Good afternoon and welcome to another episode of Likeable Science here on Think Tech Hawaii. I'm your host Ethan Allen. I'm glad you could join us today. With me today in the Think Tech studio is Dr. Dara O'Carroll. Dara's been on a couple times before. Welcome again. Yeah, good to be back. Yeah, it's always a pleasure to have a good articulate passion MD year on to talk about medical stuff which is likeable science because it impacts impacts all of us, right? Of course. And we're gonna be talking today actually about sort of a topic that's beginning to be more relevant every day to all of us, right? Yeah. Just sort of we're on the edge of it right now. It's how climate change is impacting human health. Yes, yeah. And so I think anybody with a scientific framework or anybody who's, I don't want to say has half a brain but at least a quarter of a brain, if they've been following any of the developments around the world is that our climate is changing and it's changing quickly. Right. And I don't think it's an argument anymore. And there's a lot of people who feel that way, especially the International Panel for Climate Change, the IPCC used the foremost body on this whole science and literature is overwhelmingly saying humans are affecting our climate. And what is happening is it's our CO2 production and our other greenhouse gases that are causing this. I don't think that's a question. But just like any disease process happens, the earth is now kind of gradually having this incremental change and it's pretty much creating a process that's charging the earth. The more heat that we have, the more energy the earth has. And it's changing disease processes that are happening across the globe. Right. And in a number of very different sorts of ways, right? I mean, yeah, in ways that are kind of obvious. Right. And then in ways that are not so obvious. And we can go over those. Exactly. Yeah. And it's happening, I mean, around the world, it takes sort of different forms in different places with different populations. But basically, sort of the bottom line is more and more, and it's likely to be more and more in the future. It is really going to be, this climate change is really going to affect the health of people all over the globe. Sure, it's a new world. Yeah, it's a new world. Yeah. So I think the most obvious one is that storms are becoming more frequent. Right. Since 1980, big storms, you know, are now double in frequency. And they're even trying to possibly create a new category of storm. That's right. Talking about having to add to the hurricane force. Yeah, there's category five. But now you're getting the storms that have sustained winds of 200 miles per hour. Like where do you go from there? Yeah. A sustained winds of 200, that's, you know, tornado velocity, but in a much wider breath. Yeah. And so these cyclones are ripping through, you know, the Philippines and really just just, you know, creating wild, wild havoc. And so the rate that you're going to, that you're going to get injured, or you're going to have some sort of illness from a storm flood or any of those is now going to if rates of carbon dioxide do not decrease by 2040, it'll be 50 fold chance that you're going to get hurt in a storm throughout any given year. Yeah, just really frightening changes coming up and one can only envision if one of these big super storms hits in some place like the coast of Bangladesh, low line area. Yeah, I think we've got a picture of a super storm. I'm not sure which one this was, but yeah, there we go. So these storms are really, really intense. And so the number of floods, landslides and avalanches has quadrupled since 1980 as well.  We just had a big flood in Chile. You know, there's a lot of floods going down in Australia at the moment as well. It was one last year in Oregon. Washington slid down and whole mudslide buried part of the town there. Yeah, and the Lancet came out with a study that said by the end of the century, 150,000 people per year in Europe could be affected and be killed by these extreme weather events. So I think that's the most obvious in our sphere of we're seeing storms, they get covered by the news, we see the landslides. Yeah, there's heat events and drought events again in the same extreme events. Yeah, yeah, but either one can kill. And then the ones that are kind of less obvious is the vector born disease or zoonotic diseases or diseases that are transferred by ticks or or mosquitoes or any of any other kind of insects or animals. Right, because the change in climate is changing their range or their timing of season when they're active. You've got a more humid in world, you've got a more hot, a hotter world, you're going to have more territory that mosquitoes and ticks can survive in and in longer periods. So if we've jumped to the next slide, we've got something that affected a moose here. And so behind me is a ghost moose. And so they call these ghost mooses because the really ghost moose aren't supposed to be white. And what they're doing is they're they're rubbing off these ticks that are just infesting them. So it's not only is it happening to moose, it's happening to us. They're rubbing off their fur and they're rubbing off their fur because they have up to 100,000 ticks on