Vol. 1, No. 1
20 September 1996
PROGRAM NOTES
Short Notes on a Long Art
Newsletter of the Program in Human Rights & Medicine
Department of Obstetrics & GynecologyLife is short, the art long; opportunity fleeting,
judgment difficult, experiment, dangerous.
Hippocrates
If the cure for AIDS were a single glass of clean water, most of the people in the world would not have access to treatment.
Joseph Decosas
Earlier this year, a large anonymous gift reached us via the St. Paul Foundation. That gift made possible so many new activities that a newsletter is needed to report them. While we are about it, we will also report on activities we never had space to mention in our usual monthly letters of invitation, namely, the activities of scholars associated with the Program. Since we haven't formally solicited reports from the many scholars associated with the Program, the notes on scholarly activities in Section III below are certainly incomplete. We apologize in advance for omitting mention of important projects whose existence is either unknown to us or else temporarily eluding memory. We invite you to let us know about your own scholarly activities so that we can report them in the next issue of this newsletter (during Winter Quarter). We also invite you to pass on any other items likely to interest the people associated with our program. In the meantime, we note that our dear colleague, Hymie Gordon, MD, of blessed memory, would have reached the Biblical allotment of three score and ten years on the exact date of this newsletter. Dr. Gordon, the founder, and for twenty years director, of the medical genetics program at the Mayo Clinic, was (with Elizabeth Anscombe and the present writer) co-founder of the Program in Human Rights and Medicine and, for seven-and-a-half years, until his death on the 5th of February last year, co-chair of the Program. The officers of the Program want it to be known that all of our efforts and projects this year are dedicated to the memory of Dr. Hymie Gordon.
John M. Dolan, Editor
I. Program News
Seminar Saves a Life
While physicians save human lives every day, academic scholars do not ordinarily expect their work to have immediate practical results. There are, however, occasional startling exceptions. Indeed, one of our seminars last year directly saved a human life. In the midst of his seminar on "Women in China" in November, anthropologist Steven Mosher looked out at the audience and said "If there's anyone here who can adopt an infant Chinese girl, I urge you to do so; you'll literally be saving a human life." Pat and Randy Benham, who attend our seminars and were moved by Mosher's plea, are doing precisely that ! Their new daughter, Alexandria, is not yet here. They would be grateful for your prayers for her (and them).
Krumholz Appointed Associate Program Director
Mary Krumholz, RN, BA, who has been involved in the Program's work almost from the beginning, became our first paid staff member when she assumed the half-time position of Associate Program Director on the 1st of July. The appointment makes official (and, more important, adds a salary to) an arrangement which has been a reality for some time. Her hard work is an important reason for the Program's success. We thank Mary for all the important contributions she has already made to the Program, congratulate her as she assumes her new post, and wish her continued success as she tackles even more ambitious undertakings in the year ahead!
The Program's New Home
In an important turn of events, the Program has found a new home. Thanks to Dr. Leo Twiggs, head of the Department of Obstetrics and Gynecology at the University of Minnesota, the Program in Human Rights and Medicine, while retaining its affiliation with the Human Rights Center of the Law School, now has an office and official home in the Department of Obstetrics and Gynecology:
Program in Human Rights and Medicine
Box 164 Mayo
Department of Obstetrics and Gynecology
420 Delaware Street SE
University of Minnesota
Minneapolis, MN 55455Our office is room 12-190 Moos Tower.
Our telephone number: 626-6559. Faxes can reach us at 626-0665.
Our e-mail address is: phrm@tc.umn.edu.
Our brand new web site (address: http://www.umn.edu/phrm) will soon be up and running.
The Program office hours are 1-5 pm, Monday through Friday, but we have voicemail; so, it is possible to leave messages anytime.
Four New Board Members
This has been a year for distinguished additions to our Advisory Board. You will recall that, earlier this year, Hirofumi Uzawa, PhD, the famed Japanese economist, who has been declared "a living national treasure" by the government of Japan, joined our Board. Uzawa, who has taught at Berkeley, the University of Chicago (where he and John Dolan were colleagues and friends), and the University of Tokyo, currently has a twelve-volume edition of his scholarly papers going through a Japanese press and is writing a book on medical economics.
