One of the first conundrums that medical students face is that technology has pushed doctors and patients into realms of experience where they are morally and ethically unprepared. These often occur at the extreme boundaries of life and death, where American medicine, at least, is increasingly focused. This is an old dialectic, of course: what was an extreme life-and-death situation a century ago is barely noticed today. But the new extremes are now far more extreme, thanks to technologies that push the definition of death itself into territory that is murky for experts and laymen alike. Sometimes medical technology appears to stand selfishly in the way of death, resulting in life that may not be worth living or is of such enormous cost that it harms those still alive.
This spring, an experimental technology for emergency treatment of severely injured victims of penetrating wounds such as gunshots is being tested on patients at the University of Pittsburgh Medical Center. Dubbed EPR-CAT (for Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma), its goal is to quickly lower the temperature of their brains by 50 degrees, producing a state popularly known as “suspended animation,” so that doctors have more time to work on their injuries before their brains are ruined by lack of oxygen. This is achieved by filling the victim’s blood vessels with cold saltwater. A major unknown, illuminated only by animal trials, is the extent of neurological and cognitive impairments that might afflict survivors.
The research has been funded by the U.S. Army, for obvious reasons, but will depend on human subjects from local communities around UPMC and other hospital centers, such as the University of Maryland’s shock trauma unit in Baltimore. In other words: young black males engulfed by the violence of ghetto life. By necessity, they will not be given the usual chance to consent to being experimented upon (though as a bizarre palliative, they can call a number at UPMC ahead of time and ask for an opt-out bracelet). The doctors leading the study have financial interests in the results, via patents on the EPR method used to achieve the cooling.
There are darksome aspects of this research project that have become all too common–the military funding, the exploitation of a degraded population, the absence of informed consent, the conflict of interest–that are easily obscured by the promise of a new medical miracle. Extending what has been called, since the horrors of World War I, the “Golden Hour” between life and death is probably irresistible. But the potential for backlash is profound, perhaps moreso than the scientists themselves have been trained to comprehend.
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