1 00:00:08,975 --> 00:00:11,111 WELCOME TO THE CLINICAL CENTER GRAND ROUNDS, 2 00:00:11,177 --> 00:00:14,914 A WEEKLY SERIES OF EDUCATIONAL LECTURES FOR PHYSICIANS AND 3 00:00:14,981 --> 00:00:17,550 HEALTH CARE PROFESSIONALS BROADCAST FROM THE CLINICAL 4 00:00:17,617 --> 00:00:20,520 CENTER AT THE NATIONAL INSTITUTES OF HEALTH IN 5 00:00:20,587 --> 00:00:22,322 BETHESDA, MD. 6 00:00:22,389 --> 00:00:25,859 THE NIH CLINICAL CENTER IS THE WORLD'S LARGEST HOSPITAL TOTALLY 7 00:00:25,925 --> 00:00:29,562 DEDICATED TO INVESTIGATIONAL RESEARCH AND LEADS THE GLOBAL 8 00:00:29,629 --> 00:00:32,499 EFFORT IN TRAINING TODAY'S INVESTIGATORS AND DISCOVERING 9 00:00:32,565 --> 00:00:34,667 TOMORROW'S CURES. 10 00:00:34,734 --> 00:00:44,077 LEARN MORE BY VISITING US ONLINE AT HTTP://CLINICALCENTER.NIH.GOV 11 00:00:44,144 --> 00:00:46,079 >> GOOD AFTERNOON, EVERYBODY. 12 00:00:46,146 --> 00:00:47,947 WE'LL GET STARTED. 13 00:00:48,014 --> 00:00:49,249 I'M DAVE FROM THE DEPARTMENT OF 14 00:00:49,315 --> 00:00:50,250 BIOETHICS. 15 00:00:50,316 --> 00:00:51,751 AT THE NIH CLINICAL CENTER. 16 00:00:51,818 --> 00:00:55,054 AND THIS IS -- I HOPE EVERYBODY 17 00:00:55,121 --> 00:00:56,456 REALIZES, ETHICS GRAND ROUNDS. 18 00:00:56,523 --> 00:00:58,691 OUR DEPARTMENT HOSTS ETHICS 19 00:00:58,758 --> 00:01:00,093 GRAND ROUNDS FOUR TIMES A YEAR. 20 00:01:00,160 --> 00:01:01,594 THIS IS THE FOURTH FOR THIS 21 00:01:01,661 --> 00:01:02,262 ACADEMIC YEAR. 22 00:01:02,328 --> 00:01:04,130 WE'LL START UP AGAIN FOR ANYBODY 23 00:01:04,197 --> 00:01:06,132 WHO REALLY PLANS AHEAD, THE 24 00:01:06,199 --> 00:01:08,401 FIRST WEDNESDAY IN OCTOBER AND 25 00:01:08,468 --> 00:01:10,236 THE FIRST WEDNESDAY IN DECEMBER. 26 00:01:10,303 --> 00:01:12,772 SO A COUPLE THINGS ABOUT ETHICS 27 00:01:12,839 --> 00:01:13,306 GRAND ROUNDS. 28 00:01:13,373 --> 00:01:16,176 THE GOAL OF THESE SESSIONS IS TO 29 00:01:16,242 --> 00:01:18,244 PRESENT WHAT WE THINK ARE 30 00:01:18,311 --> 00:01:19,446 INTERESTING, IMPORTANT ISSUES TO 31 00:01:19,512 --> 00:01:24,784 THE BROADER NIH COMMUNITY, SO 32 00:01:24,851 --> 00:01:26,219 THIS IS JUST SUPPOSED TO BE A 33 00:01:26,286 --> 00:01:27,120 GENERAL ETHICAL DISCUSSION. 34 00:01:27,187 --> 00:01:29,189 THIS IS NOT A SETTING FOR 35 00:01:29,255 --> 00:01:31,891 SETTING POLICY OR ANYBODY'S 36 00:01:31,958 --> 00:01:32,225 SPOKESPEOPLE. 37 00:01:32,292 --> 00:01:33,693 SO ANYBODY WHO TALKS TODAY, 38 00:01:33,760 --> 00:01:36,429 UNLESS THEY TELL YOU OTHERWISE, 39 00:01:36,496 --> 00:01:37,697 THEY'RE SPEAKING ONLY FOR 40 00:01:37,764 --> 00:01:39,899 THEMSELVES, NOT FOR ANY OF THE 41 00:01:39,966 --> 00:01:41,401 INSTITUTIONS TO WHICH THEY'RE 42 00:01:41,468 --> 00:01:44,170 AFFILIATED. 43 00:01:44,237 --> 00:01:45,572 AND ANYBODY WHO HAS QUESTIONS, 44 00:01:45,638 --> 00:01:47,640 IF YOU'RE IN LIPSETT, PLEASE GO 45 00:01:47,707 --> 00:01:51,811 TO ONE OF THE AISLE MICS AND ASK 46 00:01:51,878 --> 00:01:52,011 THEM. 47 00:01:52,078 --> 00:01:53,446 IF YOU'RE ONLINE, GO TO THE 48 00:01:53,513 --> 00:01:53,780 WEBSITE. 49 00:01:53,847 --> 00:01:55,882 THERE SHOULD BE A "SUBMIT 50 00:01:55,949 --> 00:01:56,850 QUESTIONS," YOU CLICK ON THAT. 51 00:01:56,916 --> 00:01:58,718 THOSE QUESTIONS WILL GO TO MY 52 00:01:58,785 --> 00:02:00,453 COLLEAGUE WHO'S SITTING HERE, 53 00:02:00,520 --> 00:02:02,989 ROBERT STEELE, WHO WILL THEN ASK 54 00:02:03,056 --> 00:02:04,824 THEM IN THE MIC SO EVERYBODY 55 00:02:04,891 --> 00:02:06,259 GETS TO HEAR THEM. 56 00:02:06,326 --> 00:02:07,327 AND ONE IMPORTANT THING IS THERE 57 00:02:07,393 --> 00:02:09,429 IS CME CREDITS AVAILABLE FOR 58 00:02:09,496 --> 00:02:10,430 THIS, SO IF ANYBODY IS 59 00:02:10,497 --> 00:02:12,699 INTERESTED IN CME, GET READY. 60 00:02:12,765 --> 00:02:15,101 I'M ABOUT TO READ THE NUMBER AND 61 00:02:15,168 --> 00:02:17,203 THE CODE. 62 00:02:17,270 --> 00:02:18,838 SO FOR CME, THE CODE YOU'RE 63 00:02:18,905 --> 00:02:23,109 SUPPOSED TO TEXT IS 50551. 64 00:02:23,176 --> 00:02:27,247 SO AGAIN, THE CODE IS 50551. 65 00:02:27,313 --> 00:02:29,349 AND YOU TEXT THAT CODE TO THE 66 00:02:29,415 --> 00:02:37,323 FOLLOWING PHONE NUMBER: 844 67 00:02:37,390 --> 00:02:47,634 844-980-1555. 68 00:02:47,834 --> 00:02:48,034 OKAY. 69 00:02:48,101 --> 00:02:50,236 ANYBODY HAS SUGGESTIONS FOR 70 00:02:50,303 --> 00:02:51,104 FUTURE GRAND ROUNDS, THERE'S A 71 00:02:51,170 --> 00:02:52,205 PLACE ON THE WEBSITE. 72 00:02:52,272 --> 00:02:54,040 YOU CAN MAKE THOSE 73 00:02:54,107 --> 00:02:56,576 RECOMMENDATIONS. 74 00:02:56,643 --> 00:02:57,777 ALSO I'M ON THE GLOBAL, I WOULD 75 00:02:57,844 --> 00:02:59,646 LOVE TO GET ANY RECOMMENDATIONS 76 00:02:59,712 --> 00:03:02,248 PEOPLE HAVE FOR FUTURE SESSIONS. 77 00:03:02,315 --> 00:03:04,884 SO TODAY IS RESPECT FOR THE 78 00:03:04,951 --> 00:03:06,286 DEAD, AND ARGUABLY RESPECT FOR 79 00:03:06,352 --> 00:03:08,488 THE DEAD IS ONE OF THE 80 00:03:08,555 --> 00:03:11,424 FUNDAMENTAL ETHICAL PRINCIPLES 81 00:03:11,491 --> 00:03:12,759 ACCORDING TO MAYBE THE MOST 82 00:03:12,825 --> 00:03:14,961 FAMOUS ARTICULATION OF IT BY THE 83 00:03:15,028 --> 00:03:19,566 GERMAN PHILOSOPHER EMANUEL 84 00:03:19,632 --> 00:03:20,633 CARNT, IT MEANS SOMETHING LIKE 85 00:03:20,700 --> 00:03:23,903 TREATING OTHERS ALWAYS AS ENDS 86 00:03:23,970 --> 00:03:25,772 OF THEMSELVES AND NEVER AS MEANS 87 00:03:25,838 --> 00:03:27,106 ONLY, SO TREATING PEOPLE AS ENDS 88 00:03:27,173 --> 00:03:29,609 AND NEVER AS A MEANS ONLY. 89 00:03:29,676 --> 00:03:31,177 PHILOSOPHERS HAVE SPENT THE LAST 90 00:03:31,244 --> 00:03:32,579 COUPLE HUNDRED YEARS ARGUING 91 00:03:32,645 --> 00:03:33,680 ABOUT EXACTLY WHAT THAT MEANS, 92 00:03:33,746 --> 00:03:35,181 BUT IN PRACTICE, IT MEANS THINGS 93 00:03:35,248 --> 00:03:36,482 LIKE TAKING OTHER VIEWS 94 00:03:36,549 --> 00:03:37,817 SERIOUSLY, EVEN IF YOU DISAGREE 95 00:03:37,884 --> 00:03:41,087 WITH THEM, NOT LYING TO THEM IN 96 00:03:41,154 --> 00:03:42,622 THE CLINICAL SETTING, GETTING 97 00:03:42,689 --> 00:03:43,823 PEOPLE'S CONSENT BEFORE YOU DO 98 00:03:43,890 --> 00:03:45,892 INTERVENTIONS ON THEM. 99 00:03:45,959 --> 00:03:47,093 SO ONE OF THE THINGS TO NOTICE 100 00:03:47,160 --> 00:03:48,328 ABOUT ALL THOSE EXAMPLES OF 101 00:03:48,394 --> 00:03:50,730 RESPECT FOR OTHERS IS THAT THEY 102 00:03:50,797 --> 00:03:52,031 REQUIRE THAT THE INDIVIDUAL WHOM 103 00:03:52,098 --> 00:03:54,000 YOU'RE TRYING TO RESPECT IS 104 00:03:54,067 --> 00:03:55,635 ALIVE, SO YOU DON'T LIE TO THEM, 105 00:03:55,702 --> 00:03:57,604 THEY'RE ALIVE, YOU GET THEIR 106 00:03:57,670 --> 00:03:58,905 CONSENT, THEY'RE ALIVE, AND SO 107 00:03:58,972 --> 00:04:01,774 THAT RAISES THE QUESTION OF WHAT 108 00:04:01,841 --> 00:04:04,611 DOES APPROPRIATE RESPECT INVOLVE 109 00:04:04,677 --> 00:04:06,346 AFTER A PERSON HAS DIED. 110 00:04:06,412 --> 00:04:07,447 AND THAT'S THE ISSUE THAT WE'RE 111 00:04:07,513 --> 00:04:10,383 GOING TO TALK ABOUT TODAY. 112 00:04:10,450 --> 00:04:11,484 AND PARTICULARLY IF YOU LOOK AT 113 00:04:11,551 --> 00:04:14,454 THIS WITHIN THE CONTEXT OF 114 00:04:14,520 --> 00:04:15,755 RESEARCH, THERE'S STILL OFTEN 115 00:04:15,822 --> 00:04:16,456 THIS ASSUMPTION ABOUT 116 00:04:16,522 --> 00:04:18,825 INDIVIDUALS BEING ALIVE. 117 00:04:18,891 --> 00:04:19,859 SO ONE OF THE GUIDING DOCUMENTS 118 00:04:19,926 --> 00:04:21,661 OF RESEARCH ETHICS IS CALLED THE 119 00:04:21,728 --> 00:04:22,862 BELMONT REPORT, WHICH PURPORTS 120 00:04:22,929 --> 00:04:25,064 TO PUT OUT THE PRINCIPLES THAT 121 00:04:25,131 --> 00:04:27,667 GUIDE THE ETHICS OF CLINICAL 122 00:04:27,734 --> 00:04:29,769 RESEARCH, AND WHAT THAT DOCUMENT 123 00:04:29,836 --> 00:04:32,905 SAYS IN TERMS OF RESPECT IS THAT 124 00:04:32,972 --> 00:04:34,340 WHAT RESPECT INVOLVES IS 125 00:04:34,407 --> 00:04:36,109 BASICALLY RESPECTING PEOPLE'S 126 00:04:36,175 --> 00:04:36,476 AUTONOMY. 127 00:04:36,542 --> 00:04:38,277 IT LETTING OTHER PEOPLE MAKE 128 00:04:38,344 --> 00:04:39,712 DECISIONS FOR THEMSELVES ABOUT 129 00:04:39,779 --> 00:04:41,614 HOW THEIR LIVES GO, AND AGAIN, 130 00:04:41,681 --> 00:04:43,216 OBVIOUSLY THAT REQUIRES THAT THE 131 00:04:43,282 --> 00:04:46,386 INDIVIDUAL IS ALIVE. 132 00:04:46,452 --> 00:04:47,487 MORE PERTINENT TO TODAY'S 133 00:04:47,553 --> 00:04:48,821 SESSION, THE U.S. FEDERAL 134 00:04:48,888 --> 00:04:50,857 REGULATIONS FOR CLINICAL 135 00:04:50,923 --> 00:04:52,859 RESEARCH DEFINE SUBJECTS AS 136 00:04:52,925 --> 00:04:55,461 RESEARCH AS INDIVIDUALS WHO ARE 137 00:04:55,528 --> 00:04:55,895 LIVING. 138 00:04:55,962 --> 00:04:57,530 SO AGAIN, THAT RAISES THE 139 00:04:57,597 --> 00:04:58,865 QUESTION, WHAT ABOUT RESEARCH 140 00:04:58,931 --> 00:05:00,933 WITH INDIVIDUALS WHO AREN'T 141 00:05:01,000 --> 00:05:01,467 LIVING? 142 00:05:01,534 --> 00:05:04,637 SO HERE'S WHAT LOOK LIKE TWO 143 00:05:04,704 --> 00:05:07,273 VERY OBVIOUS BUT I TAKE IT ALSO 144 00:05:07,340 --> 00:05:08,274 OBVIOUSLY MISTAKEN VIEWS. 145 00:05:08,341 --> 00:05:10,977 ONE IS, THEY'RE DEAD. 146 00:05:11,044 --> 00:05:12,311 WHAT WE'RE WORRIED ABOUT WITH 147 00:05:12,378 --> 00:05:13,946 THE ETHICS OF RESEARCH IS 148 00:05:14,013 --> 00:05:14,714 HARMING PEOPLE. 149 00:05:14,781 --> 00:05:16,015 YOU CAN'T HARM SOMEBODY ONCE 150 00:05:16,082 --> 00:05:17,116 THEY'RE DEAD, THEREFORE, YOU CAN 151 00:05:17,183 --> 00:05:18,084 DO ANY SORT OF RESEARCH YOU WANT 152 00:05:18,151 --> 00:05:19,218 WITH THEM. 153 00:05:19,285 --> 00:05:20,720 THERE'S ONE EXTREME VIEW. 154 00:05:20,787 --> 00:05:22,722 AN ALTERNATIVE EXTREME VIEW IS, 155 00:05:22,789 --> 00:05:24,023 WELL, THEY CAN'T CONSENT IF 156 00:05:24,090 --> 00:05:24,657 THEY'RE DEAD. 157 00:05:24,724 --> 00:05:26,325 WE KNOW THAT CONSENT IS CRITICAL 158 00:05:26,392 --> 00:05:27,393 FOR ETHICAL RESEARCH. 159 00:05:27,460 --> 00:05:28,261 THEREFORE, YOU SHOULDN'T BE ABLE 160 00:05:28,327 --> 00:05:30,563 TO DO ANY RESEARCH ON THEM AT 161 00:05:30,630 --> 00:05:31,130 ALL. 162 00:05:31,197 --> 00:05:32,632 THOSE, I THINK, ARE OBVIOUS 163 00:05:32,699 --> 00:05:35,168 VIEWS, BOTH OF THEM ALSO AS I 164 00:05:35,234 --> 00:05:36,169 MENTIONED SEEM OBVIOUSLY WRONG, 165 00:05:36,235 --> 00:05:37,403 SO WHAT WE'RE GOING TO TRY TO 166 00:05:37,470 --> 00:05:40,640 FIGURE OUT TODAY IF THERE'S A 167 00:05:40,707 --> 00:05:41,941 REASONABLE MIDDLE GROUND 168 00:05:42,008 --> 00:05:43,142 SOMEWHERE BETWEEN THOSE TWO 169 00:05:43,209 --> 00:05:44,577 EXTREMES. 170 00:05:44,644 --> 00:05:46,112 SO TO GET US STARTED, KATHLEEN 171 00:05:46,179 --> 00:05:47,513 FENTON IS GOING TO PRESENT A 172 00:05:47,580 --> 00:05:48,715 CASE FOR US TODAY. 173 00:05:48,781 --> 00:05:51,784 KATHLEEN FENTON IS A PEDIATRIC 174 00:05:51,851 --> 00:05:52,885 CARDIAC SURGEON. 175 00:05:52,952 --> 00:05:56,589 SHE IS THE CHIEF OF THE ADVANCED 176 00:05:56,656 --> 00:05:59,125 TECHNOLOGIES AND SURGERY BRANCH 177 00:05:59,192 --> 00:06:00,760 AT THE NATIONAL HEART, LUNG AND 178 00:06:00,827 --> 00:06:02,295 BLOOD INSTITUTE AND SHE'S ALSO 179 00:06:02,361 --> 00:06:03,696 AN AFFILIATED SCHOLAR IN OUR 180 00:06:03,763 --> 00:06:04,630 DEPARTMENT, THE DEPARTMENT OF 181 00:06:04,697 --> 00:06:05,364 BIOETHICS. 182 00:06:05,431 --> 00:06:11,604 KATHLEEN. 183 00:06:11,671 --> 00:06:13,439 >> GOOD AFTERNOON, EVERYBODY. 184 00:06:13,506 --> 00:06:14,640 I'M NOT AS LOUD AS DAVE. 185 00:06:14,707 --> 00:06:15,608 CAN YOU HEAR ME? 186 00:06:15,675 --> 00:06:19,178 >> NOBODY IS. 187 00:06:19,245 --> 00:06:22,515 >> AS HE SAID, I'M EXPRESSING MY 188 00:06:22,582 --> 00:06:24,050 OWN OPINIONS AND MY OWN 189 00:06:24,117 --> 00:06:25,585 THOUGHTS, AND I DON'T HAVE ANY 190 00:06:25,651 --> 00:06:27,987 CONFLICTS TO DISCLOSE. 191 00:06:28,054 --> 00:06:29,622 THESE ARE THE LEARNING 192 00:06:29,689 --> 00:06:30,389 OBJECTIVES WHICH WERE NEEDED FOR 193 00:06:30,456 --> 00:06:31,691 THE CME. 194 00:06:31,758 --> 00:06:32,592 WE'RE GOING TO TALK ABOUT A 195 00:06:32,658 --> 00:06:34,327 POSSIBLE RESEARCH CASE WITH 196 00:06:34,393 --> 00:06:36,095 INDIVIDUALS WHO ARE DECEASED. 197 00:06:36,162 --> 00:06:38,931 DESCRIBING THE NATURE OF THE 198 00:06:38,998 --> 00:06:40,233 RESEARCH, AND THE ETHICAL 199 00:06:40,299 --> 00:06:42,535 QUESTIONS THAT ARE RAISED. 200 00:06:42,602 --> 00:06:43,836 SO I'M GOING TO RAISE THE 201 00:06:43,903 --> 00:06:45,037 QUESTIONS AND DR. DICKERT IS 202 00:06:45,104 --> 00:06:46,939 GOING TO ANSWER THEM. 203 00:06:47,006 --> 00:06:48,207 THIS IS A FICTIONAL CASE. 204 00:06:48,274 --> 00:06:49,542 I KNOW SOME OF YOU WHO ARE USED 205 00:06:49,609 --> 00:06:51,077 TO ETHICS GRAND ROUNDS ARE USED 206 00:06:51,144 --> 00:06:52,278 TO REAL CASES. 207 00:06:52,345 --> 00:06:53,479 THIS IS A FICTIONAL CASE BUT 208 00:06:53,546 --> 00:06:56,649 IT'S BASED ON SOME OF THE 209 00:06:56,716 --> 00:06:57,850 RESEARCH THAT'S CURRENTLY BEING 210 00:06:57,917 --> 00:06:59,919 DONE AND BEING PROPOSED, AND I'M 211 00:06:59,986 --> 00:07:01,587 GUESSING THAT IT'S GOING TO BE 212 00:07:01,654 --> 00:07:02,321 PROPOSED EVEN MORE GOING 213 00:07:02,388 --> 00:07:03,356 FORWARD. 214 00:07:03,422 --> 00:07:05,625 SO THIS IS A PATIENT WHO IS A 215 00:07:05,691 --> 00:07:07,927 66-YEAR-OLD RETIRED TEACHER WHO 216 00:07:07,994 --> 00:07:09,228 HAS BASICALLY BEEN IN GOOD 217 00:07:09,295 --> 00:07:10,429 HEALTH EXCEPT FOR HIGH BLOOD 218 00:07:10,496 --> 00:07:11,430 PRESSURE, AND SHE'S GETTING 219 00:07:11,497 --> 00:07:13,166 READY FOR BED ONE NIGHT AND 220 00:07:13,232 --> 00:07:14,267 SUDDENLY GETS A TERRIBLE 221 00:07:14,333 --> 00:07:15,368 HEADACHE AND TELLS HER HUSBAND 222 00:07:15,434 --> 00:07:16,969 THAT SHE DOESN'T FEEL WELL. 223 00:07:17,036 --> 00:07:18,070 AND THEN SHE LOSES 224 00:07:18,137 --> 00:07:19,505 CONSCIOUSNESS. 225 00:07:19,572 --> 00:07:20,840 HER HUSBAND LOOKS AT HER AND HE 226 00:07:20,907 --> 00:07:22,141 THINKS SHE'S HAVING DIFFICULTY 227 00:07:22,208 --> 00:07:23,309 BREATHING AND HE DOESN'T KNOW 228 00:07:23,376 --> 00:07:23,876 WHAT HAPPENED. 229 00:07:23,943 --> 00:07:25,845 SO HE CALLS 911. 230 00:07:25,912 --> 00:07:27,180 AND AN AMBULANCE ARRIVES AND 231 00:07:27,246 --> 00:07:30,016 TAKES HER TO THE HOSPITAL. 232 00:07:30,082 --> 00:07:31,217 THEN HER HUSBAND PICKS UP THE 233 00:07:31,284 --> 00:07:33,286 PHONE AND CALLS HIS DAUGHTER, OR 234 00:07:33,352 --> 00:07:34,487 HER DAUGHTER, WHO IS A NURSE, 235 00:07:34,554 --> 00:07:35,688 AND THEY BOTH GO TO THE HOSPITAL 236 00:07:35,755 --> 00:07:37,890 TOGETHER. 237 00:07:37,957 --> 00:07:39,425 THEY GATHER ALONG WITH THEIR TWO 238 00:07:39,492 --> 00:07:40,960 SONS IN THE WAITING ROOM OF THE 239 00:07:41,027 --> 00:07:41,928 EMERGENCY DEPARTMENT, WAITING TO 240 00:07:41,994 --> 00:07:43,029 FIND OUT WHAT'S GOING TO HAPPEN 241 00:07:43,095 --> 00:07:44,330 TO THEIR MOM. 242 00:07:44,397 --> 00:07:46,732 AND A LITTLE WHILE LATER, THE 243 00:07:46,799 --> 00:07:50,136 DOCTOR COMES OUT AND SAYS THAT 244 00:07:50,203 --> 00:07:52,004 GL HAS HAD A SEVERE STROKE AND 245 00:07:52,071 --> 00:07:53,639 HER OUTCOME IS UNCERTAIN AND 246 00:07:53,706 --> 00:07:55,608 THEY'RE GOING TO TAKE HER TO THE 247 00:07:55,675 --> 00:07:56,609 ICU. 248 00:07:56,676 --> 00:07:58,544 SHE'S ON A VENTILATOR OR 249 00:07:58,611 --> 00:07:59,545 BREATHING MACHINE AND SHE'S NOT 250 00:07:59,612 --> 00:07:59,912 CONSCIOUS. 