them, which is just completely, I mean, 100,000 on these majestic animals are really bleeding them dry. And so these aren't the same ticks that affect humans. Deer ticks are the ones that's predominantly bite humans, and especially in the northeast, but they transfer all host of tick borne diseases and predominant one is Lyme disease. And Lyme disease can be a very indolent and incessant disease. But acutely, it can cause severe problems such as Bell's palsy or facial droop, heart block, you can have all sorts of arrhythmias from it. And chronically, it can cause memory loss, nerve problems, joint issues, and people deal with these for sometimes a lifetime when they get Lyme disease. So that's terrible. That's gonna get it become more common. Yeah, and the rates of it are skyrocketing in the northeast and becoming more more prevalent. malaria is now had an outbreak in Southern Europe when it hasn't been there in 100 years. I haven't heard that. Yeah, dengue is is on the move as well. Zika virus, everything is sort of kind of making moves. All because we're getting basically a warmer or hospitable climate for disease carrying insects, basically. Yeah. And then it's, you know, going on the warm, warm aspect, cholera as well, if we jump to the next slide is a picture of a girl in Bangladesh. Well, behind us is behind me is a tick. There we go. So that's that's the deer tick. Okay. Yeah. The next slide is a girl of in Bangladesh. And I mean, Bangladesh is one of the lowest lying countries in most density densely populated countries in the world. And what they're seeing is what, you know, Florida may see pretty soon. And so cholera is a disease of water inequality and water sanitation issues. But when you mix higher levels of sea higher sea levels, plus more higher temperatures, cholera has this prolific effect where it just becomes much more rapid. And so rates of cholera in Bangladesh are always been high, but they're getting higher. And thankfully, there's been some public health initiatives where they've distributed some vaccines. And that has helped to call it but they keep seeing outbreak after outbreak. And one place where things have succeeded in keeping the outbreak at bay is the in Cox Bazaar, the Rohingya camp. And so one million people they distributed an oral vaccine, which comes in two doses. And that has helped to keep them from experiencing a bad cholera outbreak. So so cholera is one. If we jump to the next slide, there's something called harmful algal bloom. So you can see behind me. And on that screen is that I mean, that's just a soupy mix of, I don't know, somebody blended some spinach into the whole Great Lakes. And so these carry all sorts of problems if you ingest or around them too much. One is cyanobacteria. And those can cause a lot of a lot of nerve issues. They can even cause seizures. And then the red tides, right? Yeah, which I don't have a photo of, but the red tides, I can have dino flagellates in them. And they have something called as brevetoxin, which can cause even on land can cause issues. So if you've got a red tide on the coast, it can actually secrete this brevetoxin into the air and up to one mile inland, it can cause asthma like issues bronchospasm, which is especially important for people with asthma, because it'll cause their asthma to become much more severe and worse. Oh, yeah. awful, awful. Okay, then we have some water source issue diseases, right? Yeah, yeah. I mean, those were sort of the water, the other water issues, but we've got some heat related issues as well.  And so the world is getting hotter. And where it's going to get the hottest is in our cities, right? Because our cities have something called the urban heat island effect, right? Because they don't have cooling plants and green trees and all these things that help evaporation and provide shade and get everything cool and said they just the cement building is just, yeah, they hold on to everything. And then the cement buildings all have AC in them, which are putting out heat as well. Yeah. And so there's a picture of downtown LA where they're they're they're feeling it as well. And where I used to work in a ER and we saw a lot of homeless, predominantly homeless with heat strokes coming in. And the the the 2003 heat wave that happened in Europe, 70,000 people died in that week to 10 days span 12,000 people alone in Paris, predominantly is people in the elderly population or people with chronic diseases such as heart failure and kidney failure. But as people who can, you know, really help themselves otherwise, is that you know, they may be stuck in an old apartment or an old building that's from the 1800s that has never experienced heat like this in a prolonged period like this. And then how do they get away? Yeah. And I mean, we've had what were the last five years have been record breaking heat, right? Yes, the five hottest years or four, four hottest years on record have been in the last five years. Yeah. You don't have to be like a genius to figure out where the trend is going. Yeah, I know it's cold now in Hawaii and in North America. But I mean, is that's that polar vortex where the hot air from the Southern Hemisphere is drawing the cold air down and that polar vortex is not keeping the air in the Arctic where it should be. So just because it's cold now and this aggravates me when Donald Trump says, can we bring back global warming?  