Now, we are pleased to announce that the Program's advisory board has three other new members: the celebrated poet and radical activist Daniel Berrigan, SJ, the linguist and philosopher Noam Chomsky of MIT, and Leo B Twiggs, MD, Head of the Department of Obstetrics and Gynecology at the University of Minnesota. We extend a heartfelt welcome to all four of our distinguished new colleagues!
Program Web Site
The Program has a web site that is about to go online. Constructed by 3W Solutions, a computing and web site design company, the site contains a history of the Program, information about our internship and prize essay competitions, the first draft of (a still radically incomplete) section of biographies of scholars associated with the Program, a calendar for the coming academic year, a selected listing of our past seminars and lecture series, and other information. Among other things, the site contains a splendid logo designed for us by 3W Solutions. (It appears atop the first page of this newsletter.) Every scholar associated with the Program is invited to submit a biography for inclusion in the web site. (Please send yours in electronic form to our e-mail address: phrm@tc.umn.edu). When placed on the server, the web site will have the following address: http://www.umn.edu/phrmII. This Year's Calendar
Human Rights Internships
The Program is conducting a competition for student human rights internships which will enable students at Minnesota institutions of higher learning (graduate and undergraduate) to carry out projects with organizations whose work focuses on persons who risk unfair treatment under our health care system. A number of organizations have expressed interest in participating in the internship program. The amount of the internship awards is $3,000. Interested students can obtain guidelines and application forms in room 12-190 Moos Tower (from 1-5 pm weekdays), the CHIP lounge in Moos Tower, and the Philosophy Department office in room 355 Ford Hall. As soon as our web site is online, it will be possible to download the forms from the Program's web site. (Pay attention to the clever solution devised by 3W. Solutions to solve the problem posed by the fact that the user's browser window may not be correctly sized to match the forms to be downloaded. They expect the trick they devised to be copied by other web site designers.) For further information, call 626-6559.
Hippocratic Essay Contest
We are also holding a prize essay competition whose theme is "Hippocratic Medicine and Contemporary Medical Practice." The prize in this competition is an award of $1,000. As in the case of the internship competition, students at Minnesota institutions of higher learning are eligible. Guidelines and applications can be obtained in 12-190 Moos Tower, the CHIP lounge, and 355 Ford Hall. Again, it will soon be possible to download the forms from our web site. Further information can be had by calling 626-6559.
An Evening with Daniel Berrigan
As a novel approach to exploring human rights issues in medical ethics and as a dramatic way of calling attention to our internship and essay competitions, we have invited the distinguished poet and radical activist Daniel Berrigan, SJ, for an evening of poetry and parables focused on human rights issues on the 16th of October. The event will take place in Willey Hall at 8 PM. General admission tickets cost $12 (with a special $7 price for full-time students enrolled at the University of Minnesota). Minnesota Public Radio, KTCA-TV, and other local media have expressed interest in covering the event. (A limited number of tickets priced at $10 have been set aside for Program members.) Tickets are available through Mary Krumholz at 626-6559 or through Ticketmaster at 989-5151.
A Rally to Ban Land Mines
The organization, MIST, formed by Marv Davidov and others, is conducting a campaign at Alliant Tech. in Golden Valley to halt the production of land mines there. On the evening of 23 October, a week after our "Evening with Daniel Berrigan," MIST is sponsoring an event at which Daniel's brother, Philip Berrigan, and Elizabeth McAllister will appear at the University to instruct people about the grave health hazard posed by land mines in many Third World countries, where they are maiming and killing large numbers of innocent civilians. Since these victims are poor and powerless, their plight has been largely ignored by the rest of the world. The rally at which Philip Berrigan and McAllister will speak is also a fund raiser for MIST. You can obtain tickets for the event, which will be held in Willey Hall, by calling 874-7715.
Malmquist, Tonry, and Dolan on Homicide
On Thursday, the 14th of November, Carl Malmquist, MD, of the University of Minnesota's Department of Sociology, whose recently published book, Homicide: A Psychiatric Perspective (American Psychiatric Press), has received widespread notice, will be the principal speaker at a panel discussion on the topic "Homicide: Clinical, Legal, and Philosophical Perspectives." The other panelists that evening are John M Dolan and world-famous criminologist Michael Tonry, of the University's Law School. The seminar is scheduled in Room 2-690 Moos Tower at 7 PM.