251 00:07:59,979 --> 00:08:02,048 A COUPLE OF DAYS GO BY, AND SHE 252 00:08:02,114 --> 00:08:04,450 GETS WORSE, NOT BETTER. 253 00:08:04,517 --> 00:08:07,954 THE ICU TEAM TELLS THE FAMILY 254 00:08:08,020 --> 00:08:09,922 THAT THEY'RE CONCERNED ABOUT HER 255 00:08:09,989 --> 00:08:11,357 OUTCOME AND HOW SHE'S DOING NOW, 256 00:08:11,424 --> 00:08:12,992 AND THAT THEY PLAN TO DO BRAIN 257 00:08:13,059 --> 00:08:14,994 DEATH TESTING TO SEE IF SHE 258 00:08:15,061 --> 00:08:17,463 MIGHT ALREADY BE GONE. 259 00:08:17,530 --> 00:08:18,798 A FEW HOURS LATER, THE DOCTOR 260 00:08:18,865 --> 00:08:20,099 COMES BACK AND TELLS THE FAMILY 261 00:08:20,166 --> 00:08:21,968 THAT SHE HAS MET BRAIN DEATH 262 00:08:22,034 --> 00:08:22,535 CRITERIA. 263 00:08:22,602 --> 00:08:23,736 AND WHAT HAPPENS WHEN THAT 264 00:08:23,803 --> 00:08:25,037 HAPPENS IN THE ICU IS THE FAMILY 265 00:08:25,104 --> 00:08:27,440 IS TOLD THAT THEY HAVE DECISIONS 266 00:08:27,506 --> 00:08:29,742 TO MAKE, INCLUDING WHAT FUNERAL 267 00:08:29,809 --> 00:08:31,010 HOME DO THEY WANT TO CALL, THEY 268 00:08:31,077 --> 00:08:32,879 NEED TO GET THE AFFAIRS IN ORDER 269 00:08:32,945 --> 00:08:35,414 OF THE DECEDENT, AND THEY NEED 270 00:08:35,481 --> 00:08:36,949 TO DECIDE WHETHER OR NOT THEY'RE 271 00:08:37,016 --> 00:08:40,987 INTERESTED IN ORGAN DONATION. 272 00:08:41,053 --> 00:08:42,088 THE DAUGHTER IMMEDIATELY SPEAKS 273 00:08:42,154 --> 00:08:42,955 UP AND TELLS THE DOCTOR THAT HER 274 00:08:43,022 --> 00:08:44,390 MOTHER REALLY BELIEVED IN SAVING 275 00:08:44,457 --> 00:08:45,591 LIVES, AND SHE ALWAYS WANTED TO 276 00:08:45,658 --> 00:08:47,426 BE AN ORGAN DONOR. 277 00:08:47,493 --> 00:08:49,328 AND SO THE ICU DOCTOR IS VERY 278 00:08:49,395 --> 00:08:50,529 GREAT FULL FOR THAT AND SAYS 279 00:08:50,596 --> 00:08:53,366 THAT HE WILL INFORM THE OPO AND 280 00:08:53,432 --> 00:08:54,767 THEY'LL BE IN TOUCH WITH THE 281 00:08:54,834 --> 00:08:58,271 FAMILY TO SEE WHAT CAN BE DONE. 282 00:08:58,337 --> 00:08:59,805 IN THE MEANTIME, THEY KEEP THE 283 00:08:59,872 --> 00:09:02,275 PATIENT ON THE LIFE SUPPORT OR 284 00:09:02,341 --> 00:09:05,011 THE VENTILATOR AND THE 285 00:09:05,077 --> 00:09:06,545 MEDICATIONS UNTIL THE PERSON 286 00:09:06,612 --> 00:09:07,947 FROM THE OPO ARRIVES. 287 00:09:08,014 --> 00:09:11,918 WITHIN AN HOUR, SHE ARRIVES AND 288 00:09:11,984 --> 00:09:13,719 SHE EXPRESSES CONDOLENCES TO THE 289 00:09:13,786 --> 00:09:15,421 FAMILY AND GRATITUDE TO THEM. 290 00:09:15,488 --> 00:09:17,056 BUT SHE UNFORTUNATELY HAS 291 00:09:17,123 --> 00:09:19,458 REVIEWED THE CASE AND SHE SAYS 292 00:09:19,525 --> 00:09:21,193 THAT SHE'S NOT QUALIFIED TO BE 293 00:09:21,260 --> 00:09:22,428 AN ORGAN DONOR. 294 00:09:22,495 --> 00:09:25,031 AND THE FAMILY IS VERY 295 00:09:25,097 --> 00:09:26,465 DISAPPOINTED BECAUSE THAT WAS 296 00:09:26,532 --> 00:09:28,000 LIKE A CONSOLATION TO THEM, 297 00:09:28,067 --> 00:09:29,068 RIGHT, THAT THEIR MOTHER MIGHT 298 00:09:29,135 --> 00:09:31,604 BE ABLE TO AT LEAST SOME GOOD 299 00:09:31,671 --> 00:09:33,806 COULD COME OUT OF IT. 300 00:09:33,873 --> 00:09:35,408 SO THE OPO REPRESENTATIVE PAUSES 301 00:09:35,474 --> 00:09:37,410 FOR A MINUTE AND THEN SHE SAYS, 302 00:09:37,476 --> 00:09:39,478 THERE'S ANOTHER OPTION THAT YOU 303 00:09:39,545 --> 00:09:41,113 HAVE THAT MIGHT HONOR HER WISHES 304 00:09:41,180 --> 00:09:43,082 TO BE ABLE TO BENEFIT OTHERS, 305 00:09:43,149 --> 00:09:44,317 EVEN THOUGH SHE CAN'T DONATE 306 00:09:44,383 --> 00:09:45,151 ORGANS. 307 00:09:45,217 --> 00:09:47,453 THERE ARE SOME DOCTORS ON THE 308 00:09:47,520 --> 00:09:48,454 HOSPITAL'S TRANSPLANT TEAM THAT 309 00:09:48,521 --> 00:09:50,756 ALSO WORK AT THE LOCAL 310 00:09:50,823 --> 00:09:51,390 UNIVERSITY HOSPITAL OR LOCAL 311 00:09:51,457 --> 00:09:52,625 UNIVERSITY THAT'S AFFILIATED 312 00:09:52,692 --> 00:09:54,527 WITH THE HOSPITAL, AND THEY'VE 313 00:09:54,593 --> 00:09:56,662 BEEN STUDYING HOW TO TRANSPLANT 314 00:09:56,729 --> 00:09:58,631 PIG HEARTS INTO PATIENTS WITH 315 00:09:58,698 --> 00:10:00,599 HEART FAILURE, AND THEY'VE COME 316 00:10:00,666 --> 00:10:02,468 A LONG WAY, THEY'VE DONE A 317 00:10:02,535 --> 00:10:04,103 NUMBER OF EXPERIMENTS IN 318 00:10:04,170 --> 00:10:07,974 NON-HUMAN PRIMATES, IN BABOONS, 319 00:10:08,040 --> 00:10:09,342 BUT THE NEXT STEP IN THE 320 00:10:09,408 --> 00:10:10,609 RESEARCH IS TO TRY TO SEE HOW 321 00:10:10,676 --> 00:10:11,978 THE HUMAN IMMUNE SYSTEM WILL 322 00:10:12,044 --> 00:10:13,479 RESPOND. 323 00:10:13,546 --> 00:10:14,714 AND WHETHER OR NOT THE 324 00:10:14,780 --> 00:10:15,781 MODIFICATIONS THEY'VE MADE TO 325 00:10:15,848 --> 00:10:18,317 THE HEART AND TO THE IMMUNE 326 00:10:18,384 --> 00:10:21,487 THERAPY FOR THE RECIPIENTS THAT 327 00:10:21,554 --> 00:10:22,788 SEEMS TO BE WORKING IN THE 328 00:10:22,855 --> 00:10:24,023 BABOONS WOULD WORK IN HUMANS OR 329 00:10:24,090 --> 00:10:24,657 NOT. 330 00:10:24,724 --> 00:10:25,858 THE ONLY WAY TO REALLY TEST THAT 331 00:10:25,925 --> 00:10:29,028 IS ON HUMANS, BUT IT'S NOT IDEAL 332 00:10:29,095 --> 00:10:31,530 TO TEST IT ON SOMEONE WHO WOULD 333 00:10:31,597 --> 00:10:33,599 DIE IF THE PIG HEART STOPS 334 00:10:33,666 --> 00:10:34,166 BEATING. 335 00:10:34,233 --> 00:10:36,802 SO THE RESEARCHERS ARE PROPOSING 336 00:10:36,869 --> 00:10:38,437 IMPLANTING THE PIG HEART INTO 337 00:10:38,504 --> 00:10:39,438 SOMEONE WHO'S ALREADY BEEN 338 00:10:39,505 --> 00:10:42,274 DETERMINED TO BE DEAD. 339 00:10:42,341 --> 00:10:44,744 AND THIS RESEARCH INVOLVES 340 00:10:44,810 --> 00:10:46,545 KEEPING A RECENTLY DECEASED 341 00:10:46,612 --> 00:10:48,814 PERSON LIKE GL ON A VENTILATOR, 342 00:10:48,881 --> 00:10:50,883 WHICH SUPPLIES OXYGEN TO THE 343 00:10:50,950 --> 00:10:53,219 BODY AND BREATHES FOR HER, AND 344 00:10:53,285 --> 00:10:55,721 IN A FEW DAYS, A SURGEON WOULD 345 00:10:55,788 --> 00:10:57,023 COME AND MAKE AN INCISION INTO 346 00:10:57,089 --> 00:10:58,657 THE CHEST AND TAKE HER HEART OUT 347 00:10:58,724 --> 00:11:01,727 AND PUT IN A HEART FROM A PIG. 348 00:11:01,794 --> 00:11:03,929 AND THEN HE WOULD CLOSE UP THE 349 00:11:03,996 --> 00:11:05,231 INCISION AND SHE WOULD COME BACK 350 00:11:05,297 --> 00:11:06,532 TO THE INTENSIVE CARE UNIT, 351 00:11:06,599 --> 00:11:08,300 WHERE SHE WOULD BE MANAGED LIKE 352 00:11:08,367 --> 00:11:10,703 ANY OTHER PATIENT WHO HAD HAD A 353 00:11:10,770 --> 00:11:11,437 HEART TRANSPLANT. 354 00:11:11,504 --> 00:11:13,539 SHE WOULD BE MONITORED TO SEE 355 00:11:13,606 --> 00:11:15,307 HOW HER BODY REACTS TO THE 356 00:11:15,374 --> 00:11:16,509 PRESENCE OF THE PIG HEART. 357 00:11:16,575 --> 00:11:18,778 SHE WOULD BE ON THE VENTILATOR, 358 00:11:18,844 --> 00:11:20,312 AND SHE WOULD BE KEPT ON 359 00:11:20,379 --> 00:11:21,514 MEDICATIONS AND POTENTIALLY ON 360 00:11:21,580 --> 00:11:25,017 OTHER MACHINES TO SUPPORT HER 361 00:11:25,084 --> 00:11:26,085 ORGAN FUNCTION WHILE THEY WOULD 362 00:11:26,152 --> 00:11:27,787 BE DOING TESTS AND PROCEDURES 363 00:11:27,853 --> 00:11:29,722 AND SHE WOULD HAVE MORE TESTS 364 00:11:29,789 --> 00:11:32,892 AND PROCEDURES THAN A NORMAL ICU 365 00:11:32,958 --> 00:11:34,994 PATIENT OR A NORMAL TRANSPLANT 366 00:11:35,061 --> 00:11:35,861 RECIPIENT BECAUSE THEY'RE DOING 367 00:11:35,928 --> 00:11:36,729 RESEARCH. 368 00:11:36,796 --> 00:11:38,464 SO THEY WOULD BE DOING, FOR 369 00:11:38,531 --> 00:11:42,034 EXAMPLE, A I LOT LOT OF BIOPSIEF 370 00:11:42,101 --> 00:11:43,636 THE TRANSPLANTED PIG HEART AND 371 00:11:43,702 --> 00:11:45,037 MONITORING HER FOR INFECTION. 372 00:11:45,104 --> 00:11:46,038 AND THEN AT THE END OF THE 373 00:11:46,105 --> 00:11:46,806 RESEARCH, THE SURGEON WOULD 374 00:11:46,872 --> 00:11:49,408 REMOVE THE PIG HEART AND TEST 375 00:11:49,475 --> 00:11:51,077 IT, AND WOULD PERFORM AN AUTOPSY 376 00:11:51,143 --> 00:11:52,711 AND WOULD THEN RELEASE THE BODY 377 00:11:52,778 --> 00:11:56,415 TO THE FUNERAL HOME JUST LIKE 378 00:11:56,482 --> 00:11:56,849 NORMAL. 379 00:11:56,916 --> 00:11:58,184 AND THE FAMILY WOULD BE ABLE TO 380 00:11:58,250 --> 00:12:02,221 HAVE A FUNERAL AT THAT POINT. 381 00:12:02,288 --> 00:12:06,592 SO HERE ARE MY QUESTIONS. 382 00:12:06,659 --> 00:12:08,227 AS DAVE MENTIONED, WHAT DOES 383 00:12:08,294 --> 00:12:09,662 RESPECT INVOLVE WHEN IT 384 00:12:09,728 --> 00:12:11,831 CONCERNING SOMEONE WHO'S DEAD? 385 00:12:11,897 --> 00:12:14,166 IS IT ETHICAL AT ALL TO CONDUCT 386 00:12:14,233 --> 00:12:15,568 RESEARCH ON THE DECEASED? 387 00:12:15,634 --> 00:12:18,437 IS IT APPROPRIATE TO DO SO IF 388 00:12:18,504 --> 00:12:19,705 THEY HAVEN'T CONSENTED TO IT? 389 00:12:19,772 --> 00:12:21,140 SHOULD THEY BE ABLE TO BE KEPT 390 00:12:21,207 --> 00:12:23,375 ON VENTILATORS AFTER DEATH TO DO 391 00:12:23,442 --> 00:12:23,642 RESEARCH? 392 00:12:23,709 --> 00:12:27,480 AND IF SO, FOR HOW LONG? 393 00:12:27,546 --> 00:12:29,882 IS THE ICU THE BEST PLACE TO DO 394 00:12:29,949 --> 00:12:31,083 THIS RESEARCH OR SHOULD IT BE 395 00:12:31,150 --> 00:12:32,184 DONE SOMEWHERE ELSE, OUTSIDE OF 396 00:12:32,251 --> 00:12:33,419 THE CLINICAL SETTING? 397 00:12:33,486 --> 00:12:35,187 WHO WOULD BE TAKING CARE OF THIS 398 00:12:35,254 --> 00:12:35,621 RECIPIENT? 399 00:12:35,688 --> 00:12:38,657 THIS IS THE -- YOU KNOW, THE 400 00:12:38,724 --> 00:12:40,192 NURSE DAUGHTER OF THIS PATIENT 401 00:12:40,259 --> 00:12:43,129 OBVIOUSLY STARTS THINKING ABOUT 402 00:12:43,195 --> 00:12:44,763 THIS, IS A REGULAR ICU NURSE 403 00:12:44,830 --> 00:12:45,965 GOING TO TAKE CARE OF SOMEONE 404 00:12:46,031 --> 00:12:47,166 WHO'S BEEN DETERMINED TO BE 405 00:12:47,233 --> 00:12:47,600 DECEASED? 406 00:12:47,666 --> 00:12:48,934 CAN A NURSE DECIDE SHE DOESN'T 407 00:12:49,001 --> 00:12:50,136 WANT TO DO THAT, EVEN IF IT'S 408 00:12:50,202 --> 00:12:50,903 HER SHIFT? 409 00:12:50,970 --> 00:12:52,104 HOW WOULD THIS AFFECT THE CARE 410 00:12:52,171 --> 00:12:52,972 OF OTHER PATIENTS? 411 00:12:53,038 --> 00:12:55,708 WOULD THEY BE -- NURSES BE BUSY 412 00:12:55,774 --> 00:12:57,143 CAREFULLY MONITORING A RESEARCH 413 00:12:57,209 --> 00:12:59,211 SUBJECT AND NOT MAYBE FREE TO 414 00:12:59,278 --> 00:13:01,380 TAKE CARE OF PATIENTS WHO HAVE A 415 00:13:01,447 --> 00:13:04,350 CHANCE TO RECOVER? 416 00:13:04,416 --> 00:13:05,317 THEN WHAT ABOUT THE FAMILY? 417 00:13:05,384 --> 00:13:06,385 WOULD BE FAMILY BE ABLE TO KNOW 418 00:13:06,452 --> 00:13:07,620 WHAT WAS HAPPENING WITH THE 419 00:13:07,686 --> 00:13:10,022 RESEARCH AND WOULD THEY BE ABLE 420 00:13:10,089 --> 00:13:14,960 TO VISIT THEIR FAMILY MEMBER? 421 00:13:15,027 --> 00:13:16,061 >> OKAY. 422 00:13:16,128 --> 00:13:18,030 SO BEFORE WE TRY TO ANSWER SOME 423 00:13:18,097 --> 00:13:21,634 OF THOSE QUESTIONS, I JUST WANT 424 00:13:21,700 --> 00:13:23,502 TO STOP FOR A MINUTE AND SEE IF 425 00:13:23,569 --> 00:13:26,906 ANYBODY HAS ANY FACTUAL DETAIL 426 00:13:26,972 --> 00:13:27,773 QUESTION ON THIS CASE OR THIS 427 00:13:27,840 --> 00:13:29,708 TYPE OF CASE. 428 00:13:29,775 --> 00:13:32,344 SO NOT QUESTION, DISCUSSION OF 429 00:13:32,411 --> 00:13:33,646 ETHICS YET BUT JUST ABOUT THE 430 00:13:33,712 --> 00:13:34,480 RESEARCH, ABOUT THE MEDICINE, 431 00:13:34,547 --> 00:13:35,314 ABOUT THE CLINICAL SETTING IN 432 00:13:35,381 --> 00:13:36,515 WHICH THIS RESEARCH IS GOING TO 433 00:13:36,582 --> 00:13:37,283 TAKE PLACE? 434 00:13:37,349 --> 00:13:38,584 IF YOU HAVE A QUESTION, COULD 435 00:13:38,651 --> 00:13:40,786 YOU PLEASE GO TO THE MIC? 436 00:13:40,853 --> 00:13:42,288 AND ROBERT WILL LET US KNOW IF 437 00:13:42,354 --> 00:13:43,389 ANYBODY ONLINE HAS ONE. 438 00:13:43,455 --> 00:13:43,589 HOLLY? 439 00:13:43,656 --> 00:13:46,992 >> HOW LONG -- SO YOU ASKED OR 440 00:13:47,059 --> 00:13:49,195 PROPOSED THE QUESTION OF HER 441 00:13:49,261 --> 00:13:51,063 BEING IN THE ICU FOR AN EXTENDED 442 00:13:51,130 --> 00:13:51,297 PERIOD. 443 00:13:51,363 --> 00:13:53,766 DO YOU HAVE A GUESS OF HOW 444 00:13:53,832 --> 00:13:55,301 MANY -- LIKE I'M THINKING ABOUT 445 00:13:55,367 --> 00:13:56,535 THE NURSE AND ALL THAT'S GOING 446 00:13:56,602 --> 00:13:58,470 ON, HOW LONG THE RESEARCH 447 00:13:58,537 --> 00:13:59,905 PROTOCOL MIGHT LAST? 448 00:13:59,972 --> 00:14:03,642 >> THIS IS AN OPEN QUESTION 449 00:14:03,709 --> 00:14:05,945 ACTUALLY, BUT I CAN TELL YOU 450 00:14:06,011 --> 00:14:08,347 THAT WHAT PEOPLE ARE DOING AND 451 00:14:08,414 --> 00:14:09,448 WHAT PEOPLE ARE PROPOSING IS 452 00:14:09,515 --> 00:14:11,517 GENERALLY IN THE RANGE OF ONE TO 453 00:14:11,584 --> 00:14:12,818 TWO MONTHS. 454 00:14:12,885 --> 00:14:13,586 >> DAVID? 455 00:14:13,652 --> 00:14:15,454 >> HI. 456 00:14:15,521 --> 00:14:16,722 ARE WE GOING TO TAKE IT FOR THE 457 00:14:16,789 --> 00:14:18,857 PURPOSE OF THIS DISCUSSION GIVEN 458 00:14:18,924 --> 00:14:19,925 THAT SCIENTIFICALLY, THIS WOULD 459 00:14:19,992 --> 00:14:22,461 BE HELPFUL INFORMATION GIVEN 460 00:14:22,528 --> 00:14:25,197 THAT PEOPLE WHO ARE BRAIN DEAD, 461 00:14:25,264 --> 00:14:27,900 EVEN IF THEY'RE LEFT ON 462 00:14:27,967 --> 00:14:28,934 VENTILATORS, THEY'RE STILL -- 463 00:14:29,001 --> 00:14:30,336 THEY HAVE BODY ORGAN SYSTEMS 464 00:14:30,402 --> 00:14:31,837 THAT START TO SHUT DOWN 465 00:14:31,904 --> 00:14:32,938 REGARDLESS OF WHETHER THEY'RE 466 00:14:33,005 --> 00:14:34,173 KEPT ON -- YOU KNOW, COMPARED TO 467 00:14:34,240 --> 00:14:35,574 A PERSON WHO HAS JUST HEART 468 00:14:35,641 --> 00:14:36,775 FAILURE WHO'S NOT BRAIN DEAD, 469 00:14:36,842 --> 00:14:39,078 ARE WE GOING TO SIDESTEP THAT 470 00:14:39,144 --> 00:14:39,278 OR -- 471 00:14:39,345 --> 00:14:41,247 >> THIS QUESTION HAS ALSO BEEN 472 00:14:41,313 --> 00:14:44,116 RAISED, AND PART OF THE PROPOSAL 473 00:14:44,183 --> 00:14:46,418 IN RESEARCH IS TO ACTUALLY LOOK 474 00:14:46,485 --> 00:14:48,687 AT HOW THE IMMUNE SYSTEM OF A 475 00:14:48,754 --> 00:14:51,290 BRAIN DEAD PERSON WORKS AND 476 00:14:51,357 --> 00:14:55,894 COMPARE THE IMMUNE -- OUTSIDE OF 477 00:14:55,961 --> 00:14:58,664 THE UNIOGRAPHER TRANSPLANT 478 00:14:58,731 --> 00:15:00,532 SETTING SEE WHAT KIND OF IMMUNE 479 00:15:00,599 --> 00:15:02,167 RESPONSE OF A BRAIN DEAD PERSON 480 00:15:02,234 --> 00:15:03,669 SO THAT'S A WHOLE OTHER AREA 481 00:15:03,736 --> 00:15:04,970 THAT NEEDS RESEARCH, OR 482 00:15:05,037 --> 00:15:05,271 QUESTION. 483 00:15:05,337 --> 00:15:05,638 THANK YOU. 484 00:15:05,704 --> 00:15:06,839 >> DEFINITELY TO SAY FOR ALL OF 485 00:15:06,905 --> 00:15:08,140 THIS, A BACKGROUND ASSUMPTION 486 00:15:08,207 --> 00:15:09,608 THAT AT LEAST IN OUR DEPARTMENT, 487 00:15:09,675 --> 00:15:10,676 WE ALWAYS MAKE, IS THAT RESEARCH 488 00:15:10,743 --> 00:15:12,645 IS ETHICAL ONLY IF IT'S 489 00:15:12,711 --> 00:15:13,412 SCIENTIFICALLY SOCIALLY 490 00:15:13,479 --> 00:15:13,746 VALUABLE. 