Right? Yeah, yeah, exactly. It's it's that's again, it's one of these big problems that really show is the sort of the global nature of this whole thing. Yes. This whole issue of how just how these changing climates in all the different ways, different mechanisms of physical mechanisms for physiological mechanisms, the disease vector mechanisms, the change in ocean and surface water temperatures, all these different things. So this is this is great. It's not great. It's awful. But it's great that we're learning about it. It's great that we're beginning to do some things about it, that more people are taking knowledge of it, gaining an understanding of it. I think at this point, we have to go off to a first break though. Okay, we'll be back. Hi, I'm Rusty Kamori, host of Beyond the Lines on Think Tech, Hawaii. My show is based on my book also titled Beyond the Lines, and it's about creating a superior culture of excellence, leadership, and finding greatness. I interview guests who are successful in business, sports, and life, which is sure to inspire you in finding your greatness. Join me every Monday as we go Beyond the Lines at 11 AM. Aloha. Aloha. This is Winston Welch. I am your host of Out and About where every other week, Mondays at three, we explore a variety of topics in our city, state, nation, and world, and events, organizations, the people that fuel them. It's a really interesting show. We welcome you to tune in, and we welcome your suggestions for shows. You got a lot of them out there, and we have an awesome studio here where we can get your ideas out as well. So I look forward to you tuning in every other week where we've got some great guests and great topics. You're going to learn a lot. You're going to come away inspired like I do. So I'll see you every other week here at 3 o'clock on Monday afternoon. Aloha. And welcome back to Likeable Science here on Think Tech, Hawaii. I'm your host, Ethan Allen. Dr. Dara O'Carroll is with me today in the studio, and we're talking about how climate change is impacting our health in mostly negative ways, right? Yeah. Yeah. The only positive way I can think of is that up to about a degree Celsius or so, a degree and a half might increase food production. But above that, it's going to decrease food production. Yeah. And we were talking about before our break, we're talking about heat impacts and some of the more sort of obvious cases that we've had recently, the huge heat death, heat relief deaths in Europe that you mentioned a few years ago and all that. But you were telling me during the break about a sort of special case of this. Yeah. Yeah. There's something called, unfortunately, Mesoamerican nephropathy or nephritis. And what it is Mesoamerica being the area from like mid-Mexico south all the way down to the northern South American countries, Guatemala, Colombia. And it's mostly on the Pacific side of these countries where there's a mysteriously, there was a group of specific group of males 30 to 50 years old, all agricultural workers who were coming in with kidney failure. And they presumed that first there was a lot of hypotheses where there was toxins because they're all around pesticides. It was banana farms, sugarcane, coffee, that sort of thing. And they've gradually over the process of studying this since the 1980s, 1990s have ruled out the toxin phenomenon because it's starting to happen in Thailand. It's starting to happen in Sri Lanka. And they're using different chemicals. And you know when they studied the blood tests of all these these young males they didn't find any evidence of hard, hard chemical indolence. And what it comes down to is that they were just getting chronically dehydrated from being out in the sun and working that hard. So the process of being dehydrated on a chronic basis just really took a toll on their kidneys.  But unfortunately most of these guys live in rural areas, agricultural areas, and they can't afford dialysis. Dialysis in itself is a life-changing event. You've got to be somewhere for three hours a day, three times a week. And a lot of them perish. And it's one of the most predominant leading causes of death in this group of people in Mesoamerica and now Sri Lanka and Thailand. And that's got to have wide-ranging effects because lots of them are adults, husbands and fathers. And so their families are then left without a wage earner. Right, yeah. And they're the breadwinners of a lot of these families. And so it's terrible. It would seem though that should be reasonably dealable with, right?  