Chomsky Film
At 7 pm, on the 30th of October (a Wednesday), a three-hour Canadian film, "Manufacturing Consent," devoted to board member Noam Chomsky's critique of the U.S. news media is being shown to one of John Dolan's logic classes in room 2-650 Moos Tower. People associated with the Program in Human Rights and their guests can attend without cost. (If we sent you a copy of this newsletter, you're sufficiently "associated" with the Program in Human Rights and Medicine to attend without cost.) If you're unacquainted with Chomsky's media analysis, it will be worth your while to arrange your schedule so that you can see this important film. (Guaranteed to raise either your awareness of media bias or your blood pressure -- or both.)
Steven Miles on Scarce Resources
On the 19th of December, a Thursday, Steven H Miles, MD, of the Center for Biomedical Ethics, will speak on the topic of managing scarce medical resources. His seminar will take place in Room 2-690 Moos Tower at 7 PM.
Velvl Greene on "Voluntary Victims"
On Thursday, the 23rd of January, Velvl Greene, the Isaac and Elizabeth Carlin Professor of Epidemiology and Public Health at Ben-Gurion University in Israel and director of the prestigious Lord Jacobovitz Center for Jewish Medical Ethics there, will give a talk titled "Voluntary Victims." The seminar will be held in room 365 Ford Hall at 7 PM. Professor Greene has kindly given us some lines about the focus of his presentation:
The overwhelming importance of compassion in a medical world so concerned with science and technology and economics is beyond debate. The pity and compassion elicited, in our culture, for innocent victims of disease and injury reflects a commendable level of moral behavior. Indeed, the more innocent the victim, the greater the sympathy. The slogan "don't blame the victim" is one of the few universally accepted principles in modern medical ethics. Not all victims, however, are equally innocent. The cold statistics that describe morbidity and mortality in Western Society today imply that most of our victims have contributed knowingly and even enthusiastically, in the past, to the medical conditions that cause their suffering. What can a compassionate society do then? When the suffering starts, so does regret and penance. But this is a matter for Theologians. What do we do in medicine? Should the "voluntary victim" be treated the same as the innocent victim by the doctor? by the third-party payer? by the community when it sets priorities for allocation of limited resources? Do we requantitate the allocation of compassion when the innocent victim is not so innocent?
Bioethics Film Festival
On three evenings in February, we will be holding a "bioethics film festival" in which strong films (such as "Rain Man") which explore important issues in medical ethics will be screened and then discussed under the direction of individuals in a position to lead a fruitful discussion of the ethical issues investigated in the film. Health professionals will be able to earn CME and CNE credit at these sessions. Details concerning this bioethics film festival will be announced a bit later in the academic year. We invite your suggestions and participation in the planning of the program.
Chomsky to Lecture & Present Awards
On the 15th of next April, at the outset of an address focused on human rights in the context of foreign policy, Noam Chomsky will present certificates of award to the winners of our human rights internships and a check for One Thousand Dollars to the student who wins our essay competition. This ceremony and lecture will take place, under our sponsorship, in the Great Hall of Coffman Union at the University of Minnesota at 12:20 PM. Chomsky always attracts a vast crowd, so plan to arrive early in order to be sure of finding a seat.
Philip Regal on the Bonobo
Professor Philip J Regal, PhD, of the University's Department of Ecology, Evolution, and Behavior is writing a book on the Bonobo, the primate biologically closest to us. Although often called "the Pygmy Chimpanzee," the Bonobo is neither small (it's about the size of a chimpanzee) nor a chimpanzee. It is on the verge of extinction. Dr. Regal has kindly agreed to present a seminar on the Bonobo for us in May. Scheduled at 7 PM on the 14th of May (a Wednesday), the seminar is titled: "The Bonobo: Our Closest Primate Cousin is Near Extinction. What is Being Lost?" The venue for the seminar will be announced during the Winter term.
Officers Teach Medical Ethics
This Winter Quarter, Steven E Calvin, MD, (co-chair of our program), John M Dolan, PhD, (the other co-chair), and Jasper Hopkins, PhD, RN, (advisory board member) will, once again, jointly offer Philosophy 5235, "Medical Ethics," a course required of graduate students minoring in bioethics. Mary Krumholz, who addressed the class last Spring, may participate again, if her schedule allows.