491 00:15:13,812 --> 00:15:15,047 IF IT'S NOT, THEN YOU DON'T EVEN 492 00:15:15,114 --> 00:15:16,382 HAVE TO GET INTO THESE QUESTIONS 493 00:15:16,448 --> 00:15:17,349 ABOUT WHAT HAPPENS IF A PERSON 494 00:15:17,416 --> 00:15:17,683 IS DEAD. 495 00:15:17,750 --> 00:15:18,984 DON'T DO THE RESEARCH, AND SO I 496 00:15:19,051 --> 00:15:22,588 THINK FOR THE MOST PART, WE CAN 497 00:15:22,655 --> 00:15:23,689 ASSUME THE STUDY WE'RE TALKING 498 00:15:23,756 --> 00:15:25,124 ABOUT, SOMEBODY WHO KNOWS WHAT 499 00:15:25,190 --> 00:15:26,225 THEY'RE TALKING ABOUT HAS DEEMED 500 00:15:26,292 --> 00:15:28,727 THE RESEARCH TO BE 501 00:15:28,794 --> 00:15:29,728 SCIENTIFICALLY OR SOCIALLY 502 00:15:29,795 --> 00:15:30,596 VALUABLE. 503 00:15:30,663 --> 00:15:31,897 ANYTHING ONLINE, ROBERT, BEFORE 504 00:15:31,964 --> 00:15:36,168 WE MOVE ON? 505 00:15:36,235 --> 00:15:38,671 >> THERE'S ONE QUESTION BUT IT'S 506 00:15:38,737 --> 00:15:40,005 NOT -- THERE'S ONE QUESTION BUT 507 00:15:40,072 --> 00:15:42,775 IT'S NOT A FACTUAL CLARIFICATION 508 00:15:42,841 --> 00:15:43,776 QUESTION SO I THINK MAYBE IT 509 00:15:43,842 --> 00:15:44,576 WOULD BE BETTER TO SAVE. 510 00:15:44,643 --> 00:15:45,044 >> ALL RIGHT. 511 00:15:45,110 --> 00:15:46,445 BEFORE WE MOVE ON, I'M GOING TO 512 00:15:46,512 --> 00:15:48,647 REPEAT, WE'RE NOT ABLE TO 513 00:15:48,714 --> 00:15:50,049 PROJECT THE CME NUMBER SO I'M 514 00:15:50,115 --> 00:15:51,050 GOING TO READ THEM AGAIN. 515 00:15:51,116 --> 00:15:51,684 SORRY ABOUT THAT. 516 00:15:51,750 --> 00:15:53,452 SO FOR PEOPLE WHO WANT TO GET 517 00:15:53,519 --> 00:15:54,753 CME CREDIT, ONCE AGAIN, THE CODE 518 00:15:54,820 --> 00:16:01,226 THAT YOU WANT TO TEXT IS 50551. 519 00:16:01,293 --> 00:16:02,628 AND THE TELEPHONE NUMBER YOU 520 00:16:02,695 --> 00:16:06,799 WANT TO TEXT THAT TO IS THE 521 00:16:06,865 --> 00:16:16,208 FOLLOWING: 844-980-1555. 522 00:16:16,275 --> 00:16:16,642 OKAY. 523 00:16:16,709 --> 00:16:18,277 SO TO HELP US THINK THROUGH THE 524 00:16:18,344 --> 00:16:19,378 ETHICAL QUESTIONS, THE 525 00:16:19,445 --> 00:16:25,150 INTRODUCTION FOR THIS STARTS 526 00:16:25,217 --> 00:16:25,617 FEBRUARY 6TH, 2008. 527 00:16:25,684 --> 00:16:27,052 I TOLD THE DISCUSSANT IT WAS 528 00:16:27,119 --> 00:16:28,220 THAT LONG AGO RECENTLY. 529 00:16:28,287 --> 00:16:29,855 HE MIGHT BE A LITTLE TRAUMATIZED 530 00:16:29,922 --> 00:16:30,322 AS A RESULT OF THAT. 531 00:16:30,389 --> 00:16:32,491 SO GO EASY ON HIM. 532 00:16:32,558 --> 00:16:34,793 EARLY ON. 533 00:16:34,860 --> 00:16:37,730 BUT THAT SESSION WAS THE SAME 534 00:16:37,796 --> 00:16:39,298 DISCUSSANT, SO NEAL NOW HAS THE 535 00:16:39,365 --> 00:16:41,467 HONOR OF BEING ONE OF FIVE 536 00:16:41,533 --> 00:16:43,335 PEOPLE WHO'VE BEEN AT ETHICS 537 00:16:43,402 --> 00:16:44,837 GRAND ROUNDS MORE THAN ONCE. 538 00:16:44,903 --> 00:16:49,308 AT THAT TIME, THE MODERATOR AND 539 00:16:49,375 --> 00:16:50,876 INTRODUCER WAS THE 540 00:16:50,943 --> 00:16:51,977 EXTRAORDINARILY ACCOMPLISHED AND 541 00:16:52,044 --> 00:16:54,146 MUCH MISSED PEOPLE MIGHT KNOW 542 00:16:54,213 --> 00:16:56,148 PAUL PLOTZ, WHO WAS HERE FOR A 543 00:16:56,215 --> 00:16:56,782 LONG TIME. 544 00:16:56,849 --> 00:16:59,952 AND HE DID THE MODERATING AND 545 00:17:00,018 --> 00:17:00,619 INTRODUCTIONS FOR US. 546 00:17:00,686 --> 00:17:05,524 I SENT HIM NEAL'S CV THE NIGHT 547 00:17:05,591 --> 00:17:06,892 BEFORE, JUST AS BACKGROUND, NEAL 548 00:17:06,959 --> 00:17:08,460 HAD BEEN A POSTBAC FELLOW WITH 549 00:17:08,527 --> 00:17:09,361 US FOR TWO YEARS. 550 00:17:09,428 --> 00:17:13,198 WE KNEW HIM, WE KNEW HE WAS, AS 551 00:17:13,265 --> 00:17:14,600 YOU WILL SEE, WONDERFUL, BUT HE 552 00:17:14,666 --> 00:17:16,468 WAS JUST OUT OF MEDICAL SCHOOL. 553 00:17:16,535 --> 00:17:21,507 PAUL GOT THE CV AND PAUL CAME 554 00:17:21,573 --> 00:17:22,708 AND PAUL WAS STANDING HERE AND 555 00:17:22,775 --> 00:17:24,576 HE STARTS INTRODUCING HIM AND HE 556 00:17:24,643 --> 00:17:26,712 HOLDS UP NEAL'S CV AND HE SAYS, 557 00:17:26,779 --> 00:17:27,946 ONE OF THE THINGS I DO WITH 558 00:17:28,013 --> 00:17:29,048 CVs IS I WEIGH THEM. 559 00:17:29,114 --> 00:17:30,582 AND I CAN TELL YOU, THIS 560 00:17:30,649 --> 00:17:33,118 PERSON'S C V IS EXTRAORDINARILY 561 00:17:33,185 --> 00:17:35,721 LIGHT. 562 00:17:35,788 --> 00:17:36,488 [LAUGHTER] 563 00:17:36,555 --> 00:17:38,657 THEN HE WENT ON TO SAY THAT IN 564 00:17:38,724 --> 00:17:40,092 ADDITION, THIS INDIVIDUAL THAT 565 00:17:40,159 --> 00:17:43,262 I'M ABOUT TO INTRODUCE IS JUST 566 00:17:43,328 --> 00:17:44,596 TWO YEARS OUT OF MEDICAL SCHOOL. 567 00:17:44,663 --> 00:17:47,199 I BELIEVE THEY NOW CALL THAT A 568 00:17:47,266 --> 00:17:49,601 PGY2, BUT I NEVER HEARD OF THAT 569 00:17:49,668 --> 00:17:51,470 BEFORE. 570 00:17:51,537 --> 00:17:53,672 FEUNLLFINALLY, THIS INDIVIDUAL A 571 00:17:53,739 --> 00:17:54,306 HOUSE OFFICER. 572 00:17:54,373 --> 00:17:55,841 HE'S DOING THIS -- THIS PERSON 573 00:17:55,908 --> 00:17:57,176 IS A HEALTH OFFICER. 574 00:17:57,242 --> 00:17:59,011 THEN HE STOPS, LOOKS UP AND HE 575 00:17:59,077 --> 00:18:00,212 SAYS, FOR PEOPLE WHO DON'T KNOW 576 00:18:00,279 --> 00:18:02,848 THESE THINGS, THAT'S A VERY LOW 577 00:18:02,915 --> 00:18:05,784 FORM OF LIFE. 578 00:18:05,851 --> 00:18:08,854 [LAUGHTER] 579 00:18:08,921 --> 00:18:10,823 SOMETIMES PAUL WOULD SAY 580 00:18:10,889 --> 00:18:12,257 ACTUALLY WHAT HE FELT. 581 00:18:12,324 --> 00:18:14,293 I COULD SAY SINCE THEN, THAT WAS 582 00:18:14,359 --> 00:18:16,728 2008, SINCE THEN, NEAL HAS GONE 583 00:18:16,795 --> 00:18:19,631 ON TO LOTS OF WONDERFUL THINGS. 584 00:18:19,698 --> 00:18:21,467 HE IS A CARDIOLOGIST NOW. 585 00:18:21,533 --> 00:18:23,435 HE'S AN ATTENDING IN THE ICU. 586 00:18:23,502 --> 00:18:26,839 HE IS THE THOMAS R. WILLIAMS 587 00:18:26,905 --> 00:18:28,240 ENDOWED PROFESSOR OF MEDICINE, 588 00:18:28,307 --> 00:18:30,776 AND HE IS ALSO A SENIOR FELLOW 589 00:18:30,843 --> 00:18:34,279 IN ETHICS AT EMORY UNIVERSITY, 590 00:18:34,346 --> 00:18:39,985 AND MORE IMPORTANTLY, NEAL HAS A 591 00:18:40,052 --> 00:18:40,853 PREVIOUS FELLOW IN OUR 592 00:18:40,919 --> 00:18:42,287 DEPARTMENT SO WE TAKE CREDIT FOR 593 00:18:42,354 --> 00:18:43,155 ALL OF THE GOOD STUFF THAT YOU 594 00:18:43,222 --> 00:18:44,590 ARE ABOUT TO HEAR. 595 00:18:44,656 --> 00:18:46,625 NEAL IS NOW A NATIONALLY 596 00:18:46,692 --> 00:18:47,493 RECOGNIZED EXPERT IN THE ETHICS 597 00:18:47,559 --> 00:18:49,928 OF CLINICAL RESEARCH, 598 00:18:49,995 --> 00:18:51,997 PARTICULARLY IN EMERGENCY 599 00:18:52,064 --> 00:18:53,098 SETTINGS, IN SETTINGS WHERE YOU 600 00:18:53,165 --> 00:18:54,633 DON'T GET INFORMED CONSENT 601 00:18:54,700 --> 00:18:57,135 BECAUSE OF EMERGENCY AND FOR 602 00:18:57,202 --> 00:18:57,903 RESEARCH WITH PEOPLE AT THE END 603 00:18:57,970 --> 00:18:58,670 OF LIFE. 604 00:18:58,737 --> 00:19:00,305 SO WELCOME, NEAL. 605 00:19:00,372 --> 00:19:01,707 HE'S GOING TO HELP US THINK 606 00:19:01,773 --> 00:19:04,710 THROUGH KATHLEEN'S QUESTIONS. 607 00:19:04,776 --> 00:19:05,911 [APPLAUSE] 608 00:19:05,978 --> 00:19:07,546 >> YOU ASKED ME IF I REMEMBERED 609 00:19:07,613 --> 00:19:09,948 THAT INTRODUCTION AND I DIDN'T, 610 00:19:10,015 --> 00:19:13,318 BUT NOW I DO WELL. 611 00:19:13,385 --> 00:19:16,922 I WA WOULD JUST ADD A LITTLE BIT 612 00:19:16,989 --> 00:19:17,489 MORE HISTORY. 613 00:19:17,556 --> 00:19:18,557 SO FIRST YOU CAN IMAGINE MY HAIR 614 00:19:18,624 --> 00:19:20,859 WAS A DIFFERENT COLOR BACK THEN. 615 00:19:20,926 --> 00:19:22,060 DAVE, I THINK, MENTIONED THAT 616 00:19:22,127 --> 00:19:24,162 MAYBE HIS WAS TOO. 617 00:19:24,229 --> 00:19:26,331 THE OTHER IS THAT THIS IS -- I 618 00:19:26,398 --> 00:19:27,900 WAS THINKING BACK ABOUT WHEN I 619 00:19:27,966 --> 00:19:33,338 FIRST WENT INTO THIS ROOM, AND I 620 00:19:33,405 --> 00:19:36,341 WAS THE FIRST POSTBAC FELLOW 621 00:19:36,408 --> 00:19:38,610 THAT YOU GUYS HAD IN 1997. 622 00:19:38,677 --> 00:19:41,446 SO THIS WAS A LONG TIME AGO THAT 623 00:19:41,513 --> 00:19:43,949 I FIRST CAME IN TO LIPSETT 624 00:19:44,016 --> 00:19:44,283 AUDITORIUM. 625 00:19:44,349 --> 00:19:46,184 I THINK -- I TOLD DAVE I 626 00:19:46,251 --> 00:19:47,786 DISCOVERED I NEEDED GLASSES IN 627 00:19:47,853 --> 00:19:49,488 THIS ROOM WHEN I WOULD ATTEND 628 00:19:49,555 --> 00:19:50,188 SOME TALKS AND I COULDN'T READ 629 00:19:50,255 --> 00:19:51,590 THE SLIDES OR WHATEVER THEY WERE 630 00:19:51,657 --> 00:19:52,824 BACK THEN. 631 00:19:52,891 --> 00:19:55,093 SO THIS ROOM HAS HISTORICAL 632 00:19:55,160 --> 00:19:56,995 SIGNIFICANCE FOR ME, THIS PLACE 633 00:19:57,062 --> 00:19:59,698 HAS A LOT OF SIGNIFICANCE TO ME, 634 00:19:59,765 --> 00:20:03,435 AND I FEEL LIKE, IN TRUTH, MY 635 00:20:03,502 --> 00:20:05,270 COUPLE YEARS AT NIH RIGHT AFTER 636 00:20:05,337 --> 00:20:06,805 I GRADUATED COLLEGE AND TRULY 637 00:20:06,872 --> 00:20:10,409 HAD NO IDEA WHAT I WAS COMING TO 638 00:20:10,475 --> 00:20:12,010 DO WAS EASILY THE MOST FORMATIVE 639 00:20:12,077 --> 00:20:13,912 TWO YEARS OF MY ENTIRE CAREER. 640 00:20:13,979 --> 00:20:15,113 SO IT REALLY SPECIAL FOR ME 641 00:20:15,180 --> 00:20:17,182 WHENEVER I GET A CHANCE TO COME 642 00:20:17,249 --> 00:20:20,586 BACK HERE AND I APPRECIATE YOU 643 00:20:20,652 --> 00:20:23,088 GUYS INVITING ME. 644 00:20:23,155 --> 00:20:26,992 I MIGHT TRADE -- IF I COULD BE 645 00:20:27,059 --> 00:20:27,926 "SATURDAY NIGHT LIVE" HOST MORE 646 00:20:27,993 --> 00:20:28,894 THAN THREE OR FOUR TIMES, THAT 647 00:20:28,961 --> 00:20:30,896 WOULD BE AWESOME, BUT NIH ETHICS 648 00:20:30,963 --> 00:20:33,932 GRAND ROUNDS MAY BE A NICE 649 00:20:33,999 --> 00:20:34,700 ALTERNATIVE TO THAT FOR ME. 650 00:20:34,766 --> 00:20:38,637 SO I APPRECIATE THE INVITATION. 651 00:20:38,704 --> 00:20:41,039 SO THANKS TO KATHLEEN FOR 652 00:20:41,106 --> 00:20:41,607 INTRODUCING THIS CASE. 653 00:20:41,673 --> 00:20:45,210 THIS IS AN ISSUE THAT I STARTED 654 00:20:45,277 --> 00:20:47,045 THINKING ABOUT A BIT, ACTUALLY 655 00:20:47,112 --> 00:20:49,448 QUITE SOME TIME AGO, PROBABLY 656 00:20:49,514 --> 00:20:50,349 AROUND 2006, 2008. 657 00:20:50,415 --> 00:20:51,850 HOLLY REMEMBERS THAT WE HAD SOME 658 00:20:51,917 --> 00:20:53,619 DISCUSSIONS WHILE I WAS A PH.D. 659 00:20:53,685 --> 00:20:54,620 STUDENT AT HOPKINS ABOUT THESE 660 00:20:54,686 --> 00:20:56,588 SORTS OF ISSUES BECAUSE I WAS 661 00:20:56,655 --> 00:20:57,456 REALLY INTERESTED IN WHAT IT 662 00:20:57,522 --> 00:20:58,757 MEANS TO RESPECT PEOPLE IN THE 663 00:20:58,824 --> 00:21:00,392 CONTEXT OF DOING RESEARCH. 664 00:21:00,459 --> 00:21:02,694 SO IT'S ONE THAT I'VE SORT OF 665 00:21:02,761 --> 00:21:03,895 MAINTAINED AN INTEREST IN AND I 666 00:21:03,962 --> 00:21:07,299 STILL THINK IS FASCINATING, AND 667 00:21:07,366 --> 00:21:08,266 AS KATHLEEN MENTIONED, REALLY 668 00:21:08,333 --> 00:21:11,436 GROWING IN IMPORTANCE. 669 00:21:11,503 --> 00:21:13,105 SO I HAVE NO RELEVANT INTEREST 670 00:21:13,171 --> 00:21:17,909 RELATED TO THIS PARTICULAR TALK. 671 00:21:17,976 --> 00:21:19,544 AND IN TERMS OF OBJECTIVES, WHAT 672 00:21:19,611 --> 00:21:20,646 I THOUGHT I'D DO WAS GIVE A 673 00:21:20,712 --> 00:21:22,381 LITTLE BIT OF HISTORICAL CONTEXT 674 00:21:22,447 --> 00:21:23,382 THAT I THINK IS HELPFUL THAT 675 00:21:23,448 --> 00:21:26,351 THIS IS NOT ENTIRELY NEW. 676 00:21:26,418 --> 00:21:28,286 MAKE WHAT I THINK IS REALLY A 677 00:21:28,353 --> 00:21:30,055 RELATIVELY STRAIGHTFORWARD CASE 678 00:21:30,122 --> 00:21:32,124 FOR WHY RESEARCH ON NEWLY AND 679 00:21:32,190 --> 00:21:33,625 NEARLY DEAD SUBJECTS IS 680 00:21:33,692 --> 00:21:34,760 IMPORTANT AND FUNDAMENTALLY 681 00:21:34,826 --> 00:21:36,061 ETHICAL. 682 00:21:36,128 --> 00:21:39,131 I WILL SORT OF DIVIDE THE KINDS 683 00:21:39,197 --> 00:21:43,669 OF CONCERNS THAT ARISE INTO AT 684 00:21:43,735 --> 00:21:44,636 LEAST THE THINGS ABOUT TREATMENT 685 00:21:44,703 --> 00:21:45,704 OF THE SUBJECT AND THEN SOME OF 686 00:21:45,771 --> 00:21:47,773 THE OTHER IMPORTANT 687 00:21:47,839 --> 00:21:49,074 CONSIDERATIONS THAT AREN'T 688 00:21:49,141 --> 00:21:49,841 REALLY ABOUT THE SUBJECT AND 689 00:21:49,908 --> 00:21:50,809 MAYBE NOT ABOUT THE SUBJECT'S 690 00:21:50,876 --> 00:21:51,810 FAMILY. 691 00:21:51,877 --> 00:21:53,445 AND THEN HIGHLIGHT SOME AREAS 692 00:21:53,512 --> 00:21:54,780 THAT I THINK ARE REALLY 693 00:21:54,846 --> 00:21:59,484 IMPORTANT IN TERMS OF PRACTICAL. 694 00:21:59,551 --> 00:22:00,986 IN MANY WAYS, I THINK THIS IS A 695 00:22:01,053 --> 00:22:03,288 PROBLEM ABOUT DETAILS, AND HOW 696 00:22:03,355 --> 00:22:06,258 WE DEAL WITH PARTICULARS RATHER 697 00:22:06,324 --> 00:22:07,793 THAN SUPER BIG PICTURE ISSUES, 698 00:22:07,859 --> 00:22:09,728 ALTHOUGH WE'LL SEE IF OTHERS MAY 699 00:22:09,795 --> 00:22:11,063 HAVE MORE FUNDAMENTAL QUESTIONS 700 00:22:11,129 --> 00:22:14,566 THAT WE CAN TALK ABOUT. 701 00:22:14,633 --> 00:22:15,901 SO I THINK IT'S IMPORTANT TO 702 00:22:15,967 --> 00:22:16,868 RECOGNIZE THAT AT MANY IN THE 703 00:22:16,935 --> 00:22:18,403 ROOM KNOW, OBVIOUSLY LEARNING 704 00:22:18,470 --> 00:22:22,441 FROM DEAD PEOPLE IS NOT A NEW 705 00:22:22,507 --> 00:22:22,774 THING. 706 00:22:22,841 --> 00:22:23,975 SO FOR ANYBODY WHO'S BEEN 707 00:22:24,042 --> 00:22:25,077 THROUGH MEDICAL TRAINING, THE 708 00:22:25,143 --> 00:22:26,712 BASIC EXPERIENCE OF DOING 709 00:22:26,778 --> 00:22:28,980 DISSECTIONS AND USING CADAVERS 710 00:22:29,047 --> 00:22:30,849 IN ANATOMY LAB IS KIND OF A 711 00:22:30,916 --> 00:22:32,184 FOUNDATIONAL PART OF MEDICAL 712 00:22:32,250 --> 00:22:32,451 TRAINING. 713 00:22:32,517 --> 00:22:35,454 SOME OF THAT MIGHT BE CHANGING, 714 00:22:35,520 --> 00:22:37,089 BUT CERTAINLY NOT AN UNFAMILIAR 715 00:22:37,155 --> 00:22:37,622 CONCEPT. 716 00:22:37,689 --> 00:22:39,491 THIS BOOK IS ONE OF THE BEST 717 00:22:39,558 --> 00:22:41,026 BOOKS I READ, STILL STICKS WITH 718 00:22:41,093 --> 00:22:43,995 ME A LOT CALLED "STIFF: THE 719 00:22:44,062 --> 00:22:46,064 CURIOUS LIVES OF HUMAN 720 00:22:46,131 --> 00:22:46,832 CADAVERS," TALKS ABOUT ALL THE 721 00:22:46,898 --> 00:22:49,000 DIFFERENT WAYS THAT WE USE HUMAN 722 00:22:49,067 --> 00:22:50,869 BODIES TO LEARN, INCLUDING 723 00:22:50,936 --> 00:22:53,171 THINGS LIKE CRASH TESTS, OTHER 724 00:22:53,238 --> 00:22:56,641 KINDS OF THINGS THAT REALLY IN 725 00:22:56,708 --> 00:22:58,310 SOME WAYS CHALLENGE NOTIONS OF 726 00:22:58,376 --> 00:23:00,078 WHAT WE TYPICALLY THINK OF AS 727 00:23:00,145 --> 00:23:02,481 BEING RESPECTFUL TREATMENT. 