In response to Dr. Loh, I agree entirely that there is far more to "human-ness" than mere science. However, the concept of "humanistic science" is an oxymoron. Science, by definition is an exact subject that applies measurements by objective methods and thus, per se, does not include attributes like opinion, emotions and feelings. We physicians must take the latter fully into consideration in making our decisions, just as much as we include science in our decision making, but we should never be deluded into confusing the two, or stirring them into one kettle.

In comment to Hans Engel, an interesting issue is to debate what is the "scientific" viewpoint and what is the "religious" viewpoint. I would argue that the question of what is a "human" is clearly not a scientific question but one of personal choice based on one's own philosophy. Why is that not a scientific question? Science deals with the ability to answer questions once definitions, based on culture, language, and baseline assumptions have been agreed upon. Science is an approach to making decisions in life and it is an end in itself when acquiring new knowledge, but it has not successfully provided the answers to ethical issues. Whenever an attempt has been made to define human life by new technology such as EEGs, it has failed to satisfy many people because those who object do not use technical or scientific definitions of life. I would further argue that it is a mistake for us to think that "science" dictates that "to be human requires a functioning mind." I believe, as a practicing physician, as does Mr. Engel that it is a personal opinion, best left to individuals. Yet I also believe that sometimes those personal choices can violate the standards of society as a whole when those beliefs are applied to those who cannot make their own choices such as children. Then society has an obligation to intervene. For those who are adults but who can no longer make a choice such as those who are comatose, then their family or friends have a role in helping make known what their choices would have been. Thus the conclusion of this approach would be that society, i.e., the legal system, would best serve the rest of us by setting up a range of options for making the transition between life and death. Then each of us could make a choice, an informed choice, as to how we want to go. For those who are unable to make the choice for themselves, a more narrow set of options would be available. It would be very interesting if in high school an optional course would be offered on "what is life" and every citizen would have to make their decisions, obviously changeable at any time when they become an adult.

Maurice, This is another instance of a conflict between religion and science in which neither can provide an absolute answer, but must rely on ethical judgment for such. From the scientific viewpoit, I believe that there is little question. The anencephalic infant and the braindead patient are not human beings in the traditional sense, but organic structures outwardly and anatomically resembling humans and should thus be potential organ donors if permission for such donation has been granted. To be human, in my opinion, requires a functioning mind, which, in turn requires a functioning brain. If souls exist, can they exist without minds? And here we have left the realm of science and completed the circle to religion.

The toughest moral decision concerns the patients in chronic vegetative state. Ideally, we might keep them alive indefinitely, or until some other disease process, such as cancer, causes death. This on the chance that 1 in 10,000 of such patients might one day wake up to reasonably adequate functioning. Economically howver, such an action is not feasible and a decision must be made regarding the time span from the time the diagnosis is first made until the discontinuation of artificial support measures.