Officers Teach Law Seminar
Once again, this Fall Quarter, David Bryden (constitutional lawyer and member of our advisory board) and John M Dolan are teaching the law school course, "Fetuses and Animals: Our Obligations Towards Various Forms of Life," which they introduced three years ago and have taught every year since. Steven E Calvin who served as a guest lecturer in the course last fall, will be serving in that capacity again, with a lecture on abortion scheduled for the 24th of October.
III. Scholarly Activity
Anscombe and the Prince of Liechtenstein
Prof. GEM Anscombe, LLD, of Cambridge University, co-founder of our Program, member of our advisory board, and one of the most eminent philosophers in the English-speaking world (writing in the New Republic, J M Cameron called her: "simply the most distinguished, intellectually formidable, original, and troublesome philosopher in sight") has had a new honor conferred upon her. The Prince of Liechtenstein has endowed a chair in philosophy at the Internationale Akademie fÅr Philosophie im FÅrstentum in Liechtenstein and invited Dr. Anscombe to become the chair's first occupant and to give the inaugural lecture for the chair. The new chair, which has been endowed in the memory of two members of the Royal Family of Liechtenstein, is the focus of a grand celebration scheduled for the 25th and 26th of October, a celebration which will have Elizabeth Anscombe's inaugural lecture as its climax. The title of her lecture is "Die Wahrheit Thun" (To Do the Truth) and examines an idea, the idea of "doing the truth," which has its earliest known expression in the 1st Epistle of St. John (I, vi). Dr. Anscombe has accepted the endowed chair for only one term. If her schedule allows, she will present a seminar or lecture here in the Spring.
Calvin Testifies
At the invitation of Rep. Henry Hyde, of Illinois, Steven E Calvin testified before the House Judiciary Committee in April on the advances in perinatal medicine since Roe v. Wade. Mary Ann Glendon of the Harvard Law School testified that same day on legal aspects of current abortion law.
Dr. Calvin recently completed a study on pregnancy toxemia in sheep with Cynthia Wolf, a ruminant specialist on the faculty of the College of Veterinary Medicine at the University of Minnesota. They are currently preparing their results for publication. This experimental work continues Dr. Calvin's long-standing interest in the causes and treatment of pregnancy toxemia in women; one of the leading causes of maternal mortality in the world.
Dolan to Address International Conference
John M Dolan, PhD, whose logic book, Inference and Imagination, appeared early last year presented two papers at the Annual Convention of Oregon Right to Life in Oregon, in May. Last academic year, he and
GEM Anscombe of Cambridge, Donald Davidson of Berkeley, Peter Geach of Cambridge, and Thomas Nagel of New York University, published a joint letter in the proceedings of the American Philosophical Association charging that the Association had wronged Saul Kripke by scheduling a session in December, 1995, at which baseless charges of plagiarism had been leveled against him; they asserted that the APA owes Kripke an apology. In November, Dolan will be addressing the League Of Catholic Women in Minneapolis and participating with Carl Malmquist and Michael Tonry in a panel discussion of homicide at the University of Minnesota. In April of 1997, he will be delivering three papers at the Sixteenth Annual Human Life International Conference, which will be held in Minnesota. His article, "Is Physician-Assisted Suicide Possible?," is scheduled to appear in a special issue of the Duquesne Law Review devoted to assisted suicide.
Hopkins Lectures at Trier
Jasper Hopkins, PhD, RN, advisory board member and internationally recognized authority on the thought of Nicholas of Cusa, gave the third annual Cusanus Lecture at the University of Trier, Germany, on the 23rd of January. Dr. Hopkins title was "Glaube und Vernunft im Denken des Nikolaus von Kues. Prolegomena zu einem Umriß seiner Auffassung" ("Faith and Reason in the Thought of Nicholas of Cusa: Prolegomena to a Sketch of his View"). The Cusanus Lecture, a grand event each year in Trier, honors Nicolaus Cusanus (1401-1464), who is sometimes referred to as "the first German Philosopher" and is best known for his work De Docta Ignorantia ("On Learned Ignorance").