728 00:23:02,547 --> 00:23:04,449 THIS IS ANOTHER ONE ABOUT A BODY 729 00:23:04,516 --> 00:23:06,218 FARM IN TENNESSEE THAT DESCRIBES 730 00:23:06,284 --> 00:23:08,920 SOME REALLY INTERESTING WAYS 731 00:23:08,987 --> 00:23:10,989 THAT PEOPLE'S BODIES ARE USED TO 732 00:23:11,056 --> 00:23:14,392 UNDERSTAND FORENSICS OF THINGS 733 00:23:14,459 --> 00:23:16,128 LIKE BODIES BEING LOCKED IN 734 00:23:16,194 --> 00:23:17,662 TRUNKS OR BURIED IN DIFFERENT 735 00:23:17,729 --> 00:23:19,097 KINDS OF PLACES AND WATCHING 736 00:23:19,164 --> 00:23:22,033 DIFFERENT KINDS OF 737 00:23:22,100 --> 00:23:22,868 DECOMPOSITION, NOT EXACTLY WHAT 738 00:23:22,934 --> 00:23:24,536 WE THINK OF WHEN WE THINK OF 739 00:23:24,603 --> 00:23:25,370 RESPECTFUL OR REVERENT TREATMENT 740 00:23:25,437 --> 00:23:25,971 OF THE BODY. 741 00:23:26,037 --> 00:23:27,506 BUT IN BOTH OF THESE BOOKS, THEY 742 00:23:27,572 --> 00:23:31,576 OUTLINE IMPORTANT WAYS THAT DEAD 743 00:23:31,643 --> 00:23:32,978 BODIES HAVE CONTRIBUTED TO OUR 744 00:23:33,044 --> 00:23:35,480 UNDERSTANDING OF MANY IMPORTANT 745 00:23:35,547 --> 00:23:36,481 ISSUES. 746 00:23:36,548 --> 00:23:38,049 SO THIS IS PROBABLY FOR ANYONE 747 00:23:38,116 --> 00:23:42,387 WHO KNOWS THIS LITERATURE, TO ME 748 00:23:42,454 --> 00:23:43,789 AT LEAST, THIS IS SORT OF LIKE 749 00:23:43,855 --> 00:23:45,991 THE FOUNDATIONAL PIECE FROM 1974 750 00:23:46,057 --> 00:23:48,627 THAT WILLARD GALEN WROTE CALLED 751 00:23:48,693 --> 00:23:49,828 HARVESTING THE DEAD. 752 00:23:49,895 --> 00:23:52,898 AND IT'S A REALLY VIVIDLY 753 00:23:52,964 --> 00:23:55,100 WRITTEN PIECE ABOUT THIS CONCEPT 754 00:23:55,167 --> 00:23:59,137 OF NEOMORTS IS THE TERM HE USES. 755 00:23:59,204 --> 00:24:00,539 I'M JUST GOING TO READ A FEW OF 756 00:24:00,605 --> 00:24:01,840 THESE SENTENCES BECAUSE I THINK 757 00:24:01,907 --> 00:24:05,043 IT REALLY VIVIDLY DESCRIBES WHAT 758 00:24:05,110 --> 00:24:07,145 WE'RE THINKING ABOUT TODAY. 759 00:24:07,212 --> 00:24:08,513 THESE CADAVERS WOULD HAVE THE 760 00:24:08,580 --> 00:24:09,614 LEGAL STATUS OF THE DEAD WITH 761 00:24:09,681 --> 00:24:11,249 NONE OF THE QUALITIES ONE NOW 762 00:24:11,316 --> 00:24:12,150 ASSOCIATES WITH DEATH. 763 00:24:12,217 --> 00:24:14,419 THEY WOULD BE WARM, RESPIRATING, 764 00:24:14,486 --> 00:24:15,854 PULSATING, EVACUATING AND 765 00:24:15,921 --> 00:24:17,823 EXCRETING BODIES REQUIRING 766 00:24:17,889 --> 00:24:19,124 NURSING, DIETARY AND GENERAL 767 00:24:19,191 --> 00:24:20,025 GROOMING ATTENTION AND CAN 768 00:24:20,091 --> 00:24:21,226 PROBABLY BE MAINTAINED SO FOR A 769 00:24:21,293 --> 00:24:22,761 PERIOD OF YEARS. 770 00:24:22,828 --> 00:24:24,496 IF WE CHOOSE TO, WE COULD WITH 771 00:24:24,563 --> 00:24:26,798 THE TECHNOLOGY ALREADY AT HAND 772 00:24:26,865 --> 00:24:28,099 LEGALLY AVAIL OURSELVES OF THESE 773 00:24:28,166 --> 00:24:29,668 NEW CADAVERS TO SERVE SCIENCE 774 00:24:29,734 --> 00:24:31,503 AND MANKIND IN DRAMATICALLY 775 00:24:31,570 --> 00:24:32,504 USEFUL WAYS. 776 00:24:32,571 --> 00:24:34,005 THE AUTOPSY THAT MOST 777 00:24:34,072 --> 00:24:35,240 RESPECTABLE OF MEDICAL 778 00:24:35,307 --> 00:24:36,541 TRADITIONS THAT LAST GIFT OF THE 779 00:24:36,608 --> 00:24:37,642 DYING PERSON TO LIVING FUTURE 780 00:24:37,709 --> 00:24:39,377 COULD BE EXTENDED IN PRINCIPLE 781 00:24:39,444 --> 00:24:41,780 BEYOND OUR RECOGNITION TO SAVE 782 00:24:41,847 --> 00:24:45,083 LIVES, RELIEVE SUFFERING -- WE 783 00:24:45,150 --> 00:24:48,453 COULD DEVELOP HOSPITALS, AN 784 00:24:48,520 --> 00:24:49,421 INAPPROPRIATE WORD BECAUSE IT 785 00:24:49,487 --> 00:24:50,222 SUGGESTS THE PRESENCE LIVING 786 00:24:50,288 --> 00:24:52,390 HUMAN BEINGS, BANKS OR FARMS OF 787 00:24:52,457 --> 00:24:53,925 CADAVERS WHICH REQUIRE FEEDING 788 00:24:53,992 --> 00:24:55,794 AND MAINTENANCE IN ORDER TO BE 789 00:24:55,861 --> 00:24:56,228 HARVESTED. 790 00:24:56,294 --> 00:25:01,366 TALKS ABOUT THESE -- CALLS THESE 791 00:25:01,433 --> 00:25:02,334 BIOEMPORIUMS, ELABORATES WAYS 792 00:25:02,400 --> 00:25:03,869 THEY CAN BE USED FOR RESEARCH OF 793 00:25:03,935 --> 00:25:05,403 VARIOUS TYPES. 794 00:25:05,470 --> 00:25:07,372 WAYS THEY CAN HELP IN TRAINING 795 00:25:07,439 --> 00:25:08,707 OR PRACTICING PROCEDURES IN WAYS 796 00:25:08,773 --> 00:25:10,442 THEY COULD PRODUCE BLOOD OR 797 00:25:10,508 --> 00:25:12,611 OTHER KINDS OF BODY PRODUCTS 798 00:25:12,677 --> 00:25:14,779 THAT COULD BE HELPFUL, IT GIVES 799 00:25:14,846 --> 00:25:16,681 THE EXAMPLE OF POTENTIALLY 800 00:25:16,748 --> 00:25:17,449 ANTITOXINS OR OTHER KINDS OF 801 00:25:17,515 --> 00:25:17,983 THINGS. 802 00:25:18,049 --> 00:25:19,184 SO IT'S NOT HARD TO IMAGINE LOTS 803 00:25:19,251 --> 00:25:23,655 OF WAYS THAT THIS COULD -- THAT 804 00:25:23,722 --> 00:25:24,322 BODIES COULD CONTRIBUTE. 805 00:25:24,389 --> 00:25:26,725 I THINK THIS PIECE IS IN SOME 806 00:25:26,791 --> 00:25:29,127 WAYS A NICE WAY OF CAPTURING 807 00:25:29,194 --> 00:25:33,865 BOTH THE KIND OF FEAR OF THIS 808 00:25:33,932 --> 00:25:35,066 WORLD AS WELL AS ITS POTENTIAL 809 00:25:35,133 --> 00:25:37,002 AND TAKES IT SERIOUSLY. 810 00:25:37,068 --> 00:25:38,870 SO I WANT TO GIVE ONE EXAMPLE AT 811 00:25:38,937 --> 00:25:40,305 LEAST FROM THE FIELD OF 812 00:25:40,372 --> 00:25:43,575 CARDIOLOGY, WHICH IS MY CLINICAL 813 00:25:43,642 --> 00:25:45,443 LIFE WHERE THIS HAS REALLY BEEN 814 00:25:45,510 --> 00:25:45,710 IMPORTANT. 815 00:25:45,777 --> 00:25:47,746 I THINK IT'S IMPORTANT KIND OF 816 00:25:47,812 --> 00:25:48,513 GROUNDING IN THIS. 817 00:25:48,580 --> 00:25:52,117 THIS IS THE CASE OF THE 818 00:25:52,183 --> 00:25:53,551 GLYCOPROTEIN 2B3A INHIBITORS. 819 00:25:53,618 --> 00:25:56,154 THIS IS IS TREATMENT FOR ACUTE 820 00:25:56,221 --> 00:25:58,890 MYOCARD YAL INFARCTION. 821 00:25:58,957 --> 00:26:00,191 MYOCARD YAL INFARCTION, IT WAS 822 00:26:00,258 --> 00:26:01,326 DEVELOPED IN THE 1980s. 823 00:26:01,393 --> 00:26:03,261 AT THAT TIME THEY WERE PROMISING 824 00:26:03,328 --> 00:26:04,195 ANIMAL DATA BUT REAL QUESTIONS 825 00:26:04,262 --> 00:26:06,331 ABOUT THE ACCURACY OF ANIMAL 826 00:26:06,398 --> 00:26:09,267 MODELS FOR 2B/3A INHIBITORS. 827 00:26:09,334 --> 00:26:10,602 IMPORTANTLY JUST TO DESCRIBE 828 00:26:10,669 --> 00:26:11,236 WHAT THIS DOES, SO THAT PICTURE 829 00:26:11,303 --> 00:26:12,470 OVER TO THE RIGHT, THAT'S A 830 00:26:12,537 --> 00:26:13,338 HEART ATTACK. 831 00:26:13,405 --> 00:26:16,608 THAT'S A BIG CLOT IN THE 832 00:26:16,675 --> 00:26:17,709 CORONARY ARTERY AND THAT'S WHAT 833 00:26:17,776 --> 00:26:20,679 CAUSES M.I. 834 00:26:20,745 --> 00:26:24,249 2 ABOUT/3A INHIBITORS BASICA 835 00:26:24,316 --> 00:26:25,684 BASICALLY -- PLATELET 836 00:26:25,750 --> 00:26:26,785 AGGREGATION SO A WAY TO HELP 837 00:26:26,851 --> 00:26:28,320 ADDRESS THAT IN THE CONTEXT OF 838 00:26:28,386 --> 00:26:28,853 ACUTE MIs. 839 00:26:28,920 --> 00:26:31,156 SO NOT SURPRISINGLY, IF YOU'RE 840 00:26:31,222 --> 00:26:32,123 DOING THIS, YOU HAVE A 841 00:26:32,190 --> 00:26:34,392 SIGNIFICANT RISK OF BLEEDING, 842 00:26:34,459 --> 00:26:37,062 AND THEY NEEDED TO DO 843 00:26:37,128 --> 00:26:37,829 PHARMACOKINETIC, PHARMACODYNAMIC 844 00:26:37,896 --> 00:26:40,031 AND TOXICITY DATA IN HUMANS. 845 00:26:40,098 --> 00:26:41,866 IT WAS CONSIDERED TO BE TOO 846 00:26:41,933 --> 00:26:44,602 RISKY AN INTERVENTION TO TEST IN 847 00:26:44,669 --> 00:26:45,270 HEALTHY SUBJECTS, WHICH IS WHAT 848 00:26:45,337 --> 00:26:47,872 WE TYPICALLY MIGHT DO, AND TOO 849 00:26:47,939 --> 00:26:48,773 RISKY FOR INDIVIDUALS COMING 850 00:26:48,840 --> 00:26:49,874 INTO THE HOSPITAL WITH A HEART 851 00:26:49,941 --> 00:26:50,642 ATTACK BECAUSE THOSE ARE PEOPLE 852 00:26:50,709 --> 00:26:52,677 WHO IF IT WENT WRONG COULD DIE. 853 00:26:52,744 --> 00:26:54,179 SO THE FIRST IN HUMAN STUDIES 854 00:26:54,245 --> 00:26:55,880 WERE DONE IN BRAIN DEAD PERSONS. 855 00:26:55,947 --> 00:26:57,949 WHO WERE INELIGIBLE FOR ORGAN 856 00:26:58,016 --> 00:27:00,151 DONATION, JUST LIKE OUR CASE 857 00:27:00,218 --> 00:27:04,189 THAT KATHLEEN DESCRIBES OF GL. 858 00:27:04,255 --> 00:27:05,190 IMPORTANTLY, THESE DRUGS WERE 859 00:27:05,256 --> 00:27:06,725 DEMONSTRATED TO BE SUFFICIENTLY 860 00:27:06,791 --> 00:27:09,094 SAFE AND THEN WENT THROUGH THE 861 00:27:09,160 --> 00:27:13,031 TYPICAL COURSE OF PHASE 1, 2, 862 00:27:13,098 --> 00:27:14,232 3 TRIALS AND HAD BECOME A 863 00:27:14,299 --> 00:27:16,234 MAINSTAY OF TREATMENT OF ACUTE 864 00:27:16,301 --> 00:27:16,668 MI. 865 00:27:16,735 --> 00:27:19,137 WE TONIG DON'T USE THESE PARTICR 866 00:27:19,204 --> 00:27:22,907 DRUGS AS MUCH ANYMORE BECAUSE 867 00:27:22,974 --> 00:27:24,976 THERE IS A REPLACEMENT BUT NO 868 00:27:25,043 --> 00:27:25,777 QUESTION THE CORNERSTONE FOR 869 00:27:25,844 --> 00:27:25,977 YEARS. 870 00:27:26,044 --> 00:27:27,479 SO IT'S A WONDERFUL SUCCESS 871 00:27:27,545 --> 00:27:29,981 STORY, I THINK, OF THOUGHTFUL 872 00:27:30,048 --> 00:27:31,950 APPLICATION OF THIS KIND OF WAY 873 00:27:32,017 --> 00:27:34,853 OF STUDYING PEOPLE. 874 00:27:34,919 --> 00:27:35,954 OTHER EXAMPLES THAT WE WON'T GO 875 00:27:36,021 --> 00:27:38,790 THROUGH IN DETAIL BUT PHASED 876 00:27:38,857 --> 00:27:39,991 DELIVERY SYSTEMS FOR CANCER IN 877 00:27:40,058 --> 00:27:43,261 PATIENT WITH AGGRESSIVE DISEASE, 878 00:27:43,328 --> 00:27:44,462 EXTERNAL OXYGENATION IN CRITICAL 879 00:27:44,529 --> 00:27:50,502 LUNG INJ INJURY AND OBVIOUSLY 880 00:27:50,568 --> 00:27:54,539 XENOTRATRANSPLANTATION IN THE PS 881 00:27:54,606 --> 00:27:55,306 RECENTLY AND IN THE CASE WE'RE 882 00:27:55,373 --> 00:27:56,174 TALKING ABOUT TODAY. 883 00:27:56,241 --> 00:28:00,678 SO I WANT TO MAKE A BASIC CASE 884 00:28:00,745 --> 00:28:03,381 FOR WHY I THINK THIS IS ETHICAL. 885 00:28:03,448 --> 00:28:05,350 SO FIRST, I THINK IT'S CLEAR 886 00:28:05,417 --> 00:28:07,752 THAT AS DESCRIBED IN THE CASE OF 887 00:28:07,819 --> 00:28:09,587 GL, THIS CAN BE VERY RESPECTFUL 888 00:28:09,654 --> 00:28:11,122 OF THE DESIRES OF INDIVIDUALS 889 00:28:11,189 --> 00:28:14,325 AND THEIR FAMILY MEMBERS TO 890 00:28:14,392 --> 00:28:15,760 CONTRIBUTE IN THEIR DEATH. 891 00:28:15,827 --> 00:28:18,596 IT OFFERS OPPORTUNITIES VERY 892 00:28:18,663 --> 00:28:20,031 CONCRETELY TO PEOPLE INELIGIBLE 893 00:28:20,098 --> 00:28:22,033 FOR ORGAN DOU DONATION, WHICH IE 894 00:28:22,100 --> 00:28:23,401 OF THE OTHER MAIN ALTERNATIVES 895 00:28:23,468 --> 00:28:24,235 WE HAVE FOR MAKING A 896 00:28:24,302 --> 00:28:24,969 CONTRIBUTION IN THIS STATE. 897 00:28:25,036 --> 00:28:26,838 I THINK IT'S ALSO IMPORTANT WITH 898 00:28:26,905 --> 00:28:28,907 THE CAVEAT THAT RELATED TO THE 899 00:28:28,973 --> 00:28:29,674 QUESTION THAT WAS ASKED, THIS 900 00:28:29,741 --> 00:28:32,477 CAN BE SCIENTIFICALLY 901 00:28:32,544 --> 00:28:34,946 ADVANTAGEOUS. 902 00:28:35,013 --> 00:28:36,347 IT HAS IMPORTANT ADVANTAGES OVER 903 00:28:36,414 --> 00:28:37,482 SOME ANIMAL MODELS AS DESCRIBED 904 00:28:37,549 --> 00:28:41,186 IN THE CASE OF 2B/3As AND CAN 905 00:28:41,252 --> 00:28:42,253 CREATE SITUATIONS THAT CAN'T BE 906 00:28:42,320 --> 00:28:43,354 CREATED IN LIVE PERSONS. 907 00:28:43,421 --> 00:28:45,423 AGAIN, THIS IS WITH THE CAVEAT 908 00:28:45,490 --> 00:28:46,524 ABOUT POTENTIAL LIMITATIONS 909 00:28:46,591 --> 00:28:47,425 ABOUT BRAIN DEATH IN CERTAIN 910 00:28:47,492 --> 00:28:50,128 KINDS OF STATES. 911 00:28:50,195 --> 00:28:51,763 IT AVOIDS RISK TO TRADITIONAL 912 00:28:51,830 --> 00:28:52,664 SUBJECTS, SO BOTH HEALTHY 913 00:28:52,730 --> 00:28:53,731 SUBJECTS AND PATIENTS, THAT'S 914 00:28:53,798 --> 00:28:56,568 WHY I THINK THE 2B/3A CASE IS A 915 00:28:56,634 --> 00:28:58,536 GOOD EXAMPLE, IT SHOWS WHY BOTH 916 00:28:58,603 --> 00:29:00,071 TYPICAL POPULATIONS FOR STUDYING 917 00:29:00,138 --> 00:29:00,872 THIS ARE INAPPROPRIATE. 918 00:29:00,939 --> 00:29:02,440 AND I THINK IT'S ENTIRELY 919 00:29:02,507 --> 00:29:04,809 CONSISTENT FROM AN ETHICAL 920 00:29:04,876 --> 00:29:06,111 PERSPECTIVE WITH OTHER WAYS THAT 921 00:29:06,177 --> 00:29:07,178 WE USE BODIES. 922 00:29:07,245 --> 00:29:08,480 I MENTIONED EARLY ON SOME OF THE 923 00:29:08,546 --> 00:29:10,582 WAYS THAT WE USE BODIES THAT 924 00:29:10,648 --> 00:29:12,550 DON'T INVOLVE PERPETUATING ORGAN 925 00:29:12,617 --> 00:29:14,619 FUNCTION BUT IN THE CASE OF 926 00:29:14,686 --> 00:29:16,821 ORGAN DONATION, WE CERTAINLY 927 00:29:16,888 --> 00:29:17,422 PERPETUATE ORGAN FUNCTION IN 928 00:29:17,489 --> 00:29:19,023 ORDER TO ALLOW FOR APPROPRIATE 929 00:29:19,090 --> 00:29:19,891 PROCUREMENT OF ORGANS. 930 00:29:19,958 --> 00:29:21,559 SO I DON'T THINK IT 931 00:29:21,626 --> 00:29:24,062 NECESSARILY -- THERE'S NO 932 00:29:24,129 --> 00:29:25,029 DISCONNECT WITH OTHER WAYS WE 933 00:29:25,096 --> 00:29:29,000 USE BODIES. 934 00:29:29,067 --> 00:29:31,369 SO WHERE ARE THE CONCERNS? 935 00:29:31,436 --> 00:29:32,570 I THINK ONE GROUP OF CONCERNS 936 00:29:32,637 --> 00:29:34,105 HAS TO DO WITH THE SUBJECT 937 00:29:34,172 --> 00:29:36,841 ITSELF, AND I'LL JUST SAY AS A 938 00:29:36,908 --> 00:29:38,276 CAVEAT, I'LL CHOOSE TO USE THE 939 00:29:38,343 --> 00:29:39,377 WORD "SUBJECT." 940 00:29:39,444 --> 00:29:40,145 ONE OF THE INTERESTING THINGS 941 00:29:40,211 --> 00:29:41,980 ABOUT THIS WORLD IS NOBODY'S 942 00:29:42,046 --> 00:29:43,448 REALLY FOUND THE VOCABULARY YET 943 00:29:43,515 --> 00:29:46,484 TO TALK ABOUT ENTITIES IN 944 00:29:46,551 --> 00:29:48,119 VARIOUS STATES OF EXISTENCE. 945 00:29:48,186 --> 00:29:49,754 WE'LL USE THE WORD SUBJECTS 946 00:29:49,821 --> 00:29:50,955 BECAUSE THEY'RE PEOPLE WHO ARE 947 00:29:51,022 --> 00:29:51,923 BEING STUDIED. 948 00:29:51,990 --> 00:29:54,225 I WANT TO SAY PEOPLE BEING 949 00:29:54,292 --> 00:29:55,660 STUDIED -- THEY ARE BODIES BEING 950 00:29:55,727 --> 00:29:57,095 STUDIED AND WE'RE GOING TO CALL 951 00:29:57,162 --> 00:29:58,463 THEM SUBJECTS FOR THE PURPOSE OF 952 00:29:58,530 --> 00:29:59,130 DISCUSSION. 953 00:29:59,197 --> 00:30:01,166 SO ONE SET OF WORRIES HAS TO DO 954 00:30:01,232 --> 00:30:02,333 WITH DISRESPECTFUL TREATMENT, 955 00:30:02,400 --> 00:30:02,534 RIGHT? 956 00:30:02,600 --> 00:30:04,002 AND IN GENERAL, WHEN WE THINK 957 00:30:04,068 --> 00:30:05,069 ABOUT DISRESPECTFUL TREATMENT, 958 00:30:05,136 --> 00:30:06,838 WE TALK ABOUT THE KINDS OF 959 00:30:06,905 --> 00:30:08,173 TREATMENTS THAT PEOPLE WOULDN'T 960 00:30:08,239 --> 00:30:09,140 HAVE WANTED. 961 00:30:09,207 --> 00:30:10,909 OR THAT VIOLATE NORMS OF HOW WE 962 00:30:10,975 --> 00:30:12,310 TREAT PERSONS OR BODIES. 963 00:30:12,377 --> 00:30:13,545 I'VE THOUGHT A LOT ABOUT ISSUES 964 00:30:13,611 --> 00:30:15,947 OF RESPECT AND I THINK IN 965 00:30:16,014 --> 00:30:18,016 GENERAL, THIS IS OFTEN WHEN WE 966 00:30:18,082 --> 00:30:19,751 ACT IN WAYS THAT DON'T 967 00:30:19,817 --> 00:30:21,186 DEMONSTRATE THAT WE 968 00:30:21,252 --> 00:30:23,388 APPROPRIATELY VALUE AS DAVE 969 00:30:23,454 --> 00:30:25,123 MENTIONED PERSONS AS ENDS AND 970 00:30:25,190 --> 00:30:29,093 NOT JUST AS MERE MEANS. 971 00:30:29,160 --> 00:30:29,961 A SECOND SET OF CONCERNS ABOUT 972 00:30:30,028 --> 00:30:33,264 SUBJECTS HAS TO DO WITH HARMS. 973 00:30:33,331 --> 00:30:36,301 IN THE CASE OF PARTICULARLY THE 974 00:30:36,367 --> 00:30:39,404 NEARLY DEAD POPULATION, YOU HAVE 975 00:30:39,470 --> 00:30:41,105 SOME CONCERNS ABOUT HASTENING 976 00:30:41,172 --> 00:30:42,640 DEATH, OTHER PHYSICAL OR MEDICAL 977 00:30:42,707 --> 00:30:43,942 HARMS, AGAIN, ESPECIALLY IN 978 00:30:44,008 --> 00:30:44,943 CASES WHERE DEATH HASN'T 979 00:30:45,009 --> 00:30:47,345 OCCURRED. 