your writings in a way that both I felt was clarifying and troubling about this question of the meaning of the word "soul."  Now, I mean, it's clear the word soul is a word really for a mystery, for a sense of significance we have. 

In my own tradition as a Christian, the word soul really means the sense that we come from a benevolent source, that we have an intrinsic dignity and that we have an eternal destiny.  It isn't really an explanation of things, of something so much as it is an affirmation of something and it isn't a thing at all when properly seen in deep theological discourse.  I found it a little bit troubling, the emphasis where the soul is only a word for something about the body unless it is qualified slightly because I would, in another sense, see the body as a word for something about the soul, in the sense that there's some kind of an affirmation missing if you say the soul is only something about the body.  It implies that there's only materiality and there's where the problem with this — you spoke in I think a very interesting way about the transformation from mathematical thought to biological thought.  That's good insight that historically has been — it seems to me now the danger in this territory of transplantation is moving from biological thought to molecular thought where we really are reduced to parts. 

And just one final comment before you tell me which zone we're in, it seems to me that the interesting analogy that might be salutary in this overall reflection on the meaning of transplantation would be to recognize that at least in the case of a live donor, well, in the case of any donor, actually, live or dead, it's essential that we harvest, so to speak or remove the organ and strangely suspend its living nature by cooling it, if we have to transport it.  We kind of take it out of the zone of the living, but we know very well that it's a part that cannot sustain itself without its presence in the whole and so, it's almost as though  you kind of take the organ out of Leib and put it into Körper and then bring it back in Leib, and you — anyway, you get my point.  There's a question here of whether we need to rethink something about what a body really is in relationship to what we've been calling the soul and how transplantation might be re-envisioned as something more in keeping with our sense of these mysteries of the source and significance of our being in a transcended realm.

DR. SPICKER:  Well, I didn't have — I warned over and over again, you see I'm warning myself, not to accept, buy into or use the descriptive account of matter or body that's so prevalent right down to that word you just used, molecular, I think you said. 

DR. HURLBUT:  In the sense of molecules aren't warm and they aren't alive.

DR. SPICKER:  Yeah, I understand but I guess what I'm trying to convey is what la Mettrie really understood and he wasn't the best telling of it either.  It has to do with the notion of organization.  He finds — in one place he says, he finds no, we would say contradiction or problem with the thought that matter thinks.  Not Descartes or the Cartesian picture that there's thinking and one sense of being in matter body and another, but there's no problem conceiving of a certain kind of organization of matter that thinks and a certain kind of conceiving of the reorganization of matter that gets buried or then later after it's buried or that gets cremated and fired with or without additional —

The first thing, I mean, this is the center objection that — so to speak, I'm not accusing you of an objection, it's natural.  You can come in here as a philosopher and expect it, especially with theologians in the room.  Right away there's challenges to my way of thinking with others.  It challenges, you know, what must go on, must go on beyond the earthly material life, whatever that former shape is.   If there is something other than that, and you've described that in the beginning of your comments when you said things like eternal and affirmative and so on.

You know, I don't mean to digress but you remind me of the same problem Darwin had.  Isn't it the same thing?  He was such a good man and it's so sad about the impact of his theory on his sister and her strong religious views.  And we have people who accept, of course, or we wouldn't have had this whole debate with creation and getting it out of the science class and so on if we really didn't see there was sound evidence for the Darwinian side of it not a mere theory.  It's just a bad way to put it.

So I see that analogy.  For me it's exactly the same kind of worry.  But the Darwinian position still allows us theos — it allows for divinity in the universe, perhaps not the monotheistic God, perhaps not the gods of the Greeks, but some kind of transcendent, a force in the universe if we can use this word.  You used the word mystery, I use it right back at you.  You know, what's good for the goose is good for the gander.  What we don't know, we have to sometimes respect that we won't know.  But it doesn't force — it just doesn't have the force to compel me to capitulate to anything like the Cartesian position.  It just simply doesn't may more than Darwin had to somehow abandon his view because the theologic expected a lot of problems. 

God was supposed to intervene at different times to produce different species.  He was able to show us it just doesn't make any sense.  It's not necessary.  I mean, it made sense but it wasn't necessary and that, of course, is the heart of the debate with the creationists.  That's really the heart of the debate or discussion.  So I'm not trying to pontificate, an interesting choice of words, not trying to pontificate on this position, just that one needs to be prepared for much better thinking about what we mean by body and that's why I like Leib.  I don't like our English word because it draws us back to this narrow or naive or simplistic view.