Yeah, even that doesn't help as much as just being in the heat for that long. And so, I mean, this wasn't happening in the 80s and 90s or started happening in the late 80s, 90s, this wasn't happening before. And so I don't know if you can argue that with this fact that like climate is changing the way it affects humans, you know? Yeah. And then on moving on to air pollution, there's a little bit of smog behind me in LA. But that's another obvious. And people are track air quality, air quality index and smog, predominantly ozone, ground level ozone that's in smog, which is three oxygen molecules, really harmful to the lungs. It causes asthma problems. It causes COPD or emphysema problems. Even rates of visits to the ER and lost workdays, all skyrocket when the air quality index is getting worse. And it's a very complex problem too because it's actually can be, I gather, a mixture of man-made sources and natural sources. The terpenes and things of plants are dumping out. Yeah. Then interact in some manner with a lot of these man-made pollutants to make more irritating compounds and compounds that are more harmful. Yeah. Yeah. And if we move to the next slide, I think we have a diagram. Well, this is, if we jump to the big picture of it, yeah, this diagram here is kind of how these particulate matter or all these smog and terpenes that Ethan just mentioned affect the body. So really the process is of the pharynx, which is basically your back of your throat from your nose all the way down to the biggest part of your airway, the trachea. There's two functions that it serves. One is to humidify the air. So by the time the air gets down into your lungs, it's 100% humidified. So that's why the fact of breathing, you lose water. So that's why, if you're living in a dry environment, make sure you're drinking water. But two is to catch all these particulate matter and things that are in the air. And so if it's got so we're talking on microns here. So coarse particles are around 10 microns or a little bit less. And so your upper airways will catch those. They've got little hairs that are lining the upper airways that kind of bring everything back up. And that's why you've got to clear your throat and that sort of nature. But the fine particles that are less than 2.5 microns or even the ultra fine particles that are less than one or the really, really fine that are less than 0.1, they go all the way down into your lung and your alveoli where you're actually where you are transferring oxygen. Right.  Yeah.  Yeah. And if you're chronically exposed to bad air that is getting all the way down here with carbon material, wildfires that are causing soot to be dispersed in the air, rates of obviously lung cancer, even rates of heart attack are increased when air quality is is poor. So it's really something that can really affect your health. Right. Again, this is something that we have a good deal of control over in theory. We could choose if we have this social will basically to control that more tightly. Yeah. But indeed, right now our political leaders are trying to loosen controls on some of that. Right. And coal is such an old technology. Why are we trying to go back to old and dirty technology where you're just ruining the environment? And then again, this compounds with increased heat you know, and makes everything worse, right? Oh yeah. The hotter the environment is, the more ozone is going to be going to be made when you combine that with the smog and the particulate matter that's in the air. You know, you're really asking for trouble. Yeah. And so I think the next slide shows a big picture of a fire that was in up all the way up in Northern Alberta. And you can see the smoke plume. This is a satellite photo going all the way down into the middle of the United States, into the Midwest. And so you could have a fire so far away, but this particulate matter is dumping on you, you know, hundreds to 1500 kilometers in displacement. Yeah. That was a very bad case that last summer for a while, Seattle, Washington and Portland, Oregon had the distinction of having the worst air quality of any city in the world for several days because of fires that were happening up in British Columbia. There were 100 worst fires going on at once and all that smoke and particulates were coming right down over Seattle and Portland. Yeah. Making air. I heard one once we're saying there's equivalent to smoking eight packs of cigarettes a day or something if you're outside. Yeah. No, that's, that's, that's terrible. You don't want to be a subject to your body to that. You know, every insult you have increases your rate for problems in the future. And I believe our next photo shows another satellite photo of well, here's, here's, we'll get on the topic of drought. And so we're going to have a warmer planet which is going to change the rates and where our, where our water is being displaced. Right. And a lot of the areas that are already hot and dry are going to get hotter and drier. Correct. Yeah. You're going to have wetter spots, but you're also going to have hotter and drier spots. And so you're going to have increased dust storms. You're going to have water issues. You're going to have a lot of problems keeping people hydrated who are already having issues. Right. Well, we already, in some of these less developed nations, women and girls particularly are spending significant amount of time getting water for their families. Yeah. They have to walk half an hour, an hour, two hours in some cases to go and get water. Yeah. And if it's hotter and drier, that situation is only going to get worse. Yeah. And clean water especially. Right. You know, there might be water that's close by, but it might be with the hotter temperatures you're going to have more of the algae in it, more of the cholera that are in it, and more of the