980 00:30:47,412 --> 00:30:48,746 THEN THE CONCEPT OF DIGNITARY 981 00:30:48,813 --> 00:30:49,948 HARMS, WHICH I THINK REALLY 982 00:30:50,014 --> 00:30:51,049 CLOSELY CONNECTS UP TO THE 983 00:30:51,115 --> 00:30:53,585 CONCEPT OF DISRESPECTFUL 984 00:30:53,651 --> 00:30:54,552 TREATMENT, BUT THAT'S THE OTHER 985 00:30:54,619 --> 00:30:55,820 MAJOR TYPE OF HARM THAT TENDS TO 986 00:30:55,887 --> 00:30:57,855 GET DISCUSSED. 987 00:30:57,922 --> 00:31:00,358 THE LAST AND I'M INCLUDING THIS 988 00:31:00,425 --> 00:31:01,459 IN SUBJECT CENTER CONCERNS 989 00:31:01,526 --> 00:31:04,429 BECAUSE I THINK FAMILY ARE 990 00:31:04,495 --> 00:31:07,165 CLEARLY WRAPPED UP IN A 991 00:31:07,232 --> 00:31:11,536 SUBJECT'S EXISTENCE AND IDENTITY 992 00:31:11,603 --> 00:31:15,240 ARE IMPACT/HARMS TO FAMILY 993 00:31:15,306 --> 00:31:16,341 MEMBERS, INTERFERENCE WITH DEATH 994 00:31:16,407 --> 00:31:17,642 AND GRIEVING PROCESS AND HOW A 995 00:31:17,709 --> 00:31:18,743 PERSON IS TREATED AT THE END OF 996 00:31:18,810 --> 00:31:21,145 THEIR LIFE OR AFTER THEY DIE. 997 00:31:21,212 --> 00:31:22,914 THERE'S ALSO A SET OF 998 00:31:22,981 --> 00:31:25,216 NON-SUBJECT CENTERED CONCERNS, 999 00:31:25,283 --> 00:31:25,683 RIGHT? 1000 00:31:25,750 --> 00:31:26,818 DIVERSION OF CLINICAL RESOURCES 1001 00:31:26,884 --> 00:31:29,087 IN TERMS OF FACILITIES, 1002 00:31:29,153 --> 00:31:30,722 MEDICATION, STAFF, ALL THESE ARE 1003 00:31:30,788 --> 00:31:31,823 ISSUES THAT KATHLEEN HAS ALREADY 1004 00:31:31,889 --> 00:31:33,758 STARTED TO HIGHLIGHT. 1005 00:31:33,825 --> 00:31:35,293 POTENTIAL CONCERNS ABOUT HARMS 1006 00:31:35,360 --> 00:31:36,527 TO STAFF, PARTICULARLY 1007 00:31:36,594 --> 00:31:37,595 INDIVIDUALS WHO HAVE OBJECTIONS 1008 00:31:37,662 --> 00:31:39,130 TO PROVIDING THIS TYPE OF 1009 00:31:39,197 --> 00:31:39,998 TREATMENT, WHO FEEL LIKE THEY 1010 00:31:40,064 --> 00:31:43,101 CAN'T DO THEIR OTHER JOB. 1011 00:31:43,167 --> 00:31:44,969 AND EROSION OF TRUST FROM THE 1012 00:31:45,036 --> 00:31:45,470 COMMUNITY. 1013 00:31:45,536 --> 00:31:47,238 WHAT WE'RE TALKING ABOUT ARE NOT 1014 00:31:47,305 --> 00:31:48,239 THINGS THAT MOST PEOPLE THINK 1015 00:31:48,306 --> 00:31:52,176 ARE HAPPENING WITH REGARD TO 1016 00:31:52,243 --> 00:31:56,547 TREATMENT OF DEAD PERSONS, AND 1017 00:31:56,614 --> 00:31:58,283 IT COULD CERTAINLY RUN THE RISK 1018 00:31:58,349 --> 00:32:00,485 OF UNDERMINING VIEWS OF 1019 00:32:00,551 --> 00:32:02,687 INSTITUTIONS AND RESEARCHERS IN 1020 00:32:02,754 --> 00:32:03,855 THE COMMUNITY IF IT'S THE 1021 00:32:03,921 --> 00:32:05,523 THOUGHT THAT PEOPLE ARE DOING 1022 00:32:05,590 --> 00:32:06,824 ACTIVITIES THAT ARE MORALLY 1023 00:32:06,891 --> 00:32:08,826 PROBLEMATIC. 1024 00:32:08,893 --> 00:32:10,428 AND THEN OTHER KINDS OF WORRIES 1025 00:32:10,495 --> 00:32:11,562 THAT THIS IS WHAT HAPPENS TO YOU 1026 00:32:11,629 --> 00:32:14,499 IF YOU GO TO THE HOSPITAL. 1027 00:32:14,565 --> 00:32:15,833 SO I'M JUST GOING TO SAY OUT 1028 00:32:15,900 --> 00:32:19,337 FRONT, I THINK ALL THESE CONC 1029 00:32:19,404 --> 00:32:20,638 CONCERNS ARE ADDRESSABLE IN 1030 00:32:20,705 --> 00:32:21,739 PRINCIPLE AND I'LL GO THROUGH 1031 00:32:21,806 --> 00:32:23,274 WHY AND THEN I WANT TO GET INTO 1032 00:32:23,341 --> 00:32:25,009 SOME WHAT I THINK ARE SOME OF 1033 00:32:25,076 --> 00:32:26,878 THE DETAILS THAT MAKE SOME OF 1034 00:32:26,944 --> 00:32:29,614 THEM A BIT MORE CHALLENGING. 1035 00:32:29,681 --> 00:32:32,250 SO IN TERMS OF THE SUBJECT 1036 00:32:32,317 --> 00:32:33,418 CENTER CONCERNS ABOUT 1037 00:32:33,484 --> 00:32:34,852 DISRESPECTFUL TREATMENT, AS I 1038 00:32:34,919 --> 00:32:36,187 MENTIONED, A LOT OF THAT TENDS 1039 00:32:36,254 --> 00:32:38,156 TO BE AROUND WHAT THE SUBJECT 1040 00:32:38,222 --> 00:32:40,458 WOULD HAVE WANTED. 1041 00:32:40,525 --> 00:32:42,760 MOST OF THOSE ISSUES ARE 1042 00:32:42,827 --> 00:32:44,062 ADDRESSED BY CONSENT OR 1043 00:32:44,128 --> 00:32:46,464 AUTHORIZATION THAT'S BASED ON 1044 00:32:46,531 --> 00:32:46,931 SUBSTITUTED JUDGMENT. 1045 00:32:46,998 --> 00:32:50,868 IN THE CASE THAT WE HEARD, THIS 1046 00:32:50,935 --> 00:32:53,471 WAS CLEARLY SOMETHING -- CLEARLY 1047 00:32:53,538 --> 00:32:54,572 AN EXAMPLE OF WHERE THE FAMILY 1048 00:32:54,639 --> 00:32:56,341 WAS TRYING TO APPLY WHAT THEY 1049 00:32:56,407 --> 00:32:57,742 KNEW ABOUT G.L. TO THIS 1050 00:32:57,809 --> 00:33:00,845 SITUATION. 1051 00:33:00,912 --> 00:33:03,014 AND SO IT'S HARD TO SAY THAT 1052 00:33:03,081 --> 00:33:04,215 THIS IS SOMETHING THAT THE 1053 00:33:04,282 --> 00:33:05,016 SUBJECT WOULDN'T HAVE WANTED 1054 00:33:05,083 --> 00:33:05,883 EVEN THOUGH THE SUBJECT WASN'T 1055 00:33:05,950 --> 00:33:06,951 THE PERSON THAT MADE THAT 1056 00:33:07,018 --> 00:33:09,420 DECISION. 1057 00:33:09,487 --> 00:33:10,588 THE OTHER WAY THAT WE THINK 1058 00:33:10,655 --> 00:33:11,789 ABOUT DISRESPECTFUL TREATMENT IS 1059 00:33:11,856 --> 00:33:13,324 THAT IT VIOLATES NORMS OF HOW WE 1060 00:33:13,391 --> 00:33:15,493 TREAT PERSONS OR BODIES. 1061 00:33:15,560 --> 00:33:18,796 I THINK IT'S IMPORTANT TO NOTE 1062 00:33:18,863 --> 00:33:19,997 THAT MOST OF THESE KINDS OF 1063 00:33:20,064 --> 00:33:22,834 NORMS IN ADDITION TO BEING ONES 1064 00:33:22,900 --> 00:33:24,268 WE GENERALLY LET PEOPLE MAKE 1065 00:33:24,335 --> 00:33:26,904 DECISIONS ABOUT FOR THEMSELVES, 1066 00:33:26,971 --> 00:33:31,809 MOST NORMS ARE NOT FIXED AND 1067 00:33:31,876 --> 00:33:34,445 THEIR EXPRESSIONINGS OF VALUES 1068 00:33:34,512 --> 00:33:36,748 WE HAVE AS A SOCIETY, I THINK 1069 00:33:36,814 --> 00:33:38,149 ORGAN DONATION IS THE PERFECT 1070 00:33:38,216 --> 00:33:38,916 EXAMPLE OF THAT. 1071 00:33:38,983 --> 00:33:40,585 THE EARLY DAYS OF ORGAN 1072 00:33:40,651 --> 00:33:41,786 PROCUREMENT, THAT FUNDAMENTALLY 1073 00:33:41,853 --> 00:33:42,787 CHALLENGED WHAT PEOPLE THOUGHT 1074 00:33:42,854 --> 00:33:43,921 WAS APPROPRIATE AND IS CURRENTLY 1075 00:33:43,988 --> 00:33:45,957 VERY MUCH WITHIN THE NORM THAT 1076 00:33:46,023 --> 00:33:47,492 PEOPLE THINK ABOUT WITH REGARD 1077 00:33:47,558 --> 00:33:49,360 TO APPROPRIATE TREATMENT OF DEAD 1078 00:33:49,427 --> 00:33:49,594 PERSONS. 1079 00:33:49,660 --> 00:33:51,796 SO I THINK IT'S KEY THAT NORMS 1080 00:33:51,863 --> 00:33:53,531 CAN BE CHANGED, ESPECIALLY WHEN 1081 00:33:53,598 --> 00:33:56,801 THEY'RE MOVED TOWARDS SOMETHING 1082 00:33:56,868 --> 00:33:59,637 THAT HAS AN IMPORTANT VALUE TO 1083 00:33:59,704 --> 00:34:02,507 SOCIETY. 1084 00:34:02,573 --> 00:34:05,076 IN TERMS OF HARMS TO 1085 00:34:05,143 --> 00:34:06,577 INDIVIDUALS, THE WORRYS ABOUT 1086 00:34:06,644 --> 00:34:07,745 HASTENING DEATH AND OTHER 1087 00:34:07,812 --> 00:34:09,614 PHYSICAL HARMS I THINK ARE 1088 00:34:09,680 --> 00:34:13,117 LARGELY OBVIATED BY RESTRICTION 1089 00:34:13,184 --> 00:34:15,019 FOR PERSONS TO WHOM THE OUTCOME 1090 00:34:15,086 --> 00:34:15,920 IS VERY CLEARLY CERTAIN. 1091 00:34:15,987 --> 00:34:17,188 DAVE AND I WERE TALKING ABOUT 1092 00:34:17,255 --> 00:34:17,488 THIS BEFORE. 1093 00:34:17,555 --> 00:34:18,756 THERE CERTAINLY IS A BIG RANGE 1094 00:34:18,823 --> 00:34:21,626 OF WHAT CONSTITUTES NEARLY DEAD 1095 00:34:21,692 --> 00:34:23,127 PERSONS, AND THAT'S WHERE WE 1096 00:34:23,194 --> 00:34:25,863 TEND TO THINK MORE ABOUT 1097 00:34:25,930 --> 00:34:27,198 POTENTIAL HARMS REGARDING HOW 1098 00:34:27,265 --> 00:34:30,468 THE DEATH PROCESS OCCURS OR 1099 00:34:30,535 --> 00:34:32,336 CONCERNS FOR POTENTIAL SUFFERING 1100 00:34:32,403 --> 00:34:33,671 OR OTHER KINDS OF PAIN PEOPLE 1101 00:34:33,738 --> 00:34:34,972 MIGHT HAVE, BUT IN GENERAL, MANY 1102 00:34:35,039 --> 00:34:38,609 OF THESE STUDIES RESTRICT 1103 00:34:38,676 --> 00:34:40,011 INCLUSION TO PERSONS FOR WHOM 1104 00:34:40,077 --> 00:34:41,345 THE OUTCOME IS RELATIVELY CLEAR 1105 00:34:41,412 --> 00:34:42,880 AND WE DON'T WORRY AS MUCH ABOUT 1106 00:34:42,947 --> 00:34:46,384 THOSE PHYSICAL HARMS. 1107 00:34:46,451 --> 00:34:47,819 IN TERMS OF DIGNITARY HARMS, I 1108 00:34:47,885 --> 00:34:50,655 THINK IT'S REALLY IMPORTANT TO 1109 00:34:50,721 --> 00:34:52,190 COME BACK TO THIS NOTION OF 1110 00:34:52,256 --> 00:34:55,193 AUTHORIZATION OR CONSENT. 1111 00:34:55,259 --> 00:34:58,229 I DO THINK WE THINK OF DIGNITY 1112 00:34:58,296 --> 00:34:59,730 AS BEING LARGELY RELATED TO WHAT 1113 00:34:59,797 --> 00:35:01,933 PEOPLE CARE ABOUT, SO IT'S VERY 1114 00:35:01,999 --> 00:35:03,801 DIFFICULT TO MAKE JUDGMENTS 1115 00:35:03,868 --> 00:35:05,336 ACROSS THE BOARD ABOUT WHAT IS 1116 00:35:05,403 --> 00:35:07,972 AND ISN'T A DIGNIFIED DEATH, 1117 00:35:08,039 --> 00:35:08,840 ESPECIALLY IN THE ABSENCE OF 1118 00:35:08,906 --> 00:35:10,174 KNOWING WHAT PEOPLE CARED ABOUT. 1119 00:35:10,241 --> 00:35:11,676 I THINK WHEN YOU THINK ABOUT THE 1120 00:35:11,742 --> 00:35:15,213 CASE OF G.L., MY GUESS IS FROM 1121 00:35:15,279 --> 00:35:16,581 WHAT WAS DESCRIBED, THIS WOULD 1122 00:35:16,647 --> 00:35:19,917 NOT BE A VIOLATION OF HER 1123 00:35:19,984 --> 00:35:21,118 DIGNITY BECAUSE, IN FACT, HER 1124 00:35:21,185 --> 00:35:22,553 NOTION OF WHO SHE WAS WAS 1125 00:35:22,620 --> 00:35:23,621 SOMEBODY WHO WANTED TO 1126 00:35:23,688 --> 00:35:25,189 CONTRIBUTE TO SOCIETY AND THAT'S 1127 00:35:25,256 --> 00:35:30,895 VERY MUCH CONSISTENT WITH THIS. 1128 00:35:30,962 --> 00:35:34,065 IN TERMS OF HARMS TO THE FAMILY, 1129 00:35:34,131 --> 00:35:35,500 THE PRIMARY WORRY AS I MENTIONED 1130 00:35:35,566 --> 00:35:36,934 IS ABOUT INTERFERING WITH THE 1131 00:35:37,001 --> 00:35:40,204 DEATH OR GRIEVING PROCESS, AND 1132 00:35:40,271 --> 00:35:43,941 THIS, I THINK, HAS TWO REAL WAYS 1133 00:35:44,008 --> 00:35:44,408 TO OBVIATE. 1134 00:35:44,475 --> 00:35:45,710 ONE IS, AS WE TALKED ABOUT 1135 00:35:45,776 --> 00:35:47,245 ALREADY, THE NOTION OF CONSENT 1136 00:35:47,311 --> 00:35:49,881 OR AUTHORIZATION, AND THE OTHER 1137 00:35:49,947 --> 00:35:51,482 IS WE HAVE A LONG EXPERIENCE 1138 00:35:51,549 --> 00:35:53,384 LEARNING HOW TO DEAL WITH PEOPLE 1139 00:35:53,451 --> 00:35:56,420 IN THESE CIRCUMSTANCES TO MEET 1140 00:35:56,487 --> 00:35:57,989 THEIR NEEDS FROM AN EMOTIONAL 1141 00:35:58,055 --> 00:35:58,856 SUPPORT PERSPECTIVE AND 1142 00:35:58,923 --> 00:36:00,057 UNDERSTAND THEIR EXPECTATIONS 1143 00:36:00,124 --> 00:36:01,692 ABOUT THE DYING PROCESS FROM 1144 00:36:01,759 --> 00:36:03,594 YEARS WITH ORGAN DONATION AND 1145 00:36:03,661 --> 00:36:04,028 PROCUREMENT. 1146 00:36:04,095 --> 00:36:05,329 IT DOESN'T MEAN WE HAVE THESE 1147 00:36:05,396 --> 00:36:06,531 ALL WRAPPED UP WITH REGARD TO 1148 00:36:06,597 --> 00:36:09,834 HOW TO HANDLE THESE SITUATIONS, 1149 00:36:09,901 --> 00:36:11,035 BUT WE CERTAINLY HAVE EXPERIENCE 1150 00:36:11,102 --> 00:36:12,236 TO DRAW FROM. 1151 00:36:12,303 --> 00:36:13,437 THE NON-SUBJECT CENTERED 1152 00:36:13,504 --> 00:36:16,507 CONCERNS, I THINK, ARE 1153 00:36:16,574 --> 00:36:17,608 INTERESTING AND TEND TO BE VERY 1154 00:36:17,675 --> 00:36:18,643 PRACTICAL IN THEIR FOCUS. 1155 00:36:18,709 --> 00:36:20,878 IN TERMS OF DIVERSION OF 1156 00:36:20,945 --> 00:36:23,848 RESOURCES, THIS CERTAINLY ISN'T 1157 00:36:23,915 --> 00:36:24,949 A UNIQUE PROBLEM IN RESEARCH. 1158 00:36:25,016 --> 00:36:26,250 EVERYTHING THAT WE DO THAT 1159 00:36:26,317 --> 00:36:29,020 INVOLVES RESEARCH THAT'S 1160 00:36:29,086 --> 00:36:31,222 INTEGRATED WITHIN THE CLINICAL 1161 00:36:31,289 --> 00:36:32,957 DELIVERY SYSTEM IN SOME WAYS 1162 00:36:33,024 --> 00:36:33,824 REQUIRES PRIORITIZATION AND WE 1163 00:36:33,891 --> 00:36:35,059 HAVE TO FIGURE OUT HOW TO MAKE 1164 00:36:35,126 --> 00:36:36,794 SURE WE DON'T COMPROMISE OTHER 1165 00:36:36,861 --> 00:36:37,895 MISSIONS, SO THERE'S A QUESTION 1166 00:36:37,962 --> 00:36:39,564 OF HOW MUCH WE ALLOW, HOW OFTEN 1167 00:36:39,630 --> 00:36:41,198 WE DO IT, HOW WE STRUCTURE IT, 1168 00:36:41,265 --> 00:36:42,500 BUT I DON'T THINK IT'S A 1169 00:36:42,567 --> 00:36:44,135 FUNDAMENTAL PROBLEM. 1170 00:36:44,201 --> 00:36:45,570 IN TERMS OF HARMS TO STAFF, THE 1171 00:36:45,636 --> 00:36:47,204 MOST STRAIGHTFORWARD SOLUTION AT 1172 00:36:47,271 --> 00:36:48,773 LEAST CONCEPTUALLY IS IF SOMEONE 1173 00:36:48,839 --> 00:36:50,074 HAS OBJECTIONS TO PARTICIPATING 1174 00:36:50,141 --> 00:36:52,376 IN THESE KIND OF RESEARCH, IT 1175 00:36:52,443 --> 00:36:53,678 PROBABLY VERY IMPORTANT. 1176 00:36:53,744 --> 00:36:54,111 FOR US 1177 00:36:54,178 --> 00:36:56,247 TO OFFER THEM OPPORTUNITIES TO 1178 00:36:56,314 --> 00:36:57,748 OPT OUT. 1179 00:36:57,815 --> 00:36:59,083 THAT DOESN'T MEAN IT'S EASY TO 1180 00:36:59,150 --> 00:37:00,484 IMPLEMENT BUT AT LEAST 1181 00:37:00,551 --> 00:37:01,485 CONCEPTUALLY, IT'S NOT A 1182 00:37:01,552 --> 00:37:02,386 COMPLICATED PROBLEM. 1183 00:37:02,453 --> 00:37:04,789 AND IN TERMS OF EROSION OF TRUST 1184 00:37:04,855 --> 00:37:05,656 AND COMMUNITY, THIS ALSO IS 1185 00:37:05,723 --> 00:37:07,758 SOMETHING THAT'S REALLY CORE TO 1186 00:37:07,825 --> 00:37:09,060 WHAT WE THINK ABOUT RESEARCH 1187 00:37:09,126 --> 00:37:10,061 ETHICS ALL THE TIME, RIGHT? 1188 00:37:10,127 --> 00:37:11,829 WE DO A LOT OF THINGS IN THE 1189 00:37:11,896 --> 00:37:12,697 CONTEXT OF RESEARCH THAT ARE 1190 00:37:12,763 --> 00:37:14,765 DIFFERENT FROM WHAT PEOPLE'S 1191 00:37:14,832 --> 00:37:17,501 EXPECTATIONS ARE. 1192 00:37:17,568 --> 00:37:20,571 AND IT DOESN'T MEAN THIS ISN'T A 1193 00:37:20,638 --> 00:37:21,672 POTENTIALLY THORNIER SET OF 1194 00:37:21,739 --> 00:37:22,673 ISSUES OR REQUIRES MORE WORK, 1195 00:37:22,740 --> 00:37:24,742 BUT I THINK USING TOOLS OF 1196 00:37:24,809 --> 00:37:25,509 TRANSPARENCY, GOOD 1197 00:37:25,576 --> 00:37:26,844 COMMUNICATION, DEMONSTRATION OF 1198 00:37:26,911 --> 00:37:28,479 VALUE AND PROPER ENGAGEMENT OF 1199 00:37:28,546 --> 00:37:29,580 STAKEHOLDERS, I DON'T KNOW THAT 1200 00:37:29,647 --> 00:37:30,448 THERE'S ANY REASON TO BELIEVE 1201 00:37:30,514 --> 00:37:32,016 THAT THIS IS A FUNDAMENTAL 1202 00:37:32,083 --> 00:37:35,286 PROBLEM. 1203 00:37:35,353 --> 00:37:36,821 SO IN ALL OF THESE CASES THOUGH 1204 00:37:36,887 --> 00:37:38,122 AS I'VE STARTED TO GET AT, I 1205 00:37:38,189 --> 00:37:39,757 THINK THE DEVIL IS IN THE 1206 00:37:39,824 --> 00:37:41,392 DETAILS, PROBABLY MUCH MORE SO 1207 00:37:41,459 --> 00:37:43,494 THAN IT IS IN BIG PICTURE 1208 00:37:43,561 --> 00:37:44,061 CONCEPTUAL QUESTIONS. 1209 00:37:44,128 --> 00:37:45,363 SO LET'S SORT OF LOOK BACK AT A 1210 00:37:45,429 --> 00:37:46,764 COUPLE OF THE SPECIFIC ISSUES 1211 00:37:46,831 --> 00:37:48,799 THAT I THINK KATHLEEN HAS RAISED 1212 00:37:48,866 --> 00:37:50,201 AN THAT WE TEND TO THINK ABOUT A 1213 00:37:50,267 --> 00:37:52,269 LOT IN THESE KIND OF CONTEXTS. 1214 00:37:52,336 --> 00:37:53,504 SO ONE IS THE ROLE OF CONSENT. 