Kjellstrand Everywhere
Carl M Kjellstrand, MD, PhD, member of our advisory board and member of the faculty at the University of Alberta, is on sabbatical conducting research at the Department of Public Health Sciences of the Bowman Gray School Of Medicine in Winston-Salem, North Carolina, and, starting in March, at the Department of Epidemiology at the University of Washington in Seattle. Some of you have been out of touch with him since he assumed his position at the University of Alberta in 1990, so we will supply a somewhat fuller report on his recent activities.
Dr. Kjellstrand, convinced that the rationing of medicine is coming on full force, under a false guise of economic necessity, has been studying age-discrimination in health care. He writes: "It is so easy for physicians to become the handmaidens of social darwinistic gangsterism, by subtly hiding the ageism, the invariable result of undercover rationing, under futility's mantle. 'We are not rationing, we are prudently withholding unnecessary and cruel treatment.' It is an evil form of insurance-fraud, practiced by HMOs and governments." He organized a three-day conference addressing this topic titled "Frontiers in Medicine" in Banff, Canada, under the auspices of Journal of Medicine. His contribution to the conference was a paper titled "High Technology Medicine and the Old - the Dialysis Example." Among the participants were former governor Lamm, former deputy-minister of health in Ontario Dr. Barkin, Drs. Orepolous, Wing, Bîttiger, Wetle, Engelhardt and Churchill. The proceedings were published in the Journal of International Medicine in January 1996. Recently, Dr. Kjellstrand debated Dr. Hirsch in Toronto at a meeting of the International Society of Geriatric Nephrology, arguing that "all old patients should be offered dialysis" (in a paper scheduled to appear in Geriatric Nephrology and Urology). Dr. Kjellstrand is preparing a paper to be presented at the meeting of International Psychonephrology in New York, in October 1996. In it, he argues that "the world can well afford dialysis of all needy, the cost will be much less than the open intergovernmental international arms trade. Compared to fraud, greed, incompetence, bribes and patronage by governments and private enterprise, high-tech medicine is peanuts." He debated T Wing from the United Kingdom on this topic at the meeting of the International Society of Nephrology in Barcelona in Fall, 1995. His contribution to the debate was published in Renal Failure earlier this year.
In addition to attacking medical rationing, Dr. Kjellstrand advocates more open debate about assisted suicide and the discontinuation of life-support which is, in his judgment, "often only death-prolongation." He writes that "Dr. J Kevorkian, by his openness has thrown much needed light on physician-assisted suicide" in "Jack Kevorkian - A Medical Hero." One of Dr. Kjellstrand's favorite passages is a remark by Seneca (4 B.C. -65 A.D.): "It is not a question of dying earlier or later, but of dying ill or well. And dying well means escape from the danger of living ill."
Dr. Kjellstrand's recent bibliography in medical ethics includes the following pieces:
"Who Should Decide About Your Death?," Editorial, JAMA, 267: 103 - 104. 1992; (with Dossetor J), "Dialysers and Transplanters are the Ethical Pointmen in Medicine," in Ethical Problems in Dialysis and Transplantation, (eds. Kjellstrand C, Dossetor J, Kluwer Acad. Publ., The Netherlands, 1992), pp xi - xvi; (with Dossetor, J.) "Stopping Dialysis. An Ethical Analysis," ibid., pp 147 - 155; (with Dossetor J.) "Ethical Problems in Selection for Dialysis and Transplantation," Ibid., pp 37 - 52; "Stopping Dialysis, Practical Aspects and Cultural Differences," Ibid., pp 105-118; "Disguising Unjust Rationing by calling It Futile Therapy," The Bioethics Bulletin University of Alberta 4 (2):1 - 3, 1992; "Stopping Dialysis - Different Views," in: Nephrology and Urology in the Aged Patient, Kluwer Acad Publ. Dordrecht 1993, pp 563 - 568; (with Hasinoff D) "Exclusion of Old Patients from Dialysis in Sweden, Canada and USA," Ibid pp 569 - 584, 415; "The Search for Scientific Truth Versus Corporate Interests," Seminars in Dialysis, 6 : 281 - 283, 1993; (with Moody H.) "Hemodialysis in Canada - A First Class Medical Crisis," leading article in Can. Med. Assoc. J, 150: 1067 - 71, 1994; "Patient and Therapy Perspectives: Choosing the Patient. - 'Is Better Worse ?'," Chapter 2, in: Quality Assurance in Dialysis, eds Thuna, RS and Henderson, LW, pp 11 - 22, Kluwer Acad. Publ Netherlands 1994; (with Cohen, L, and McCue, JD, and Germain M) "Dialysis Discontinuation: A 'Good' Death?," Arch Int Med 155: 42 - 47. 1995; "High Technology Medicine and the Old: the Dialysis Example," J. Internal Medicine, 239: 195 - 210, 1996; "As Fiduciaries, Physicians Hold in Trust: Life, Death and Money, and Least of those is Money," Renal Failure, 18 : 417 - 423, 1996; (with Roberts, J) "Jack Kevorkian - A Medical Hero," Editorial BMJ, 312 : 1434, 1996; (with Cranford, R and Kaye, M) "Stopping Dialysis: Practice and Cultural, Religious and Legal Aspects," Chapter 63 pp. 1480 - 1501, in Replacement of Renal Function by Dialysis. Fourth Edition, eds: Winchester J, Jacobs C, Koch K, and Kjellstrand C, Kluwer Academic Publ, The Netherlands, 1996.