issues as well. You know, I've had on this on my show earlier a guy with it who makes something called Muddy Drops, which are a poor ceramic tablet and a silver infusion. You drop that into water and it knocks out all your pathogens very neatly. Well, it's a wonderful technology. I suspect it's going to become more widespread. Yeah. Let's hope we're not going to need it as much, but it's there for you if we need it. Yeah. Yeah. Well, droughts are obviously a devastating phenomenon. Yeah. Yeah. And the next slide shows a photo of a dust storm that's coming off the Sahara Desert and this is really, really mind blowing to me is that you could see Spain in the upper right corner there and that dust storm is as big as Spain. Which is halfway across the Atlantic. Yeah. And it's moving across the Atlantic and that dust will go ahead and deposit all the way over in Florida and the Caribbean. And so dust is marvelously good at transporting pathogens, fungi, influenza can even go across it, other viruses and bacteria. Every gram of dust, you can take a pinch of it in your fingers, about 100,000 bacteria live in that dust. And so when this is sprinkling over other areas, it's increasing the rate of disease that are transported across the globe. Yeah, spreading stuff all around. Yeah. And so you've got dust going from North Africa to North America. You've also got vice versa. You've got a lot of dust coming from the Mongolian plains in China and coming down and sweeping over the Southeast countries, but also Taiwan, Japan, even across Pacific over it, over it's in North America as well. So it comes coming from both sides and you've got if you've got drier climates, it's only going to increase. Right. Exactly. Exactly. It's just going to be worse. That's and then there the other effective course of drought is that drought means typically less productive farming. Right. Typically farmers cannot grow as much because most plants, all plants need water. And typically the more, in a lot of cases, up to a certain point at least, the more water you have, the better, the healthier, the bigger plants you get in the middle of a drought.  You don't have that food supply.  And you're opening yourself up then for all kinds of other illnesses as well as probably dietary insufficiencies. Right. Yeah, completely. And then you look at the world's oceans with the increasing acid levels in pH that is happening and our coral reefs that are disappearing, that whole ecosystem may completely be altered and changed. And so what the, our fishing supply may completely be gone. Yes. I was reading a while ago that it's something like three billion people on this planet already, more or less directly depend on fish for some significant part of their protein. And something like 17 out of the major 19 fisheries on this planet are considered threatened or endangered basically that they're collapsing or already collapsed. And when that gets a little bit worse, I mean they're already fishing down the food chain to a smaller fish and all that. That's, we're just going to lose a little chunk of food supply and more and more people are not going to get the protein they need and. Yep. Yeah. No. It's, it's, it's, let's hope that something is, is done about it. But there's a lot of ways that our food supply is really going to be affected. Yeah. Yeah. And then our next slide, I believe, is our last one and we can jump to a big photo of that as well. That's a study that came out just in November of 2018. So very recently.  And the darker red colors in Maroon are, where rates of miscarriages were curiously found to be a lot higher than the rest of the countries. So the rest of the country was down around 8 to 7 to 8%. And some of these areas were having miscarriages around of 13 to 14%. And all of these areas were closer to the river. And what was happening is that the sea level is rising and spilling back into the, into these rivers and depositing salinity and salt into their drinking water. And so when you intake too much salt and they were on the order of normal salt should be around 5 grams give or take per day. Some of these women were in taking around 17 grams. And when you increase salt it's going to increase your blood pressure. And especially during pregnancy it's very detrimental. And you can have rates of preeclampsia and miscarriages, which they saw here. So this is a way obvious way that's not so obvious that climate is affecting health but also increasing miscarriages. Yeah, and if it's happening there there's lots of places around the coast of the world where we're getting saline intrusion into groundwater that people are using for drinking. So again this problem we're seeing a little bit of it now and we're likely to be seeing more of it. Yeah, the Mekong Delta all Cambodia Laos and China are really going to start seeing it next. And what happens when again it had Hurricane Sandy spills a lot of seawater into the New York drinking pot or into Florida. So All the Pacific Islands. Yeah, yeah. Carabas, you know, is literally sinking and they're six feet or less above water now. So what are they going to do with theirs? No, no. It's truly, truly this is pretty amazing. I have to say in some sense there are you have helped me make one of the least likable episodes likable science. Unlikable science? But it's relevant science and it really shows how we need science to inform us of these problems so we can at least take the action we need. Yeah. So I thank you very much for coming on and giving us such a such a great view of these multi-faceted changes here. Thank you, Dara. And I hope you'll come back and join us next week on another episode of Likable Science here on Think Tech Hawaii.