1215 00:37:53,571 --> 00:37:56,774 SO IN THIS CASE, G.L. DID NOT 1216 00:37:56,841 --> 00:37:57,775 PROVIDE CONSENT FOR BEING IN 1217 00:37:57,842 --> 00:38:00,177 THIS STUDY, BUT THE FAMILY 1218 00:38:00,244 --> 00:38:01,145 AUTHORIZED INCLUSION AND SOME 1219 00:38:01,212 --> 00:38:03,447 PEOPLE MIGHT FIND THAT 1220 00:38:03,514 --> 00:38:04,982 PROBLEMATIC. 1221 00:38:05,049 --> 00:38:06,417 ONE REASON PEOPLE MIGHT FIND 1222 00:38:06,484 --> 00:38:07,518 THAT PROBLEMATIC IS IN GENERAL, 1223 00:38:07,585 --> 00:38:09,020 WE HAVE GREATER BOUNDARIES 1224 00:38:09,086 --> 00:38:10,688 AROUND SURROGATE CONSENT FOR 1225 00:38:10,755 --> 00:38:11,889 RESEARCH THAT DOESN'T HAVE 1226 00:38:11,956 --> 00:38:13,557 POTENTIAL FOR DIRECT BENEFIT. 1227 00:38:13,624 --> 00:38:17,395 YOU LOOK AT KIDS OR OTHER 1228 00:38:17,461 --> 00:38:18,396 POPULATIONS THAT DON'T HAVE 1229 00:38:18,462 --> 00:38:21,565 CAPACITY, WE DON'T LET THEM, WE 1230 00:38:21,632 --> 00:38:22,133 SET RISK CAPS. 1231 00:38:22,199 --> 00:38:23,567 SO THE THINGS WE LET PEOPLE TO 1232 00:38:23,634 --> 00:38:26,404 AGREE TO THEMSELVES, WE DON'T 1233 00:38:26,470 --> 00:38:27,538 LET OTHERS AGREE TO FOR THEM. 1234 00:38:27,605 --> 00:38:28,873 BUT GENERALLY THAT'S BASED ON A 1235 00:38:28,939 --> 00:38:30,508 NOTION OF HEALTH RISKS, RIGHT, 1236 00:38:30,574 --> 00:38:33,144 WHICH ISN'T PRESENT HERE. 1237 00:38:33,210 --> 00:38:33,944 WE ALLOW PEOPLE, ON THE OTHER 1238 00:38:34,011 --> 00:38:36,147 HAND, TO MAKE DECISIONS ABOUT 1239 00:38:36,213 --> 00:38:37,682 ORGAN DONATION, ABOUT ALMOST 1240 00:38:37,748 --> 00:38:39,083 EVERY OTHER ASPECT OF HOW OUR 1241 00:38:39,150 --> 00:38:40,751 BODY IS TREATED AFTER DEATH AND 1242 00:38:40,818 --> 00:38:42,386 I DON'T REALLY SEE A REASON FOR 1243 00:38:42,453 --> 00:38:43,587 WHY WE WOULD MAKE A DISTINCTION 1244 00:38:43,654 --> 00:38:44,155 HERE. 1245 00:38:44,221 --> 00:38:46,223 MOREOVER, IN THIS PARTICULAR 1246 00:38:46,290 --> 00:38:47,425 CASE, EVERYTHING ABOUT G.L. 1247 00:38:47,491 --> 00:38:48,426 SEEMS CONSISTENT WITH THIS, AND 1248 00:38:48,492 --> 00:38:51,395 IT SEEMS TO BE A VERY GOOD 1249 00:38:51,462 --> 00:38:52,563 APPLICATION OF THE SUBSTITUTED 1250 00:38:52,630 --> 00:38:52,963 JUDGMENT. 1251 00:38:53,030 --> 00:38:54,265 I THINK THE BIGGER ETHICAL 1252 00:38:54,331 --> 00:38:55,232 CHALLENGE MIGHT BE IF YOU RUN 1253 00:38:55,299 --> 00:38:56,333 INTO SITUATIONS WHERE THE FAMILY 1254 00:38:56,400 --> 00:38:57,768 ISN'T SUPPORTIVE, BUT G.L. HAD 1255 00:38:57,835 --> 00:38:58,769 MADE IT VERY CLEAR THAT SHE 1256 00:38:58,836 --> 00:39:00,104 WANTED TO PARTICIPATE. 1257 00:39:00,171 --> 00:39:01,405 ONE OF THE STUDIES THAT DAVE AND 1258 00:39:01,472 --> 00:39:03,074 I DID YEARS AND YEARS AGO WAS 1259 00:39:03,140 --> 00:39:05,142 ABOUT HOW OPOs HANDLE 1260 00:39:05,209 --> 00:39:07,978 QUESTIONS WHEN AN INDIVIDUAL HAS 1261 00:39:08,045 --> 00:39:09,313 VERY CLEARLY EXPRESSED A WISH TO 1262 00:39:09,380 --> 00:39:10,314 DONATE AND THE FAMILY HAS 1263 00:39:10,381 --> 00:39:10,614 OBJECTIONS. 1264 00:39:10,681 --> 00:39:12,917 SO THOSE ISSUES COULD 1265 00:39:12,983 --> 00:39:13,718 POTENTIALLY BECOME MORE 1266 00:39:13,784 --> 00:39:15,553 CHALLENGING. 1267 00:39:15,619 --> 00:39:17,221 IN TERMS OF BOUNDARIES OF 1268 00:39:17,288 --> 00:39:21,258 RESPECTFUL CONDUCT, THIS STUDY 1269 00:39:21,325 --> 00:39:22,159 INVOLVES DOING SOMETHING THAT'S 1270 00:39:22,226 --> 00:39:23,894 VERY DIFFERENT FROM WHAT MOST 1271 00:39:23,961 --> 00:39:24,662 PEOPLE IMAGINE IF THEY WERE 1272 00:39:24,729 --> 00:39:27,064 BRAIN DEAD. 1273 00:39:27,131 --> 00:39:28,966 PERFORMING A TRANSPLANT SURGERY, 1274 00:39:29,033 --> 00:39:30,267 HARVESTING THE ORGAN, MECHANICAL 1275 00:39:30,334 --> 00:39:31,702 VENTILATION AND OTHER NECESSARY 1276 00:39:31,769 --> 00:39:32,603 MEDICAL INTERVENTIONS. 1277 00:39:32,670 --> 00:39:33,804 I THINK IT'S REALLY IMPORTANT TO 1278 00:39:33,871 --> 00:39:35,239 NOTE THESE ARE ALL ACCEPTED 1279 00:39:35,306 --> 00:39:37,174 PRACTICES WITHIN NORMAL MEDICAL 1280 00:39:37,241 --> 00:39:39,043 CARE AND REALLY CONSISTENT WITH 1281 00:39:39,110 --> 00:39:40,711 WHAT HAPPENS IN ORGAN DONATION 1282 00:39:40,778 --> 00:39:41,712 AND PROCUREMENT ALREADY. 1283 00:39:41,779 --> 00:39:43,814 IT'S DIFFICULT FOR ME TO SEE WHY 1284 00:39:43,881 --> 00:39:46,217 THE SPECIFIC PROCEDURES RAISE 1285 00:39:46,283 --> 00:39:48,085 SUBSTANTIAL QUESTIONS IN AND OF 1286 00:39:48,152 --> 00:39:48,385 THEMSELVES. 1287 00:39:48,452 --> 00:39:49,820 WHERE I THINK THE CONTROVERSY 1288 00:39:49,887 --> 00:39:52,556 TENDS TO BE IS MORE IN SORT OF 1289 00:39:52,623 --> 00:39:53,624 TWO AREAS. 1290 00:39:53,691 --> 00:39:56,327 ONE IS I THINK PEOPLE TEND TO BE 1291 00:39:56,393 --> 00:39:57,862 PARTICULARLY SENSITIVE ABOUT 1292 00:39:57,928 --> 00:39:58,763 RESUSCITATION, SO IF YOU WERE 1293 00:39:58,829 --> 00:40:00,831 DOING THIS, SO THIS IS A PERFECT 1294 00:40:00,898 --> 00:40:03,901 EXAMPLE, YOU DO A HEART 1295 00:40:03,968 --> 00:40:05,569 TRANSPLANT AND THE PATIENT GOES 1296 00:40:05,636 --> 00:40:06,871 INTO DEFIB RIGHT AFTERWARDS IN 1297 00:40:06,937 --> 00:40:08,205 THE CONTEXT OF ACUTE REJECTION, 1298 00:40:08,272 --> 00:40:10,608 WOULD YOU SHOCK THEM BACK? 1299 00:40:10,674 --> 00:40:12,943 THAT'S SOMETHING THAT SOMETIMES 1300 00:40:13,010 --> 00:40:15,212 PEOPLE HAVE SUGGESTED, 1301 00:40:15,279 --> 00:40:17,748 RESUSCITATION IS A LI LINE THAT 1302 00:40:17,815 --> 00:40:18,949 SHOULDN'T BE CROSSED IN THAT 1303 00:40:19,016 --> 00:40:20,050 CONTEXT. 1304 00:40:20,117 --> 00:40:21,385 I'LL SAY ESPECIALLY IN THIS 1305 00:40:21,452 --> 00:40:22,253 CONTEXT, I DON'T UNDERSTAND THIS 1306 00:40:22,319 --> 00:40:22,887 REASON. 1307 00:40:22,953 --> 00:40:24,455 IT'S CONSISTENT WITH WHAT WE DO 1308 00:40:24,522 --> 00:40:25,589 WITH A PATIENT IN THAT CONTEXT, 1309 00:40:25,656 --> 00:40:26,857 SO IT ACTUALLY MIGHT BE QUITE 1310 00:40:26,924 --> 00:40:27,958 IMPORTANT TO BE ABLE TO 1311 00:40:28,025 --> 00:40:28,959 UNDERSTAND HOW PEOPLE RESPOND TO 1312 00:40:29,026 --> 00:40:29,527 THIS. 1313 00:40:29,593 --> 00:40:31,362 SO I DON'T KNOW THAT THERE'S ANY 1314 00:40:31,428 --> 00:40:34,231 OBVIOUS BARRIER RELATED TO 1315 00:40:34,298 --> 00:40:34,698 RESUSCITATION. 1316 00:40:34,765 --> 00:40:38,269 WHERE I THINK YOU RUN INTO 1317 00:40:38,335 --> 00:40:39,503 PARTICULAR CONCERNS ARE WHEN WE 1318 00:40:39,570 --> 00:40:40,905 THINK ABOUT KINDS OF INTENTIONAL 1319 00:40:40,971 --> 00:40:42,873 INSULTS OR TRAUMA. 1320 00:40:42,940 --> 00:40:44,642 SO IMAGINE IF YOU WERE DOING 1321 00:40:44,708 --> 00:40:46,277 TRAUMA RESEARCH AND IT INVOLVES 1322 00:40:46,343 --> 00:40:47,678 A GUNSHOT WOUND, IF WE THINK 1323 00:40:47,745 --> 00:40:48,913 ABOUT HAVING SOMEONE AND WE HAVE 1324 00:40:48,979 --> 00:40:52,750 TO GO SHOOT THEM, WHILE BRAIN 1325 00:40:52,817 --> 00:40:53,851 DEAD, THAT'S GOING TO TURN 1326 00:40:53,918 --> 00:40:55,085 PEOPLE'S STOMACHS, RIGHT? 1327 00:40:55,152 --> 00:40:57,154 IN A WAY THAT THINGS THAT -- 1328 00:40:57,221 --> 00:40:58,689 RAISES SOMETHING WE DON'T 1329 00:40:58,756 --> 00:40:59,123 NORMALLY DO. 1330 00:40:59,190 --> 00:41:00,691 I THINK IT'S A REALLY GOOD -- 1331 00:41:00,758 --> 00:41:01,759 I'D LIKE US TO THINK THROUGH 1332 00:41:01,826 --> 00:41:02,860 CASES LIKE THAT A LITTLE BIT 1333 00:41:02,927 --> 00:41:03,994 MORE, ABOUT WHERE DO THE 1334 00:41:04,061 --> 00:41:05,963 BOUNDARIES REALLY LIE. 1335 00:41:06,030 --> 00:41:07,765 I THINK THE KEY DETERMINANT HAS 1336 00:41:07,832 --> 00:41:09,266 TO BE WHETHER IT'S JUSTIFIED BY 1337 00:41:09,333 --> 00:41:11,669 THE SCIENCE. 1338 00:41:11,735 --> 00:41:13,737 BUT I DO THINK AS I MENTIONED 1339 00:41:13,804 --> 00:41:19,210 EARLY ON, THERE'S A LOT OF 1340 00:41:19,276 --> 00:41:20,578 EXAMPLES, WHETHER PUTTING BODIES 1341 00:41:20,644 --> 00:41:22,213 IN TRUNKS OR USING THEM IN CRASH 1342 00:41:22,279 --> 00:41:24,615 TEST SIMULATIONS OR OTHER THINGS 1343 00:41:24,682 --> 00:41:25,716 THAT PUSH BOUNDARIES A LOT 1344 00:41:25,783 --> 00:41:28,352 FURTHER THAN WE MIGHT RECOGNIZE. 1345 00:41:28,419 --> 00:41:29,553 HOLLY'S QUESTION ABOUT LENGTH OF 1346 00:41:29,620 --> 00:41:30,221 TIME, RIGHT? 1347 00:41:30,287 --> 00:41:36,260 AND THIS IS A WEBSITE FROM THE 1348 00:41:36,327 --> 00:41:37,695 MIU EXPERIENCE OF THE FIRST 1349 00:41:37,761 --> 00:41:40,397 STUDY OF PIG KIDNEYS, 1350 00:41:40,464 --> 00:41:42,266 XENOTRANSPLANTATION, WHERE 1351 00:41:42,333 --> 00:41:46,136 SOMEONE WAS BASICALLY KEPT 1352 00:41:46,203 --> 00:41:47,471 PERFUSING FOR TWO MONTHS. 1353 00:41:47,538 --> 00:41:50,941 SO THAT'S A LONG TIME TO THINK 1354 00:41:51,008 --> 00:41:52,243 ABOUT ENROLLMENT TO WHEN A 1355 00:41:52,309 --> 00:41:54,712 FUNERAL HAPPENS FOR THAT 1356 00:41:54,778 --> 00:41:54,945 PATIENT. 1357 00:41:55,012 --> 00:41:56,347 AND I THINK IT'S A REALLY GOOD 1358 00:41:56,413 --> 00:41:58,616 QUESTION AND PROBABLY MAY BE THE 1359 00:41:58,682 --> 00:41:59,450 CENTRAL QUESTION PEOPLE THINK 1360 00:41:59,516 --> 00:42:02,586 ABOUT IS REALLY HOW LONG IS TOO 1361 00:42:02,653 --> 00:42:03,787 LONG. 1362 00:42:03,854 --> 00:42:05,556 IT'S NO QUESTION THE TIME FRAMES 1363 00:42:05,623 --> 00:42:07,124 HAVE TO BE JUSTIFIED BY THE 1364 00:42:07,191 --> 00:42:07,358 SCIENCE. 1365 00:42:07,424 --> 00:42:08,559 WHEN YOU LOOK AT THE HISTORY OF 1366 00:42:08,626 --> 00:42:09,326 GUIDELINES THAT HAVE BEEN 1367 00:42:09,393 --> 00:42:11,395 PROPOSED IN THIS SPACE, YOU SEE 1368 00:42:11,462 --> 00:42:12,730 EVERYTHING FROM SORT OF SEVERAL 1369 00:42:12,796 --> 00:42:16,367 HOURS LIKE WAS THE CASE IN THE 1370 00:42:16,433 --> 00:42:19,637 2B/3A STUDIES, TO SORT OF "IT 1371 00:42:19,703 --> 00:42:19,904 DEPENDS." 1372 00:42:19,970 --> 00:42:21,739 I THINK EXTENDED PERIODS OF TIME 1373 00:42:21,805 --> 00:42:22,406 ARE PARTICULARLY CHALLENGING 1374 00:42:22,473 --> 00:42:24,842 WHEN YOU THINK ABOUT THE FAMILY 1375 00:42:24,909 --> 00:42:25,943 PERSPECTIVE. 1376 00:42:26,010 --> 00:42:27,144 WE'LL CREATE A FUNDAMENTALLY 1377 00:42:27,211 --> 00:42:28,545 DIFFERENT PROCESS FOR DYING AND 1378 00:42:28,612 --> 00:42:29,280 GRIEVING. 1379 00:42:29,346 --> 00:42:30,447 AND MAKE IT REALLY IMPORTANT TO 1380 00:42:30,514 --> 00:42:32,116 BE CLEAR ABOUT WHETHER YOU ALLOW 1381 00:42:32,182 --> 00:42:33,851 FAMILIES TO VISIT, WHETHER 1382 00:42:33,918 --> 00:42:35,052 YOU -- WHAT KINDS OF UPDATES YOU 1383 00:42:35,119 --> 00:42:36,153 GIVE THEM. 1384 00:42:36,220 --> 00:42:37,588 I THINK TO JUST SAY WE'RE NOT 1385 00:42:37,655 --> 00:42:41,292 GOING TO DO THAT SEEMS DEEPLY 1386 00:42:41,358 --> 00:42:42,760 PROBLEMATIC AND DOESN'T 1387 00:42:42,826 --> 00:42:44,061 ACKNOWLEDGE THE WAY PEOPLE 1388 00:42:44,128 --> 00:42:45,296 EXPECT DEATH TO OCCUR, BUT HOW 1389 00:42:45,362 --> 00:42:46,797 TO MAKE THAT HAPPEN IS IMPORTANT 1390 00:42:46,864 --> 00:42:50,100 TO THINK THROUGH. 1391 00:42:50,167 --> 00:42:53,203 I THINK LONG STUDIES RUN THE 1392 00:42:53,270 --> 00:42:55,372 RISK OF WITHDRAWAL WHEN YOU'VE 1393 00:42:55,439 --> 00:42:56,240 GOT A LOT INVESTED. 1394 00:42:56,307 --> 00:42:58,275 YOU'VE GOT A TWO MONTH END POINT 1395 00:42:58,342 --> 00:42:59,343 FOR XENOTRANSPLANTATION STUDY 1396 00:42:59,410 --> 00:43:00,477 AND A MONTH AND A HALF IN 1397 00:43:00,544 --> 00:43:01,912 SOMEBODY SAYS WE'RE DONE, UNPLUG 1398 00:43:01,979 --> 00:43:02,680 HER. 1399 00:43:02,746 --> 00:43:04,315 THAT'S A DISASTER. 1400 00:43:04,381 --> 00:43:06,116 AND SO WE HAVE TO THINK ABOUT 1401 00:43:06,183 --> 00:43:06,850 THIS ESPECIALLY IN THE CONTEXT 1402 00:43:06,917 --> 00:43:09,820 OF STUDIES WITH VERY LONG 1403 00:43:09,887 --> 00:43:10,487 DURATION. 1404 00:43:10,554 --> 00:43:11,889 I THINK WE ALSO DON'T HAVE A LOT 1405 00:43:11,956 --> 00:43:12,990 OF GOOD EVIDENCE ABOUT WHAT 1406 00:43:13,057 --> 00:43:13,857 PEOPLE THINK AND MORE 1407 00:43:13,924 --> 00:43:14,892 IMPORTANTLY, WHAT PEOPLE'S 1408 00:43:14,959 --> 00:43:16,760 EXPERIENCES ARE IN THIS CONTEXT. 1409 00:43:16,827 --> 00:43:20,030 SO ONE OF THE THINGS THAT I'LL 1410 00:43:20,097 --> 00:43:21,565 EMPHASIZE THROUGHOUT ALL OF THIS 1411 00:43:21,632 --> 00:43:22,466 IS IT'S IMPORTANT TO UNDERSTAND 1412 00:43:22,533 --> 00:43:23,801 THAT IN THE PROCESS. 1413 00:43:23,867 --> 00:43:25,336 IN TERMS OF OUR INTERACTIONS, 1414 00:43:25,402 --> 00:43:26,337 I'VE ALREADY GONE THROUGH THIS 1415 00:43:26,403 --> 00:43:27,237 BEFORE, BUT WE'RE NOT STARTING 1416 00:43:27,304 --> 00:43:28,505 FROM SCRATCH, WE DO HAVE A LOT 1417 00:43:28,572 --> 00:43:30,841 OF EXPERIENCE IN HOW TO INTERACT 1418 00:43:30,908 --> 00:43:33,677 WITH FAMILIES OF DYING PATIENTS, 1419 00:43:33,744 --> 00:43:34,878 AND OBVIOUSLY HOW WE DO THIS HAS 1420 00:43:34,945 --> 00:43:36,013 TO BE ANCHORED IN THE SPECIFICS 1421 00:43:36,080 --> 00:43:36,880 OF THE PROTOCOL. 1422 00:43:36,947 --> 00:43:39,083 AND AGAIN, I THINK IT'S REALLY 1423 00:43:39,149 --> 00:43:40,384 IMPORTANT TO DO RIGOROUS 1424 00:43:40,451 --> 00:43:41,285 EMPIRICAL RESEARCH INTO THE 1425 00:43:41,352 --> 00:43:42,286 EXPERIENCES OF FAMILIES WHO HAVE 1426 00:43:42,353 --> 00:43:44,355 BEEN THROUGH THIS. 1427 00:43:44,421 --> 00:43:45,789 THERE'S LOTS OF THEORETICAL 1428 00:43:45,856 --> 00:43:47,091 CONCERNS AND A LOT TO DERIVE 1429 00:43:47,157 --> 00:43:52,396 FROM CLINICAL CON TECHS T T CONY 1430 00:43:52,463 --> 00:43:56,800 HOME FOR DIFFERENT OU OUTCOMES. 1431 00:43:56,867 --> 00:43:57,868 SO THE LOCATION OF THE RESEARCH 1432 00:43:57,935 --> 00:43:59,536 AND TEAM COMPOSITION, I'LL SORT 1433 00:43:59,603 --> 00:44:00,637 OF WRAP UP WITH THE LAST COUPLE 1434 00:44:00,704 --> 00:44:03,273 OF SLIDES HERE. 1435 00:44:03,340 --> 00:44:04,308 IT IS AN INTERESTING QUESTION 1436 00:44:04,375 --> 00:44:05,342 WHETHER THIS SHOULD BE DONE 1437 00:44:05,409 --> 00:44:06,010 WITHIN CLINICAL UNITS. 1438 00:44:06,076 --> 00:44:07,244 THAT'S NOT AN EASY THING TO JUST 1439 00:44:07,311 --> 00:44:09,213 SAY YOU SET UP AN ICU TO RUN A 1440 00:44:09,279 --> 00:44:14,018 STUDY OF ONE PERSON. 1441 00:44:14,084 --> 00:44:16,020 SO HOW TO THINK ABOUT HOW TO 1442 00:44:16,086 --> 00:44:18,889 GEOGRAPHICALLY LOCATE THIS IS A 1443 00:44:18,956 --> 00:44:19,490 REALLY IMPORTANT QUESTION IN 1444 00:44:19,556 --> 00:44:20,557 TERMS OF WHAT RESOURCES ARE 1445 00:44:20,624 --> 00:44:21,225 AVAILABLE, AND THERE'S LOTS OF 1446 00:44:21,291 --> 00:44:22,426 WAYS IN WHICH SEPARATION WOULD 1447 00:44:22,493 --> 00:44:24,495 BE DESIRABLE BUT NOT DOABLE IN 1448 00:44:24,561 --> 00:44:25,396 MANY FACILITIES. 1449 00:44:25,462 --> 00:44:26,830 YOU ALL MAY BE A UNIQUE SPACE 1450 00:44:26,897 --> 00:44:29,333 FOR THIS, RIGHT, IT'S A RESEARCH 1451 00:44:29,400 --> 00:44:29,700 HOSPITAL. 1452 00:44:29,767 --> 00:44:32,469 NOT EVERY HOSPITAL IS LIKE THAT. 1453 00:44:32,536 --> 00:44:33,771 IT MAY BE IMPORTANT TO HAVE 1454 00:44:33,837 --> 00:44:34,972 ISOLATED CENTERS WHERE YOU 1455 00:44:35,039 --> 00:44:36,040 DEVELOP EXPERTISE AND TBRUCT TO 1456 00:44:36,106 --> 00:44:38,742 DOINFRASTRUCTURE TO DO THIS KIND 1457 00:44:38,809 --> 00:44:38,976 OF WORK. 1458 00:44:39,043 --> 00:44:42,279 SO THE OTHER SORT OF STICKY 1459 00:44:42,346 --> 00:44:44,481 ISSUES HAVE TO DO WITH WHO 1460 00:44:44,548 --> 00:44:45,015 PROVIDES OVERSIGHT. 