healthy person is ethically unacceptable. Once again, Hippocrates made his appearance. Lillehei wanted to stand the oath on its head. Primum non nocere. First do no harm. Lillehei must be stopped.
Lillehei’s mentor Owen Wangensteen was Watson’s equal in power and prestige, and his argument also was based on uncompromising logic. His department of surgery was world famous for advancing surgery through innovation. His star protégé Lillehei had performed the proposed procedure successfully in animals. If Lillehei was denied, blood would stain Watson’s hands … a child would die for no other reason than Watson was afraid to try something new. Watson’s reaction was his own version of the Bikini Atoll. He felt like the top of his head would blow off with the suggestion that he would be painted as a child killer. He was not the real potential killer of innocents, he raged, pointing a trembling metaphorical finger: it was that man, the one who proposed the research, C. Walton Lillehei.
Here then is the classic, explosive confrontation that has bedeviled groundbreaking research through all my years in cardiology. Just eighteen months earlier Lewis and Lillehei’s hypothermic surgery had established the feasibility of open heart surgery. Now where Watson saw risk, Lillehei and Wangensteen saw opportunity. Where Watson saw that both patients might die, Lillehei saw that a child condemned to early death might be given life. The issue as Watson fought Wangensteen on that Minneapolis afternoon was specific to one family, but I see variations on this theme argued in every Institutional Review Board (IRB) meeting, in which we critically review and approve every research project in the medical center prior to its initiation. What criteria are we as a society to use in making such decisions?
My experience provides a bizarre answer. With our human gift of twisted logic, we decide the ethically correct position after we learn the outcome of the research. Charles Bailey was terribly, morally, Hippocratically wrong. Until he was right.
Wangensteen won the argument based on uncertainty: the first-ever human cross-circulation surgery deserved to be tried, because no one could say cross-circulation wouldn’t work, and if the Lord was willing and it worked, this form of open heart surgery could save countless numbers of dying children. The gain justified the risk. Wangensteen and Lillehei prevailed, but Watson made it clear that crazy Walt Lillehei was on a very short leash. The winner of the ethical battle would await the result of surgery. Lillehei’s first patient, two-year-old Gregory Gittens, seemed to do quite well until the second postoperative week, when he developed pneumonia and died. Rather than resolve the issue, the Gittens experience escalated tension to new levels as both sides saw it proved how right they had been.
* * *
AT AGE FOUR Annie Brown was already clearly destined for a very short life. She had a hole in the wall that separated her right and left ventricles, called a ventricular septal defect (VSD). Annie’s VSD was large, and her lungs were drowning in her own blood. She could not play with other kids because of progressive fatigue and shortness of breath. She had already undergone repeated hospitalizations for pneumonia. Now she had episodes of coughing up blood as the distended blood vessels in her lungs ruptured. Doctors told her parents Doris and Joseph that she would probably not survive to be a teenager.
Imagine the wrenching decision that now confronted Doris and Joseph. They knew that a young Minneapolis heart surgeon named Walton Lillehei had developed a new way of operating on the heart, called open heart surgery, and that he had tested it successfully—in dogs. But they also knew that his first patient Gregory Gittens, a youngster with the same heart defect as Annie’s, had died in the hospital after Lillehei’s surgery. Having lived with Annie’s progressive deterioration, the
Lillehei’s mentor Owen Wangensteen was Watson’s equal in power and prestige, and his argument also was based on uncompromising logic. His department of surgery was world famous for advancing surgery through innovation. His star protégé Lillehei had performed the proposed procedure successfully in animals. If Lillehei was denied, blood would stain Watson’s hands … a child would die for no other reason than Watson was afraid to try something new. Watson’s reaction was his own version of the Bikini Atoll. He felt like the top of his head would blow off with the suggestion that he would be painted as a child killer. He was not the real potential killer of innocents, he raged, pointing a trembling metaphorical finger: it was that man, the one who proposed the research, C. Walton Lillehei.
Here then is the classic, explosive confrontation that has bedeviled groundbreaking research through all my years in cardiology. Just eighteen months earlier Lewis and Lillehei’s hypothermic surgery had established the feasibility of open heart surgery. Now where Watson saw risk, Lillehei and Wangensteen saw opportunity. Where Watson saw that both patients might die, Lillehei saw that a child condemned to early death might be given life. The issue as Watson fought Wangensteen on that Minneapolis afternoon was specific to one family, but I see variations on this theme argued in every Institutional Review Board (IRB) meeting, in which we critically review and approve every research project in the medical center prior to its initiation. What criteria are we as a society to use in making such decisions?
My experience provides a bizarre answer. With our human gift of twisted logic, we decide the ethically correct position after we learn the outcome of the research. Charles Bailey was terribly, morally, Hippocratically wrong. Until he was right.
Wangensteen won the argument based on uncertainty: the first-ever human cross-circulation surgery deserved to be tried, because no one could say cross-circulation wouldn’t work, and if the Lord was willing and it worked, this form of open heart surgery could save countless numbers of dying children. The gain justified the risk. Wangensteen and Lillehei prevailed, but Watson made it clear that crazy Walt Lillehei was on a very short leash. The winner of the ethical battle would await the result of surgery. Lillehei’s first patient, two-year-old Gregory Gittens, seemed to do quite well until the second postoperative week, when he developed pneumonia and died. Rather than resolve the issue, the Gittens experience escalated tension to new levels as both sides saw it proved how right they had been.
* * *
AT AGE FOUR Annie Brown was already clearly destined for a very short life. She had a hole in the wall that separated her right and left ventricles, called a ventricular septal defect (VSD). Annie’s VSD was large, and her lungs were drowning in her own blood. She could not play with other kids because of progressive fatigue and shortness of breath. She had already undergone repeated hospitalizations for pneumonia. Now she had episodes of coughing up blood as the distended blood vessels in her lungs ruptured. Doctors told her parents Doris and Joseph that she would probably not survive to be a teenager.
Imagine the wrenching decision that now confronted Doris and Joseph. They knew that a young Minneapolis heart surgeon named Walton Lillehei had developed a new way of operating on the heart, called open heart surgery, and that he had tested it successfully—in dogs. But they also knew that his first patient Gregory Gittens, a youngster with the same heart defect as Annie’s, had died in the hospital after Lillehei’s surgery. Having lived with Annie’s progressive deterioration, the
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