Today I'm going to be taking a look at a Linux distribution that I've never taken a look at before. This distribution is called Regata OS. Regata OS is a Brazilian-based distribution. It's based off of OpenSusa and it's designed primarily for those that want to play video games or create content. So let me go ahead and switch to my desktop here and let me navigate to the Regata OS website. Let's see if I can type correctly here. The website is written in Portuguese but you do have a translation here. You can choose English here and it will translate the page into English for you. There's not a lot of information on the website but here on the front page the little blurb at the top of the screen tells you exactly what Regata OS is all about. The latest version is version 23. I've already downloaded the ISO. It looks like they're going to have their own unique gaming store and their own software center. One thing from the front page here is they talk about GPUs especially. You can see Regata OS already runs some applications with the dedicated GPU by default on AMD and Nvidia laptops. And they do mention also about hybrid graphics. Hybrid graphics should work out of the box. Hopefully on Regata OS I don't have any device to test that on. Today what I'm going to do is I'm going to take a quick first look of Regata OS inside a virtual machine. So I've spun up a virtual machine here. I gave this virtual machine six gigs of RAM. I gave it two threads of my 24 thread threadripper CPU. So let's go ahead and boot into Regata OS. And we come to the screen here with the time and date. I'm assuming this is a login manager. If I click on anything or just hit enter. I don't know if I just happened to hit enter at the right time. But I get into the live environment and the live environment. Is this KDE Plasma? Yes it is. So that is cool. So the first thing I want to do is I want to go ahead and run through a quick installation of Regata OS. So let me click on the icon here. And it does look like they're going to use the Calamari's installer. So that's nice because I'm very familiar obviously with the Calamari's installer. So the first thing I need to do is choose a language for the installer. Because by default the installer is in Brazilian Portuguese. I want it in English. So if I hit E, get to the E's here. British English, American English. There it is. And now I can actually read what's going on in the installer program itself. Now let me click next. And what do I want to do as far as partitions? I want to erase the disk and give the entire 25 gig virtual hard drive in this VM over to Regata OS. And then I'll click next. And it looks like that's all we have to do. This is one of the most straightforward installers I've ever seen. All you do is choose a language and then choose what you want to do with the partitions I guess. So I'm just going to click the install button. It's going to warn us that it's going to format the drive right to the disk. I'm going to choose install now and away it goes. This will probably take a few minutes. I'm going to pause the video. I'll step away, grab me a cup of coffee. I'll be back once this portion of the installation has completed. And the installation has completed. Of course here in the Kalimorris installer, what you need to do is tick restart now and then click done and then reboot the machine to complete the installation. One thing that the installer didn't do, we didn't create a username and a password. We didn't set the hostname of the computer or any of that. I'm assuming we'll take care of that once we reboot. So let me go ahead and click done and reboot the machine. And on reboot once again we get the screen with the time and date. I'm assuming if I just click, well actually I didn't even need to click. It just goes ahead and puts us right into a live environment here. And this time looks like the Kalimorris installer again. Did I not? May have needed to detach the ISO. Now it is the Kalimorris installer again, but this time it is, it's different. This is weird. So now we go through setting up location, keyboard, and users and all of that. Okay, well let me choose American English obviously for the language. And let me move this up so you can see the buttons here. The time zone, it has correctly chosen the time zone that I'm in, the central time zone here in the US. I'm assuming it's using a geolocation to figure that out. English US is the keyboard. I'm just going to click next on that. And then let me go ahead and create my username. I'll call my user DT. We'll make the host name of this computer. We'll call this regatta-vert. And then let's create a strong and complicated password for the DT user. Repeat the strong and complicated password. And then log in automatically without being asked for a password. I do not want that ticked