1461 00:44:45,082 --> 00:44:46,750 IT ISN'T NECESSARILY WITHIN THE 1462 00:44:46,817 --> 00:44:48,452 PURVIEW OF IRBs BECAUSE THE 1463 00:44:48,519 --> 00:44:49,486 DEFINITION OF RESEARCH AT THE 1464 00:44:49,553 --> 00:44:52,956 SAME TIME IS THE KINDS OF 1465 00:44:53,023 --> 00:44:53,824 THINGS -- SOME INSTITUTIONS HAVE 1466 00:44:53,891 --> 00:44:55,426 SET UP UNIQUE GROUPS TO REVIEW 1467 00:44:55,492 --> 00:44:55,759 THIS. 1468 00:44:55,826 --> 00:44:58,162 LOTS OF QUESTIONS ABOUT 1469 00:44:58,228 --> 00:44:58,829 TERMINOLOGY. 1470 00:44:58,896 --> 00:45:00,364 AND THEN I THINK MANY OF THESE 1471 00:45:00,431 --> 00:45:01,498 ISSUES GET TOUGHER WHEN WE THINK 1472 00:45:01,565 --> 00:45:02,933 ABOUT PEOPLE WHO ARE NOT DEAD 1473 00:45:03,000 --> 00:45:03,467 YET. 1474 00:45:03,534 --> 00:45:04,668 WHETHER THAT'S BECAUSE THEY'RE 1475 00:45:04,735 --> 00:45:06,503 UNDERGOING A TERMINAL WEAN, 1476 00:45:06,570 --> 00:45:07,805 WHETHER THEY HAVEN'T MET BRAIN 1477 00:45:07,871 --> 00:45:10,574 DEATH CRITERIA, OR EVEN 1478 00:45:10,641 --> 00:45:15,712 PROCESSES -- STUDIES LIKE 1479 00:45:15,779 --> 00:45:17,247 AUTOPSIES WHERE THE WHOLE 1480 00:45:17,314 --> 00:45:18,148 PROCESS IS ALTERED. 1481 00:45:18,215 --> 00:45:19,349 SO IN SUMMARY I HOPE TO HAVE 1482 00:45:19,416 --> 00:45:20,451 MADE THE CASE THAT RESEARCH LIKE 1483 00:45:20,517 --> 00:45:21,652 THIS IS CRITICALLY IMPORTANT, 1484 00:45:21,718 --> 00:45:22,986 AND I THINK THERE'S A VERY 1485 00:45:23,053 --> 00:45:25,722 STRONG ETHICAL CASE FOR DOING 1486 00:45:25,789 --> 00:45:26,156 IT. 1487 00:45:26,223 --> 00:45:27,724 I DON'T THINK ANY OF THE CORE 1488 00:45:27,791 --> 00:45:29,026 ETHICS CONCERNS ARE 1489 00:45:29,093 --> 00:45:29,693 INSURMOUNTABLE AND THE MOST 1490 00:45:29,760 --> 00:45:31,128 SIGNIFICANT SETS OF ISSUES ARE 1491 00:45:31,195 --> 00:45:32,696 REALLY PRACTICAL RATHER THAN 1492 00:45:32,763 --> 00:45:33,130 CONCEPTUAL. 1493 00:45:33,197 --> 00:45:34,231 STUDYING AND LEARNING FROM OUR 1494 00:45:34,298 --> 00:45:35,599 EXPERIENCE IS ABSOLUTELY 1495 00:45:35,666 --> 00:45:37,167 CRITICAL IN ORDER TO MAXIMIZE 1496 00:45:37,234 --> 00:45:40,871 RESPECTFUL TREATMENT OF AND THE 1497 00:45:40,938 --> 00:45:41,805 IMPACT ON FAMILIES AND STAFF. 1498 00:45:41,872 --> 00:45:43,140 WE CAN'T DO THIS WITHOUT 1499 00:45:43,207 --> 00:45:43,574 STUDYING IT. 1500 00:45:43,640 --> 00:45:45,409 AND I THINK THERE'S PROBABLY 1501 00:45:45,476 --> 00:45:46,743 SIGNIFICANT VALUE IN CLUSTERING 1502 00:45:46,810 --> 00:45:47,811 EXPERTISE OR CAPACITY FOR DOING 1503 00:45:47,878 --> 00:45:51,615 THIS KIND OF WORK. 1504 00:45:51,682 --> 00:45:52,616 SO I'LL CLOSE WITH THAT AND LOOK 1505 00:45:52,683 --> 00:45:53,183 FORWARD TO DISCUSSION. 1506 00:45:53,250 --> 00:45:59,423 [APPLAUSE] 1507 00:45:59,490 --> 00:46:01,191 >> THANKS, NEAL. 1508 00:46:01,258 --> 00:46:03,794 DID YOU WANT TO GET US STARTED, 1509 00:46:03,861 --> 00:46:04,027 ROBERT? 1510 00:46:04,094 --> 00:46:05,429 >> I HAVE A FEW THAT MAYBE WOULD 1511 00:46:05,496 --> 00:46:07,865 BE GOOD TO START WITH THAT ARE 1512 00:46:07,931 --> 00:46:09,433 ALL CLUSTERED TOGETHER ON A 1513 00:46:09,500 --> 00:46:10,634 SIMILAR SORT OF ISSUE 1514 00:46:10,701 --> 00:46:11,935 DEMARCATING LIFE AND DEATH. 1515 00:46:12,002 --> 00:46:12,936 SO I'LL START WITH THE FIRST 1516 00:46:13,003 --> 00:46:13,670 ONE. 1517 00:46:13,737 --> 00:46:16,240 IS THERE A CLEAR AND DISTINCT 1518 00:46:16,306 --> 00:46:18,342 LINE BETWEEN BRAIN DEATH AND AN 1519 00:46:18,408 --> 00:46:19,343 UNUSUALLY PROLONGED STATE OF 1520 00:46:19,409 --> 00:46:19,676 COMA? 1521 00:46:19,743 --> 00:46:22,412 DOES THIS COMPLICATE THE COHORT 1522 00:46:22,479 --> 00:46:25,015 OF POSSIBLE, QUOTE-UNQUOTE, 1523 00:46:25,082 --> 00:46:26,683 PARTICIPANTS? 1524 00:46:26,750 --> 00:46:30,187 >> I'M NOT SURE I FULLY 1525 00:46:30,254 --> 00:46:31,388 UNDERSTAND THE QUESTION BUT I'LL 1526 00:46:31,455 --> 00:46:34,024 TAKE A STAB AT IT AND MAKE SURE 1527 00:46:34,091 --> 00:46:35,926 THAT -- AND ANYONE, KATHLEEN OR 1528 00:46:35,993 --> 00:46:36,460 DAVE, JUMP IN. 1529 00:46:36,527 --> 00:46:38,862 I THOUGHT ABOUT HAVING A CAVEAT 1530 00:46:38,929 --> 00:46:41,331 SO I WASN'T GOING TO ADDRESS ANY 1531 00:46:41,398 --> 00:46:42,933 ISSUES RELATED TO DEATH SO MAYBE 1532 00:46:43,000 --> 00:46:44,368 I'LL JUST FALL BACK ON THAT, BUT 1533 00:46:44,434 --> 00:46:48,105 THERE'S A LOT OF QUESTIONS ABOUT 1534 00:46:48,172 --> 00:46:49,773 WHAT CONSTITUTES DEATH OR AS 1535 00:46:49,840 --> 00:46:53,477 GOOD AS DEATH OBVIOUSLY. 1536 00:46:53,544 --> 00:46:56,446 AND I THINK, YOU KNOW, THE BEST 1537 00:46:56,513 --> 00:46:58,649 I CAN SAY IS IT'S MOST 1538 00:46:58,715 --> 00:47:00,851 STRAIGHTFORWARD IN THE CASE OF 1539 00:47:00,918 --> 00:47:02,252 PATIENT WHO ARE CLEARLY -- WHO 1540 00:47:02,319 --> 00:47:03,587 MEET CRITERIA FOR BRAIN DEAD 1541 00:47:03,654 --> 00:47:06,256 BECAUSE THAT'S A VERY ACCEPTED 1542 00:47:06,323 --> 00:47:09,226 STANDARD. 1543 00:47:09,293 --> 00:47:10,394 WHAT YOU CAN DO WITHER OH 1544 00:47:10,460 --> 00:47:11,495 POPULATIONS REALLY DEPENDS 1545 00:47:11,562 --> 00:47:14,264 HEAVILY ON WHAT THE STUDY IS, 1546 00:47:14,331 --> 00:47:15,966 WHAT YOU THINK THAT PERSON'S 1547 00:47:16,033 --> 00:47:18,869 STATE IS, AND IF YOU THINK THERE 1548 00:47:18,936 --> 00:47:21,738 ARE POTENTIAL FOR THE INDIVIDUAL 1549 00:47:21,805 --> 00:47:23,207 TO HAVE DIFFERENT KINDS OF HARMS 1550 00:47:23,273 --> 00:47:28,412 OR PAIN OR SUFFERING,, OBVIOUSLY 1551 00:47:28,478 --> 00:47:29,446 A VERY DIFFERENT KETTLE OF FISH. 1552 00:47:29,513 --> 00:47:30,614 >> THAT'S SUPER HELPFUL. 1553 00:47:30,681 --> 00:47:32,015 ALSO I THINK IT MAYBE ANSWERS 1554 00:47:32,082 --> 00:47:33,317 THE NEXT QUESTION, WHICH IS 1555 00:47:33,383 --> 00:47:37,321 POINTING OUT THAT SOME LOW 1556 00:47:37,387 --> 00:47:38,088 GROUNDED MINORITY POSITION THAT 1557 00:47:38,155 --> 00:47:39,289 BRAIN DEATH IS NOT DEATH, SO 1558 00:47:39,356 --> 00:47:42,793 WHAT ARE THE IMPLICATIONS OF 1559 00:47:42,859 --> 00:47:45,896 THAT. 1560 00:47:45,963 --> 00:47:48,632 A THIRD QUESTION ON A SIMILAR 1561 00:47:48,699 --> 00:47:49,833 NOTE, THIS TIME SORT OF GOING IN 1562 00:47:49,900 --> 00:47:54,972 THE OTHER DIRECTION, IS -- 1563 00:47:55,038 --> 00:47:57,741 SORRY, I'M GOING THROUGH THESE 1564 00:47:57,808 --> 00:48:03,213 PRESENTLY. 1565 00:48:03,280 --> 00:48:05,082 HOW IS SUBJECT DEFINED AND WHEN 1566 00:48:05,148 --> 00:48:06,283 DOES A SUBJECT NO LONGER 1567 00:48:06,350 --> 00:48:08,285 CONSTITUTE A DEAD PERSON WORTHY 1568 00:48:08,352 --> 00:48:11,655 OF ETHICAL CONCERNS, EG, DO SOME 1569 00:48:11,722 --> 00:48:13,323 OR ALL OF THESE ETHICAL ISSUES 1570 00:48:13,390 --> 00:48:17,094 ALSO APPLY TO TISSUE OR CELL 1571 00:48:17,160 --> 00:48:21,465 LINES LIKE HELA CELLS? 1572 00:48:21,531 --> 00:48:23,967 >> I GUESS -- I'LL TRY TO ANSWER 1573 00:48:24,034 --> 00:48:25,002 THE PIECE OF THAT THAT I THINK 1574 00:48:25,068 --> 00:48:28,839 IS MOST CONNECTED TO THIS, WHICH 1575 00:48:28,905 --> 00:48:30,607 IS THAT AT LEAST IN PRINCIPLE, 1576 00:48:30,674 --> 00:48:33,210 AS DAVE MENTIONED IN THE 1577 00:48:33,277 --> 00:48:35,679 INTRODUCTION, PEOPLE WHO MEET 1578 00:48:35,746 --> 00:48:37,214 OUR CRITERIA FOR BRAIN DEATH, 1579 00:48:37,281 --> 00:48:39,082 FOR EXAMPLE, ARE NOT HAVING 1580 00:48:39,149 --> 00:48:40,217 EXPERIENCES, AND YET I THINK ALL 1581 00:48:40,284 --> 00:48:43,053 OF US WOULD SAY THAT THESE KINDS 1582 00:48:43,120 --> 00:48:45,355 OF ACTIVITIES HAVE IMPORTANT 1583 00:48:45,422 --> 00:48:46,990 BEARING ON THE NARRATIVE OF 1584 00:48:47,057 --> 00:48:47,858 THEIR LIFE, RIGHT? 1585 00:48:47,924 --> 00:48:50,394 AND SO THE EXTENT TO WHICH 1586 00:48:50,460 --> 00:48:51,895 SOMEONE EXPRESSED PREFERENCES 1587 00:48:51,962 --> 00:48:53,163 ABOUT WANTING TO CONTRIBUTE IN 1588 00:48:53,230 --> 00:48:59,303 CERTAIN WAYS, THE EXTENT TO 1589 00:48:59,369 --> 00:49:00,604 WHICH -- HOW THEY ARE IN DEATH 1590 00:49:00,671 --> 00:49:02,139 REFLECT WHO THEY WERE IN LIFE, I 1591 00:49:02,205 --> 00:49:03,740 THINK THERE'S AN ELEMENT OF THEM 1592 00:49:03,807 --> 00:49:04,708 THAT'S REALLY RELEVANT TO WHAT 1593 00:49:04,775 --> 00:49:07,644 WE DO TO THEM AFTER THEY MEET 1594 00:49:07,711 --> 00:49:10,380 CRITERIA FOR DEATH. 1595 00:49:10,447 --> 00:49:13,984 I THINK THE EXTENT TO WHICH -- 1596 00:49:14,051 --> 00:49:18,322 SO I THINK THESE FEEL MORE 1597 00:49:18,388 --> 00:49:19,556 EXPERIENTIAL AND MORE CLOSELY 1598 00:49:19,623 --> 00:49:20,324 CONNECTED TO THE PERSON THAN 1599 00:49:20,390 --> 00:49:21,858 MANY OF THE ISSUES ABOUT HOW 1600 00:49:21,925 --> 00:49:25,295 DATA IS USED OR HOW PART ARE U 1601 00:49:25,362 --> 00:49:26,596 USED LATER, SO I THINK THIS HAS 1602 00:49:26,663 --> 00:49:27,964 A MUCH MORE KIND OF EMOTIONAL 1603 00:49:28,031 --> 00:49:31,301 CONNECTION TO THE INDIVIDUAL. 1604 00:49:31,368 --> 00:49:32,569 ALTHOUGH THE BASIC NOTION OF 1605 00:49:32,636 --> 00:49:34,204 SOMEONE'S KIND OF LIFE STORY 1606 00:49:34,271 --> 00:49:35,739 BEING RELEVANT TO WHAT HAPPENS 1607 00:49:35,806 --> 00:49:37,307 TO THEM AFTERWARDS, I THINK 1608 00:49:37,374 --> 00:49:40,077 OVERLAPS. 1609 00:49:40,143 --> 00:49:41,945 EXPWR THANKS. 1610 00:49:42,012 --> 00:49:42,913 >> THANKS. 1611 00:49:42,979 --> 00:49:45,449 I'LL TAKE A TURN OFF THE MIC 1612 00:49:45,515 --> 00:49:45,615 NOW. 1613 00:49:45,682 --> 00:49:47,017 >> I'LL JUST FOLLOW UP AS THE 1614 00:49:47,084 --> 00:49:50,620 NEXT PERSON IS COMING IS, JUST A 1615 00:49:50,687 --> 00:49:51,188 TERMINOLOGY POINT. 1616 00:49:51,254 --> 00:49:52,322 THERE'S BEEN A BIG SHIFT IN 1617 00:49:52,389 --> 00:49:54,591 RESEARCH ETHICS FROM SUBJECTS TO 1618 00:49:54,658 --> 00:49:55,559 PARTICIPANTS. 1619 00:49:55,625 --> 00:49:57,561 AND THE IDEA IS THAT'S SUPPOSED 1620 00:49:57,627 --> 00:49:59,563 TO SIGNAL THAT THE INDIVIDUALS 1621 00:49:59,629 --> 00:50:00,997 WHO ARE INVOLVED IN RESEARCH 1622 00:50:01,064 --> 00:50:03,633 AREN'T JUST PASSIVE SUBJECTS OF 1623 00:50:03,700 --> 00:50:04,935 THINGS BEING DONE TO THEM, BUT 1624 00:50:05,001 --> 00:50:06,636 THEY'RE ACTIVELY CONTRIBUTING IN 1625 00:50:06,703 --> 00:50:08,171 SOME SENSE. 1626 00:50:08,238 --> 00:50:10,407 WHEN YOU DECIDED SUBJECTS, I WAS 1627 00:50:10,474 --> 00:50:11,408 WONDERING, DID YOU HAVE THAT IN 1628 00:50:11,475 --> 00:50:12,409 MIND AND WERE YOU THINKING 1629 00:50:12,476 --> 00:50:13,577 SUBJECTS IS JUST MORE 1630 00:50:13,643 --> 00:50:14,978 APPROPRIATE ONCE THEY'RE DEAD, 1631 00:50:15,045 --> 00:50:16,380 OR I JUST WASN'T GOING TO THINK 1632 00:50:16,446 --> 00:50:17,214 ABOUT THIS AND I DON'T KNOW? 1633 00:50:17,280 --> 00:50:18,615 >> YEAH, I WAS TRYING TO NOT 1634 00:50:18,682 --> 00:50:19,850 THINK ABOUT IT. 1635 00:50:19,916 --> 00:50:23,086 I MEAN, THE TRUTH IS, YOU 1636 00:50:23,153 --> 00:50:30,594 COULD -- IN A MEANINGFUL WAY, 1637 00:50:30,660 --> 00:50:32,329 THIS CASE THAT WE JUSTED -- G.L. 1638 00:50:32,396 --> 00:50:35,866 IS IN SOME WAYS PARTICIPATING IN 1639 00:50:35,932 --> 00:50:38,969 THE SENSE THAT THE FAMILY 1640 00:50:39,035 --> 00:50:40,670 ALLOWED HER BODY TO BE INCLUDED 1641 00:50:40,737 --> 00:50:42,205 BECAUSE THAT'S WHO SHE WAS, AND 1642 00:50:42,272 --> 00:50:44,708 THEY FELT LIKE THIS WAS A WAY TO 1643 00:50:44,775 --> 00:50:47,444 ENACT WHAT SHE WANTED HER STORY 1644 00:50:47,511 --> 00:50:50,881 TO BE, AND SO I DON'T MEAN TO 1645 00:50:50,947 --> 00:50:51,448 DEVALUE THAT. 1646 00:50:51,515 --> 00:50:54,151 I THINK TO ME, SUBJECT CARRIES 1647 00:50:54,217 --> 00:50:58,221 LESS IN THE SENSE THAT IT 1648 00:50:58,288 --> 00:50:59,689 DOESN'T -- THERE ISN'T AN 1649 00:50:59,756 --> 00:51:01,458 ONGOING EXPERIENCER IN THIS 1650 00:51:01,525 --> 00:51:03,527 CASE, SO PARTICIPANT IMPLIES AN 1651 00:51:03,593 --> 00:51:04,628 ONGOING LEVEL OF ENGAGEMENT. 1652 00:51:04,694 --> 00:51:05,462 I THINK THAT'S PART OF THE 1653 00:51:05,529 --> 00:51:06,329 REASON WE USE THAT. 1654 00:51:06,396 --> 00:51:07,964 IT'S NOT JUST BECAUSE PEOPLE 1655 00:51:08,031 --> 00:51:10,267 HAVE SORT OF THINGS AT STAKE BUT 1656 00:51:10,333 --> 00:51:11,301 BECAUSE WE'RE SUPPOSED TO BE 1657 00:51:11,368 --> 00:51:12,669 INTERACTING WITH PEOPLE IN 1658 00:51:12,736 --> 00:51:19,309 IMPORTANT WAYS. 1659 00:51:19,376 --> 00:51:21,278 I DON'T THINK PEOPLE WHO MEET 1660 00:51:21,344 --> 00:51:22,279 CRITERIA FOR BRAIN DEATH CAN 1661 00:51:22,345 --> 00:51:23,280 ENGAGE WITH US IN THE SAME WAY 1662 00:51:23,346 --> 00:51:27,551 AS PEOPLE WHO ARE CLEARLY LIV 1663 00:51:27,617 --> 00:51:27,784 LIVING. 1664 00:51:27,851 --> 00:51:30,220 BUT I DIDN'T MEAN TO DEVALUE THE 1665 00:51:30,287 --> 00:51:31,521 NOTION THAT IF WE'RE GETTING 1666 00:51:31,588 --> 00:51:34,791 SOME FORM OF CONSENT OR 1667 00:51:34,858 --> 00:51:36,026 AUTHORIZATION AND WE'RE 1668 00:51:36,092 --> 00:51:36,960 PRETENDING -- NOT PRETENDING -- 1669 00:51:37,027 --> 00:51:38,595 WE ARE BELIEVING THAT THIS WAS A 1670 00:51:38,662 --> 00:51:39,896 REFLECTION OF WHAT THEY WANTED, 1671 00:51:39,963 --> 00:51:41,364 THAT THEY IN SOME SENSE HAD SOME 1672 00:51:41,431 --> 00:51:42,466 AGENCY IN THIS PIECE. 1673 00:51:42,532 --> 00:51:45,001 BUT I THINK IT'S MUCH MORE 1674 00:51:45,068 --> 00:51:46,203 STRAIGHTFORWARD TO TALK ABOUT 1675 00:51:46,269 --> 00:51:48,438 THEM AS SUBJECTS BECAUSE LESS 1676 00:51:48,505 --> 00:51:50,507 IS -- TO ME LESS IS SORT OF 1677 00:51:50,574 --> 00:51:53,243 CONVEYED BY THAT. 1678 00:51:53,310 --> 00:51:55,278 MAYBE THAT'S NOT SUFFICIENTLY 1679 00:51:55,345 --> 00:51:55,512 PRECISE. 1680 00:51:55,579 --> 00:51:57,180 WE CAN COME UP WITH A DIFFERENT 1681 00:51:57,247 --> 00:51:59,115 WORD. 1682 00:51:59,182 --> 00:51:59,616 NEOMORT SOUNDS BAD. 1683 00:51:59,683 --> 00:52:02,152 >> I WAS GOING TO SUGGEST -- 1684 00:52:02,219 --> 00:52:02,719 THAT SOUNDS TERRIBLE. 1685 00:52:02,786 --> 00:52:05,856 >> SO TOTALLY WITH YOU ON THE 1686 00:52:05,922 --> 00:52:07,591 SUBJECT RELATED ISSUES, AND I 1687 00:52:07,657 --> 00:52:11,261 JUST WANT TO PUSH A BIT ON THE 1688 00:52:11,328 --> 00:52:13,797 QUESTION OF TIME AND HOW SIMILAR 1689 00:52:13,864 --> 00:52:19,069 THIS IS TO ORGAN DONATION. 1690 00:52:19,135 --> 00:52:21,505 SO I'M GOING TO ASSUME THAT YOU 1691 00:52:21,571 --> 00:52:23,206 DON'T PERFUSE SOMEONE FOR UP TO 1692 00:52:23,273 --> 00:52:24,641 TWO MONTHS FOR ORGAN DONATION, 1693 00:52:24,708 --> 00:52:26,776 AND I'M GOING TO ASSUME THAT'S 1694 00:52:26,843 --> 00:52:27,177 RELATIVELY QUICK. 1695 00:52:27,244 --> 00:52:31,915 I DON'T KNOW BUT I'M GUESSING 1696 00:52:31,982 --> 00:52:33,550 THAT MAYBE -- IS IT THE CASE, 1697 00:52:33,617 --> 00:52:36,253 THIS MAY BE A QUESTION BUT -- 1698 00:52:36,319 --> 00:52:39,289 WHETHER THE ICU STAFF IS TASKED 1699 00:52:39,356 --> 00:52:42,392 TO KEEPING THAT PERSON ALIVE 1700 00:52:42,459 --> 00:52:44,728 UNTIL THE PERSON COMING TO 1701 00:52:44,794 --> 00:52:46,696 PROCURE THE ORGANS ARRIVE. 