Prem Presents Papers
Konald A Prem, MD, member of our board and former head of Ob/Gyn, presented a paper on "Gynecological Oncology" at a three-day conference on "Optimizing Health for Older Persons: Practical Strategy" sponsored by the Department of Family Practice in St. Paul last June. During that same month he participated in a panel discussion titled "Ask the Doctor/Ask the Pharmacist: Concerns and Effects of Medications" at an international conference in St Paul marking the silver anniversary of the Couple to Couple League, an organization he helped to found and whose medical board he has headed throughout its history. In May, Dr. Prem attended the annual meeting of the American Association of Pro-Life Obstetricians and Gynecologists in Denver, Colorado. In August he attended a board meeting of the National Commission on Human Life, Reproduction, and Rhythm whose purpose was to decide questions that needed resolution to enable the quarterly publication, Child and Family, to move its publication operations from Chicago to Pittsburgh.
Twiggs Directs Studies, Presents Papers
Leo B Twiggs, MD, member of our advisory board and head of Ob/Gyn, is currently Principal Investigator in a study sponsored by SmithKline Beecham investigating Topotecan versus Taxol in women with advanced epithelial ovarian carcinoma. He is also Co-Investigator in a Department of Health and Human Services study titled "Growth, Migration, and Invasion of Ovarian Cancer Cells." Awarded the American Society for Colposcopy and Cervical Pathology "Colposcopy Recognition Award" in 1992, he was chosen to be listed in The Best Doctors in the United States publication in 1994-95. He has recently addressed conferences and given grand rounds at venues across the United States and abroad, including ASCCP Postgraduate Courses in Colorado, Florida, and Canada, in 1994, the International Congress on Pathology in Buenos Aires, Argentina, in 1994, the Annual Autumn Seminar in Minneapolis, in 1994, St Joseph's Hospital in Minot, ND, in 1994, the ACOG Postgraduate Course in San Diego, CA, in 1994, the University of Kansas Medical Center School of Medicine-Wichita, in Kansas City, Kansas, in 1994, the University of Hawaii in 1995, the Midwinter Symposium at the University of Arizona in Scottsdale, AZ, in 1995, and the ASCCP Postgraduate Course on "Comprehensive Colposcopy" in Mexico City in 1995.
Weissbrodt Elected to U.N. Post
David Weissbrodt, JD, co-director of the Human Rights Center and member of our advisory board, was elected this Spring by the United Nations Commission on Human Rights to serve for a four-year term as the United States member of the U.N. Sub-Commission on Prevention of Discrimination and Protection of Minorities. The Sub-Commission meets annually in August to authorize studies by its 26 members of such issues as human rights and disability, traditional health practices affecting the health of women and children, fair trial, and other topics. It is also responsible for responding to human rights violations in such countries as Burundi, Iran, Iraq, Rwanda, and Turkey. In addition to his work on the Sub-Commission in August, Prof. Weissbrodt is spending academic year 1996-97 on sabbatical with his family in Geneva, where he is teaching human rights at the Graduate Institute of International Studies at the University of Geneva. His fellow officers in the Program in Human Rights and Medicine salute David on his election to the prestigious U.N. Sub-Commission and wish him a very happy and productive sabbatical year!