Life, Death and Medical Research - 17 August 2001

Round my corner, only four blocks north on Fifth Avenue, there lies, in a famous hospital, a once-famous beauty of the type that in the long ago Time magazine taught us to call "a socialite".

She has lain there for 22 years, to all appearances dead and beyond human care.

On the contrary, although she has no pulse, no heartbeat, she's watched continuously 24 hours a day.

Apparently there is, from time to time, a minuscule brainwave. So by the laws of New York state she's alive.

And because, since the day in 1979 when she fell unconscious, no one knows what her end-of-life wish might have been, she stays attached to her tubes and need not be pronounced dead so long as there's a measurable electrical response from her brain stem.

When this fatal stroke happened the newspapers leapt to explain a phrase that had not previously come to the attention of the general public - namely "brain stem".

And that's when too it became general, surprisingly general knowledge that the 50 states have their own separate laws about when in fact death takes place.

Until then most people thought, as perhaps many still do, that after a person collapses it was just like the movies: The doctor kneels down, puts a thumb and a finger on the wrist of the stricken one, counts three, looks up and slowly shakes his head.

A year or two earlier there was the interesting case of Generalissimo Francisco Franco - the dictator of Spain.

He was, no question, mortally ill. And though in a coma for a month or more he gave no positive sign of expiring.

This put his team of doctors in a frightful stew. The death of a dictator, however plainly attributable to a known disease, always stirs tales of conspiracies and rumours of assassination.

The problem for Franco's doctors was, as it is more and more with the advance of medical technology, first how to define mortality and then when to let it settle in.

And due to similar bio-medical progress in assisting and defining the other end at a beginning of life we now find ourselves - we being you and I and everybody who can read and watch - involved in answering what has become an exquisitely debatable question, namely: Which is the exact moment when life begins.

I suppose for centuries most Westerners held to the view of the church - which remember for 14, 15 centuries was the Catholic church - which said life begins when the egg and the sperm unite and thus create an embryo which is at once a human being due all the reverence and rights of every grown person.

And therefore it is still held that because you have to destroy some embryos to produce embryonic stem cells for any research whatever therefore you have crossed the moral line which says "Thou shalt not kill".

But then in our time along came fertility clinics where embryos are implanted in the wall of the womb. Most embryos fail in one way or another to implant themselves.

The usual experience, I gather, is that for every pregnancy the successful implant happens to one embryo out of eight or nine. The rest are stored for a year or two and then destroyed.

The special British medical authority that is the leader in this field reports that during the past decade 55,000 babies were born in Britain by invitro fertilising. And that in the process over a quarter of a million embryos were destroyed.

There has not been here, or I believe in Britain, either general or particular criticism of fertility clinics. The Catholic bishops have not tried to ban them.

Let me say now, before you leave the building, that I'm not going to go into this business since it is of blinding complexity and the deeper you go into judging the fitness or propriety of any particular stand for research use you will encounter half a dozen schools of thought that have quite different views of when a cell - a process, a medical event - turns into a human.

Let me say two things. One, that a national poll on President Bush's address to the nation on stem cell research gave him about 60% approval. But of the 30-odd per cent who could have wished him to ban all such research over 80% said his compromise was acceptable.

The poll which I'd hoped for was never taken. It was this.

Apart from its use for any research whatsoever can you honestly say you know what a brain stem is?

I believe the honest answer from the citizens of any country polled would be 99% "No".

Wherefore, in case such a poll comes your way, let me recite the crudest, simplest, definition of a brain stem which can claim great accuracy - mainly because it doesn't tell you what the function of the stem is, except that in the case of the comatose beauty it must show some minute expression of activity before she can be pronounced dead.

Very well. The term "grey matter" is surely known to all of us, usually in facetious contexts.

Grey matter is composed of the nerve cell bodies and surrounding mesh of fibres that make up the core of the spinal cord and, mark this, its upward extension into the base of the brain. The upward extension is the brain stem. So there.

The second and final comment comes from another Briton - tops, as we used to say, in his peculiar profession.

He remarked at the end of a newspaper interview, almost as a private afterthought when the interview was all over: "Of course the research which will successfully help or cure Parkinson's, diabetes, senile dementia and so on won't come for years [pause] if ever." If that's where he can live it so shall we.

Meanwhile whatever happens outside Texas, short of an international calamity, President Bush says he will keep to his beloved ranch throughout the month, much to the low key displeasure of the White House press corps - which goes with him everywhere.

The last time I followed and lived with the White House corps there were, at most, a dozen of them and I was the only foreign correspondent.

Today, what with small television stations in Laksholm, Sweden, or Thunderbolt, New Mexico, having a White House scribe - there are several hundred of them.

They don't like this stretch of Texas and the surrounding scrub desert, and contrast their lot with the gaudy pictures painted by the old hands who tell of the rollicking days of camping and lake swimming with Ronald Reagan in the balmy air under the sparkling skies of the Santa Inez mountains overlooking the Pacific.

Or the great fishing and golf, alongside Gerald Ford, in the Rockies. Or riding the incoming waves at Kennebunkport with G W's dad: Sailing, tennis, jousting in the town by night.

If I'd been along I could have made their mouths salivate even more with vivid and true recollections of two warm Christmas's down in Palm Beach observing pretty correspondents and even pretty non-correspondents down there on the white beaches and the glimmering aquamarine ocean.

And John Kennedy pausing after his graceful swing on one of the 10 finest golf courses in America. John Kennedy chuckling to point out the brave trouble a little freighter was having trying to ride against the Gulf Stream.

And the dazzling nights and fine food available in small places as fine food always is wherever great chefs follow the movement of money.

So how, a clutch of rather solemn correspondents was asked, how about Crawford, Texas, G W's beloved ranch country?

They filed stories calling it "parched", "barren" and "hot". All complained about the broiling sun.

Reminded that, surely they do their stuff in an air-conditioned press room, "It is," was the stony reply, "a muggy gymnasium."

The grumbles, of course, have reached the president and one day last week he had them over and said: "I know a lot of you wish you were on the east coast lounging on the beach but when you're from Texas and love Texas this is where you come home, this is my home."

He tries to impress on them that he was a young man who came here, went into the oil business and has spent most of his life here.

Curious how some presidents want to invent an image and then impress it on the people as their true selves.

Jimmy Carter decided that the public image of a president could be eased and softened and made more user-friendly by addressing the nation wearing a cardigan.

It was a mistake. The people hated it.

And however movingly President Bush goes on about his deep love of Texas, even if he recited Robert W Service's heartbreaking verse about "hunger not of the belly kind that's banished with bacon and beans but the pure love of a hungry man for home and all that it means", he cannot blur the root image of the privileged son of an old upper crust Yankee Connecticut family, New England prep school, Yale - member of its most exclusive club - grandson of a Connecticut senator, son of a Yankee president.

I asked an old, conservative friend of mine, a man who positively did not vote for Al Gore, what he thought of George W now - his polices, his claims as a Texan - how's he doing so far?

"Well," he said, "as somebody said about Wagner, he's not as bad as he sounds."

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