1702 00:52:46,763 --> 00:52:47,664 I'LL SET THAT ASIDE. 1703 00:52:47,731 --> 00:52:50,767 SO THE THING I WANTED TO ASK YOU 1704 00:52:50,834 --> 00:52:54,271 ABOUT IS, FROM AN ORGAN DONATION 1705 00:52:54,337 --> 00:52:58,241 PERSPECTIVE, IF I'M A STAFF 1706 00:52:58,308 --> 00:52:59,376 MEMBER INVOLVED HERE, I KNOW 1707 00:52:59,442 --> 00:53:03,313 THAT BY FACILITATING ORGAN 1708 00:53:03,380 --> 00:53:07,417 DONATION, I'M GOING TO BENEFIT 1709 00:53:07,484 --> 00:53:08,518 IDENTIFIABLE HUMANS WITH THOSE 1710 00:53:08,585 --> 00:53:10,921 ORGANS. 1711 00:53:10,987 --> 00:53:13,490 VERSUS, YOU KNOW, SURE, THERE 1712 00:53:13,557 --> 00:53:16,459 MIGHT BE SOME LONG-TERM SOCIAL 1713 00:53:16,526 --> 00:53:19,729 VALUE IN MY FACILITATING THIS 1714 00:53:19,796 --> 00:53:20,964 BODY TO CONTINUE TO BE ALIVE TO 1715 00:53:21,031 --> 00:53:23,934 TEST THIS, BUT IS THERE ANY 1716 00:53:24,000 --> 00:53:25,302 CONCEPTUAL DIFFERENCE THERE OR 1717 00:53:25,368 --> 00:53:30,707 IS THAT REALLY MORE ABOUT MY 1718 00:53:30,774 --> 00:53:34,711 PERSONAL VALUES AS A PROVIDER? 1719 00:53:34,778 --> 00:53:35,745 IS THAT SOMETHING WE SHOULD BE 1720 00:53:35,812 --> 00:53:37,347 THINKING ABOUT OR NOT? 1721 00:53:37,414 --> 00:53:39,983 >> SO GREAT QUESTIONS. 1722 00:53:40,050 --> 00:53:46,056 I THINK WITH JUST TO CONCRETELY 1723 00:53:46,122 --> 00:53:47,157 ANSWER, ORDERS OF MAGNITUDE 1724 00:53:47,223 --> 00:53:48,458 DIFFERENT, BUT OFTEN FOR MOST 1725 00:53:48,525 --> 00:53:51,361 PROCUREMENT E YOU'RE LOOKING ATA 1726 00:53:51,428 --> 00:53:52,896 MATTER OF DAYS SOMETIMES BUT 1727 00:53:52,963 --> 00:53:54,431 YOU'RE NOT LOOKING AT MONTHS. 1728 00:53:54,497 --> 00:53:55,465 THAT PART IS DEFINITELY 1729 00:53:55,532 --> 00:53:55,799 DIFFERENT. 1730 00:53:55,865 --> 00:53:57,000 I THINK THIS ISSUE OF THE SORT 1731 00:53:57,067 --> 00:53:59,736 OF DIRECTNESS, IT'S NOT THE 1732 00:53:59,803 --> 00:54:01,438 BENEFIT BUT THE DIRECTNESS OF A 1733 00:54:01,504 --> 00:54:02,973 POSITIVE OUTCOME, HOW LIKELY IS 1734 00:54:03,039 --> 00:54:07,243 SOMEBODY GOING TO BE HELPED BY 1735 00:54:07,310 --> 00:54:09,012 AN INDIVIDUAL SUBJECT'S 1736 00:54:09,079 --> 00:54:09,446 INVOLVEMENT. 1737 00:54:09,512 --> 00:54:11,915 TO ME, THAT ALSO IS SORT OF AN 1738 00:54:11,982 --> 00:54:13,984 ISSUE OF MAGNITUDE AND NOT A 1739 00:54:14,050 --> 00:54:14,551 CONCEPTUAL DISTINCTION. 1740 00:54:14,618 --> 00:54:17,554 I MEAN, THE REASON WHY WE THINK 1741 00:54:17,621 --> 00:54:19,189 PEOPLE OUGHT TO IN MANY CASES 1742 00:54:19,255 --> 00:54:20,390 WANT TO CONTRIBUTE TO RESEARCH 1743 00:54:20,457 --> 00:54:21,524 IS BECAUSE WE ALL BELIEVE THAT 1744 00:54:21,591 --> 00:54:22,859 RESEARCH IS THE WAY WE MAKE 1745 00:54:22,926 --> 00:54:25,261 PROGRESS AND PEOPLE ARE GOING TO 1746 00:54:25,328 --> 00:54:27,530 BE HELPED, SO I THINK THIS 1747 00:54:27,597 --> 00:54:28,531 FALLS -- THAT REASONING IS VERY 1748 00:54:28,598 --> 00:54:32,102 MUCH IN LINE WITH WHY PEOPLE 1749 00:54:32,168 --> 00:54:33,103 DONATE ORGANS. 1750 00:54:33,169 --> 00:54:34,037 THERE'S A MORE DIRECT 1751 00:54:34,104 --> 00:54:35,038 CONNECTION, THERE'S A MORE 1752 00:54:35,105 --> 00:54:36,673 IMMEDIATE POSITIVE BENEFIT, AND 1753 00:54:36,740 --> 00:54:40,043 IN A BIG PICTURE WAY, I DON'T 1754 00:54:40,110 --> 00:54:41,645 SEE A REASON FOR A SORT OF 1755 00:54:41,711 --> 00:54:42,812 BRIGHT CONCEPTUAL DISTINCTION 1756 00:54:42,879 --> 00:54:45,148 BETWEEN THOSE TWO. 1757 00:54:45,215 --> 00:54:49,085 >> I THINK I WAS THINKING ABOUT 1758 00:54:49,152 --> 00:54:52,222 POTENTIAL -- [INAUDIBLE] AMONG 1759 00:54:52,288 --> 00:54:55,058 THE STAFF THERE IN TERMS OF HOW 1760 00:54:55,125 --> 00:54:57,594 THE PROCESS [INAUDIBLE] 1761 00:54:57,661 --> 00:54:59,229 >> I THINK THAT'S REALLY 1762 00:54:59,295 --> 00:54:59,496 IMPORTANT. 1763 00:54:59,562 --> 00:55:01,364 >> SORRY, THAT DOESN'T GET 1764 00:55:01,431 --> 00:55:03,199 PICKED UP ONLINE. 1765 00:55:03,266 --> 00:55:03,767 SORRY. 1766 00:55:03,833 --> 00:55:04,100 PLEASE REPEAT. 1767 00:55:04,167 --> 00:55:06,136 >> I WAS GOING TO SAY, THE 1768 00:55:06,202 --> 00:55:07,771 LATTER PART OF THE QUESTION WAS 1769 00:55:07,837 --> 00:55:09,172 REALLY FOCUSED ON THE POTENTIAL 1770 00:55:09,239 --> 00:55:10,373 FOR MORAL DISTRESS ON THE PART 1771 00:55:10,440 --> 00:55:12,742 OF STAFF WHO MIGHT BE INVOLVED 1772 00:55:12,809 --> 00:55:13,943 IN, AGAIN, CARING IS ONE OF 1773 00:55:14,010 --> 00:55:15,145 THOSE WORDS THAT WE DON'T KNOW 1774 00:55:15,211 --> 00:55:18,281 WHAT TO DO WITH, BUT ATTENDING 1775 00:55:18,348 --> 00:55:21,351 TO, PROVIDING INTERVENTIONS TO 1776 00:55:21,418 --> 00:55:22,552 PEOPLE WHO ARE BEING SUSTAINED 1777 00:55:22,619 --> 00:55:23,653 IN THIS WAY. 1778 00:55:23,720 --> 00:55:27,857 YOU CAN SEE THAT BEING AN EASIER 1779 00:55:27,924 --> 00:55:29,926 SELL FOR ORGAN DONATION 1780 00:55:29,993 --> 00:55:31,795 PROCUREMENT THAN IT MIGHT BE FOR 1781 00:55:31,861 --> 00:55:32,328 RESEARCH PARTICIPATION. 1782 00:55:32,395 --> 00:55:34,297 I THINK, YOU KNOW, ALL OF THESE 1783 00:55:34,364 --> 00:55:35,732 THINGS ADD UP TO THE IDEA THAT 1784 00:55:35,799 --> 00:55:38,401 WE WOULD SAY IF YOU'RE AN ICU 1785 00:55:38,468 --> 00:55:40,370 NURSE OR AN ICU DOC AND YOU'RE 1786 00:55:40,437 --> 00:55:41,671 LIKE, I WON'T PARTICIPATE IN 1787 00:55:41,738 --> 00:55:43,506 HELPING TO SUSTAIN SOMEONE FOR 1788 00:55:43,573 --> 00:55:45,141 ORGAN PROCUREMENT, WE'D SAY YOU 1789 00:55:45,208 --> 00:55:46,443 PROBABLY NEED TO FIND A NEW LINE 1790 00:55:46,509 --> 00:55:46,976 OF WORK. 1791 00:55:47,043 --> 00:55:48,478 THAT'S PART OF WHAT IT IS TO BE 1792 00:55:48,545 --> 00:55:50,780 IN ICU FOR THE MOST PART. 1793 00:55:50,847 --> 00:55:52,749 THERE'S SOME CASES NOW WITH 1794 00:55:52,816 --> 00:55:54,984 REGARD TO, YOU KNOW, NRP AND 1795 00:55:55,051 --> 00:55:55,885 OTHER KINDS OF THINGS THAT MIGHT 1796 00:55:55,952 --> 00:55:56,853 RAISE CONCERNS LIKE THAT, SO 1797 00:55:56,920 --> 00:55:59,489 MAYBE IT'S NOT CA CATEGORICALLY 1798 00:55:59,556 --> 00:56:01,124 DIFFERENT, AND THERE MAY BE 1799 00:56:01,191 --> 00:56:02,425 PEOPLE THAT DON'T PARTICIPATE IN 1800 00:56:02,492 --> 00:56:03,293 THOSE KINDS OF THINGS. 1801 00:56:03,359 --> 00:56:05,595 BUT I THINK BECAUSE OF THE 1802 00:56:05,662 --> 00:56:07,163 DIRECTNESS OF THE LIKELY IMPACT, 1803 00:56:07,230 --> 00:56:08,598 AND BECAUSE OF THE FREQUENCY AND 1804 00:56:08,665 --> 00:56:09,799 BECAUSE OF ALL THOSE 1805 00:56:09,866 --> 00:56:11,000 CONSIDERATIONS, IT'S GOING TO BE 1806 00:56:11,067 --> 00:56:12,936 EASIER TO CARVE OUT EXCEPTIONS 1807 00:56:13,002 --> 00:56:14,370 TO SAY SOMEONE DOESN'T 1808 00:56:14,437 --> 00:56:15,405 NECESSARILY HAVE TO PARTICIPATE 1809 00:56:15,472 --> 00:56:16,873 IN ACTIVITIES LIKE THIS. 1810 00:56:16,940 --> 00:56:18,341 I THINK THAT'S A WORKABLE 1811 00:56:18,408 --> 00:56:19,342 PRACTICAL PROBLEM. 1812 00:56:19,409 --> 00:56:21,311 AND I THINK WHAT WE'RE GOING TO 1813 00:56:21,377 --> 00:56:22,579 PUSH ON -- THE PUSH IS GOING TO 1814 00:56:22,645 --> 00:56:24,114 BE LESS IN THIS CONTEXT THAN 1815 00:56:24,180 --> 00:56:25,749 THERE WOULD BE IN ROUTINE ORGAN 1816 00:56:25,815 --> 00:56:26,416 PROCUREMENT. 1817 00:56:26,483 --> 00:56:28,451 >> IT INTERESTING FOR HOLLY'S 1818 00:56:28,518 --> 00:56:29,419 SECOND QUESTION, WE'VE DONE A 1819 00:56:29,486 --> 00:56:31,187 COUPLE SURVEYS WHERE WE GAVE 1820 00:56:31,254 --> 00:56:32,489 PEOPLE OPTIONS. 1821 00:56:32,555 --> 00:56:37,026 WOULD YOU PREFER TO GIVE A BLOOD 1822 00:56:37,093 --> 00:56:40,096 DONATION, WOULD YOU PREFER TO DO 1823 00:56:40,163 --> 00:56:40,964 SOMETHING AFTER WORK FOR A 1824 00:56:41,030 --> 00:56:42,365 CHARITY TO HELP SOME PERSON, OR 1825 00:56:42,432 --> 00:56:44,200 WOULD YOU PREFER TO PARTICIPATE 1826 00:56:44,267 --> 00:56:45,835 IN A RESEARCH TRIAL? 1827 00:56:45,902 --> 00:56:47,904 AND PEOPLE'S VIEWS ARE VERY 1828 00:56:47,971 --> 00:56:48,438 DIVERSE ON THAT. 1829 00:56:48,505 --> 00:56:49,739 BUT IT'S INTERESTING, WHEN YOU 1830 00:56:49,806 --> 00:56:51,641 ASK THEM WHY, THE PEOPLE WHO 1831 00:56:51,708 --> 00:56:53,343 LIKE THE BLOOD DONATION AND THE 1832 00:56:53,409 --> 00:56:55,311 CHARITY WILL SAY, I LIKE TO KNOW 1833 00:56:55,378 --> 00:56:58,648 THE PEOPLE THAT I'M HELPING, 1834 00:56:58,715 --> 00:57:02,352 ANDANDTHE PEOPLE WILL SAY RESEAH 1835 00:57:02,418 --> 00:57:04,888 WILL SAY IF I DO THOSE THINGS 1836 00:57:04,954 --> 00:57:06,356 I'LL HELP ONE OR TWO PEOPLE, BUT 1837 00:57:06,422 --> 00:57:08,224 IF I HELP IN RESEARCH, YOU CAN 1838 00:57:08,291 --> 00:57:13,229 HELP THOUSAND HUNDREDS OR THOUSF 1839 00:57:13,296 --> 00:57:13,663 PEOPLE. 1840 00:57:13,730 --> 00:57:15,198 YOU DON'T GET THAT CHANCE IN 1841 00:57:15,265 --> 00:57:15,398 LIFE. 1842 00:57:15,465 --> 00:57:16,499 >> I HAVE OTHER PEOPLE I TRY TO 1843 00:57:16,566 --> 00:57:17,767 FEEL LIKE I MAKE A DIFFERENCE ON 1844 00:57:17,834 --> 00:57:22,272 IN A BROADWAY. 1845 00:57:22,338 --> 00:57:23,840 BROAD WAY. 1846 00:57:23,907 --> 00:57:24,374 >> JASMINE? 1847 00:57:24,440 --> 00:57:25,208 >> THANK YOU VERY MUCH FOR THIS, 1848 00:57:25,275 --> 00:57:28,278 AND I THINK THIS IS GOING TO BE 1849 00:57:28,344 --> 00:57:29,412 A NICE FOLLOW-UP ON THIS 1850 00:57:29,479 --> 00:57:32,048 DISCUSSION THAT WE WERE JUST 1851 00:57:32,115 --> 00:57:33,817 HAVING BECAUSE I FEEL THE PULL, 1852 00:57:33,883 --> 00:57:35,018 BUT I THINK A LOT OF PEOPLE ARE 1853 00:57:35,084 --> 00:57:36,452 GOING TO THINK THERE'S SOMETHING 1854 00:57:36,519 --> 00:57:37,821 DIFFERENT ABOUT DONATING THEIR 1855 00:57:37,887 --> 00:57:39,689 ORGANS VERSUS DONATING TO 1856 00:57:39,756 --> 00:57:43,226 SCIENCE, AND SO I WAS WONDERING 1857 00:57:43,293 --> 00:57:44,894 IF YOU THINK IN LIGHT OF THAT 1858 00:57:44,961 --> 00:57:47,630 DIFFERENCE HOW OR IF WE OUGHT TO 1859 00:57:47,697 --> 00:57:49,432 BE SOLICITING AND ASSESSING 1860 00:57:49,499 --> 00:57:51,434 PEOPLE'S PREFERENCES, OUGHT WE 1861 00:57:51,501 --> 00:57:53,069 TO JUST SAY, OH, LOOK, THEY'RE 1862 00:57:53,136 --> 00:57:59,943 AN ORGAN DOUGH NAR, DONOR, THIE 1863 00:58:00,009 --> 00:58:01,578 TOO, OR ON YOUR LICENSE YOU'RE 1864 00:58:01,644 --> 00:58:05,248 ASKED ABOUT ORGANS AND DONATING 1865 00:58:05,315 --> 00:58:09,185 FOR SCIENTIFIC RESEARCH. 1866 00:58:09,252 --> 00:58:12,488 >> SO SO SO GREAT QUESTION. 1867 00:58:12,555 --> 00:58:13,756 AS I MENTIONED, THIS WAS 1868 00:58:13,823 --> 00:58:14,324 SOMETHING DAVE AND I THOUGHT 1869 00:58:14,390 --> 00:58:15,959 ABOUT A LONG TIME AGO, WAS SORT 1870 00:58:16,025 --> 00:58:19,062 OF WHAT TO DO WITH DIFFERENT 1871 00:58:19,128 --> 00:58:20,730 KINDS OF REQUESTS FOR DONATING 1872 00:58:20,797 --> 00:58:23,466 ORGANS AND HOW TO WEIGH THEM. 1873 00:58:23,533 --> 00:58:27,270 SO I GUESS I HAVE A COUPLE 1874 00:58:27,337 --> 00:58:28,438 WORRIES ABOUT THIS. 1875 00:58:28,504 --> 00:58:29,572 ONE OF THE OTHER THINGS I DO, I 1876 00:58:29,639 --> 00:58:30,440 THINK A LOT ABOUT EMERGENCY 1877 00:58:30,506 --> 00:58:31,608 RESEARCH AND THIS HAS COME UP IN 1878 00:58:31,674 --> 00:58:33,142 THE CONTEXT OF EMERGENCY 1879 00:58:33,209 --> 00:58:34,444 RESEARCH TOO, JUST LET PEOPLE 1880 00:58:34,510 --> 00:58:35,211 SAY WHETHER YOU'RE WILLING TO BE 1881 00:58:35,278 --> 00:58:38,381 PART OF A STUDY. 1882 00:58:38,448 --> 00:58:42,518 MY BIGGEST CONCERN IS ABOUT THE 1883 00:58:42,585 --> 00:58:43,920 DECISION PEOPLE WOULD ACTUALLY 1884 00:58:43,987 --> 00:58:45,121 BE MAKING AND THE UNDERSTANDING 1885 00:58:45,188 --> 00:58:46,322 THEY HAVE ABOUT WHAT THAT MEANS. 1886 00:58:46,389 --> 00:58:47,590 SO JUST WITHIN THIS DISCUSSION, 1887 00:58:47,657 --> 00:58:52,862 WE'VE TALKED ABOUT AN EXAMPLE OF 1888 00:58:52,929 --> 00:58:56,332 SOMEONE GETTING A 2A3B 1889 00:58:56,399 --> 00:58:59,068 INHIBITOR, HAVING LABS DONE 1890 00:58:59,135 --> 00:59:00,603 MAKING SURE THEY DON'T BLEED FOR 1891 00:59:00,670 --> 00:59:01,771 HOURS VERSUS SOMEONE BEING 1892 00:59:01,838 --> 00:59:02,639 SUSTAINED FOR TWO MONTHS. 1893 00:59:02,705 --> 00:59:04,073 THOSE ARE RADICALLY DIFFERENT. 1894 00:59:04,140 --> 00:59:07,143 AND MY GUESS IS MOST PEOPLE, IF 1895 00:59:07,210 --> 00:59:08,111 YOU LOOK AT PEOPLE THAT ARE 1896 00:59:08,177 --> 00:59:09,412 GOING TO HAVE PREFERENCES ALL 1897 00:59:09,479 --> 00:59:11,814 ALONG THAT SPECTRUM, AND IF YOU 1898 00:59:11,881 --> 00:59:15,985 HAVE SITUATIONS LIKE AN OPTION 1899 00:59:16,052 --> 00:59:17,020 TO PARTICIPATE IN RESEARCH ON 1900 00:59:17,086 --> 00:59:18,154 YOUR DRIVER'S LICENSE, PEOPLE 1901 00:59:18,221 --> 00:59:19,122 ARE GOING TO HAVE VERY DIFFERENT 1902 00:59:19,188 --> 00:59:20,089 KINDS OF CASES IN MIND. 1903 00:59:20,156 --> 00:59:21,057 ALL STUDIES ARE DIFFERENT. 1904 00:59:21,124 --> 00:59:22,892 AND I REALLY WORRY ABOUT ASKING 1905 00:59:22,959 --> 00:59:23,760 PEOPLE'S PREFERENCES WHEN THEY 1906 00:59:23,826 --> 00:59:24,928 DON'T HAVE A CASE THAT THEY'RE 1907 00:59:24,994 --> 00:59:26,829 THINKING ABOUT. 1908 00:59:26,896 --> 00:59:28,031 FOR THE MOST PART, I THINK 1909 00:59:28,097 --> 00:59:29,165 PEOPLE KNOW WHAT ORGAN DONATION 1910 00:59:29,232 --> 00:59:29,666 IS ABOUT. 1911 00:59:29,732 --> 00:59:31,601 THEY KNOW WHAT THE ORGAN -- THEY 1912 00:59:31,668 --> 00:59:33,002 MAY NOT KNOW THE PARTICULARS OF 1913 00:59:33,069 --> 00:59:34,671 WHO GETS ORGAN, THEY MAY NOT 1914 00:59:34,737 --> 00:59:35,972 KNOW PARTICULARS OF WHICH ORGANS 1915 00:59:36,039 --> 00:59:37,240 ARE TAKEN, BUT I THINK PEOPLE 1916 00:59:37,307 --> 00:59:38,908 HAVE A BETTER SENSE OF THE 1917 00:59:38,975 --> 00:59:39,809 DECISION THEY'RE MAKING. 1918 00:59:39,876 --> 00:59:41,377 AND I DON'T THINK IT'S A GOOD 1919 00:59:41,444 --> 00:59:43,012 IDEA TO ASK PEOPLE ABOUT THEIR 1920 00:59:43,079 --> 00:59:44,781 RESEARCH PREFERENCES WHEN 1921 00:59:44,847 --> 00:59:46,015 PEOPLE'S BASELINE -- THE CASES 1922 00:59:46,082 --> 00:59:47,250 THAT PEOPLE ARE GOING TO BE 1923 00:59:47,317 --> 00:59:49,986 OPERATING FROM ARE SO VERY 1924 00:59:50,053 --> 00:59:51,721 DIFFERENT. 1925 00:59:51,788 --> 00:59:53,656 I THINK THAT WOULD PROBABLY 1926 00:59:53,723 --> 00:59:54,424 SHOOT US IN THE FOOT. 1927 00:59:54,490 --> 00:59:55,758 >> LOOKS LIKE THERE'S MORE SO 1928 00:59:55,825 --> 00:59:57,760 WE'RE OUT OF TIME SO APOLOGIZE 1929 00:59:57,827 --> 00:59:59,195 TO THE ONLINE PEOPLE, ROBERT 1930 00:59:59,262 --> 01:00:00,129 WILL FORWARD THOSE TO ME AND 1931 01:00:00,196 --> 01:00:01,431 I'LL TRY TO GET TO THEM LATER 1932 01:00:01,497 --> 01:00:02,966 THIS AFTERNOON. 1933 01:00:03,032 --> 01:00:04,934 HOPEFULLY WE'LL SEE PEOPLE HERE, 1934 01:00:05,001 --> 01:00:06,369 FIRST WEDNESDAY IN OCTOBER, 1935 01:00:06,436 --> 01:00:07,670 FIRST WEDNESDAY IN DECEMBER. 1936 01:00:07,737 --> 01:00:10,173 STICK AROUND FOR THOSE. 1937 01:00:10,239 --> 01:00:11,507 IN THE MEANTIME, THANKS VERY 1938 01:00:11,574 --> 01:00:13,076 MUCH TO KATHLEEN AND NEAL FOR A 1939 01:00:13,142 --> 01:00:13,443 GREAT SESSION. 1940 01:00:13,509 [APPLAUSE]