I say that that living human runner is Leib and I say that's what there is, and there isn't some cognitive entity, a machine grinding it.  This was Kant's problem.  You know, Kant is genius, he's genius.  In other places he give way to — I've got some great quotes I think in one of the papers, some of you read it, where Kant says if we weren't left and right-sided, if we didn't have asymmetry, we couldn't know where we were with respect to the astronomy, we couldn't tell, east, west, north and south. 

We might get two but we wouldn't get the other two if there wasn't a feeling of difference, he says, left and right.  That's the philosophical anthropology, that's the body, the living body.  Even in Kant, see, Kant — I've just got to say this for a minute but here's that tripod, there's one, see it there, see this little tripod, that's all you are.  This stuff, this — what's that word they used in that movie, pulp, which is — you said it in your talk, we're real simpatico, we're just pulp.  Dig a little hole here, see and just lift out the brain and all the central nervous system and that's Stuart Spicker, see? That's the modern view, that's really what's driving these guys, okay.  That's absolutely crazy.  It's the runner that's who he is.  That's the full runner and right down to his fingertips not just the nerves in the fingertips.

And none of this — this is all getting lost.  If you want to call it the self or the person I'm watching those words, too, because they're fully loaded back into Cartesianism that really worries me deeply, but I'm really worried about the neuro-sciences of the 21st Century, they've really got me crazy.  Okay, they've got me really crazy because they're going to really finish this off, except for our esteemed colleague here.  I thought he was the enemy until I read his book and then I realized, no, we — by the way, what will go down in infamy is his page 101.  It's the one about responsibility.  It has to do with being human, it has nothing to do with brains so to speak.

CHAIRMAN PELLEGRINO:  Excuse me, Dr. Lawler.

PROFESSOR LAWLER:  Everything you just said made me a lot more confused.  I agree with you that we shouldn't think about the body and soul as separate things in some Cartesian way.  I can go along with that.  On the other hand, isn't it true that Mr. Lynch is a very poetic and moving and beautiful writer who is expressing his soul.  That is it's a mystery, that one animal and one animal only is born to die.

DR. SPICKER:  Is what —

PROFESSOR LAWLER:  Is born to die.

DR. SPICKER:  You mean, knows will die.

PROFESSOR LAWLER:  Knows will die and so understands life in terms of death and so forth.  And so has — is moved by and has opinions about the dead and so forth and what's wrong with Darwin is, he has no account of either the importance of a particular human person or why particular human persons think particular human persons are important or something along those lines.  So from this point of view, Mr. Lynch and his great presentation and his great writings, I think is not value neutral on cremation finally because it's a form of modern death denial. 

As TV screens get bigger, cemeteries get smaller and just like with baseball games, we now need to be entertained between innings, cemeteries have to have some other things to attract us besides dead people.  So I think his —

MR LYNCH:  Can I respond to that for just —

PROFESSOR LAWLER:  Yes.

MR. LYNCH:  Actually, with regard to cremation I am value neutral and proper disposition is proper disposition, whether you burn, bury, blow out of a cannon, leave it for scavenger birds, I'm indifferent to that.  What I'm interested in is what happens to the — not what happens to the dead guy, once he's disposed of but how the living get him to the brink of that disposition, that's what —

PROFESSOR LAWLER:  So you're value neutral on the literal fact of the burning, which is perfectly reasonable, but you're not value neutral on how we look at cremation.

DR. SPICKER:  How we do it.

PROFESSOR LAWLER:  That's exactly right.  So there would be a way in which it could be done well.

DR. SPICKER:  Yes, yes, done well elsewhere.

PROFESSOR LAWLER:  Right, and there might be something in fact, creepy about open caskets that's unique to us but that's not the subject for today, except to say I sort of agree with you that perhaps we can't harm the dead but it harms us not to be moved by and think about the dead in the proper way.  So it harms us to think in terms of procurement and harvesting and all that with respect to organs but we need not think of organ transplantation that way.  We can think of it in terms of a gift of the person that we remember in terms of the life of someone else and no doubt there are other ennobling ways of thinking about it.  So finally, a lot of our concern of transplantation would be in terms of the way we think about human beings in general now and the scientific ability of transplant being sucked into that.  And so what we have to do is understand our scientific ability to transplant to save lives or to extend lives to be fundamentally a good thing as long as we think about it in the proper way.

CHAIRMAN PELLEGRINO:  Thank you, Peter.  I think we have reached the end of our time so that you'll have a lunch period.  We would be back here at 2:00 o'clock, please.  Thank you both very much, Dr. Lynch and Dr. Spicker.

(Whereupon at 12:43 p.m. a luncheon recess was taken.)


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