on. I want to have to enter a password to get into any of my computers just for privacy reasons. You don't want random people just to be able to log into your computer. Use the same password for the administrator account. That's the sudo account. Yes, you probably do want that ticked on. That way you don't have to remember two different passwords. DT's password and the sudo password will be the same password. So click next, location, keyboard, all that looks good. Let's go ahead and do the setup. It's removing one package. Probably is removing the Calamari installer. It's probably the package it had to remove. And then restart now. It's automatically ticked on this time. Let me go ahead and click done. And now we get to a proper login manager here. You can see the default session is Regata OS X11. So it uses Xorg by default here. But you can switch over to Plasma Wayland. If you want to use KDE Plasma using Wayland as your display server. I'll just stick with the default which is Plasma with Xorg. Let me go ahead and log in. And it logs us in just fine. Now let me go ahead and change the display resolution here. So if I just do a search for display, display configuration. Let me go ahead and change to a 1920 by 1080 screen resolution and hit apply and keep these changes. And now this virtual machine will remember from this day forward to always be 1920 by 1080 every time I log into KDE Plasma. I do notice now in the sys tray we do have a keyboard applet here. The keyboard layout looks like it's set to Brazilian Portuguese. But just clicking it automatically switches it to the English US layout. Clicking again would switch it back to Brazilian Portuguese. So that's interesting. So let's take a look at what is installed out of the box here in Regata OS. So if I go to the development category we have Kate, which is KDE's text editor, plain text editor. Although I wouldn't call it a plain text editor. These days Kate is more of a fully featured IDE. If I go to about, this is Kate23.04.3 back into the menu system. Under the games category, this is really what we want to take a look at. Regata OS game access. So I believe this is one of their custom applications because Regata OS really is built with gaming in mind. And you can see this is actually really cool because you can see available launchers. So if you have accounts for any of this stuff, Epic Games, GOG, Battle.net, EA app, Rockstar, Ubisoft. I don't have accounts for any of these. I am not a gamer. So you're not going to see any benchmarking or me playing any of these games here on today's video. But let's assume that I had one of the Epic Games. I could click on Epic Games and install the Epic Games Store because it's not already installed. And then I'll log into the Epic Games Store. I'm assuming I could do that with good old games as well, Battle.net. Oh, yeah. I could install any of these Battle.net games such as Diablo 3 or Overwatch 2 or whatever it happens to be. So this is kind of cool. Let's take a look at the EA app. So this is going to be a lot of sports games, obviously, as well as the Star Wars games as well. Very cool need for speed. That can be fun. Yeah, I may have to actually play with this at some point on physical hardware that I would actually game. Although, typically, I don't really game much. I can go weeks, sometimes months, logging into my Steam account. I have a Steam account. I've had a Steam account for many years, but I really don't game much. But other than that, other than the Regata OS Game Access, that custom game application, we also have the Steam Launcher here as well, which the Steam Launcher, I'm assuming, would just do a Steam install. It's updating the Steam runtime environment here. Probably shouldn't have done that. This may take a few minutes. Steam's kind of a big program. But while that's running, I guess I could keep going through the menu here. Let's go into the graphics. We have Gwynvue, which is KDE's image viewer. Let's cancel the Steam update. It's going to be a big update. Also, under graphics, we have Oculus, which is the document viewer. Oculus is a document viewer. That's a PDF viewer, essentially, is what it is. If I go to about Oculus, it's also version 23.04.3. Also, under graphics, we have ScanLite, which is an image scanning utility. Not too many people have a scanner these days, but if you still do ScanLite, that's what that program is for under internet. The default browser is Firefox. So let's go ahead and launch Firefox. Taking a second to load, and let's go to Help. And about Firefox, this is Firefox 116.0.2. Close Firefox. And other than Firefox, there's really not much else under the internet category. We have KDE Connect, the Regatta OS App Store, which, actually, strange that's under the internet category, but I'm assuming it's because when you install applications, you have to do it over the internet. I mean, that's standard for any app store, right? But that's just usually not where you expect the app store to be. Usually, you don't expect it to be under an internet category, but I do like the store here. So we have Discover here, and I'm assuming this is just like a curated list of some of the more popular apps that they recommend, such as Caden Lime, Sims 4, and Discord. Obviously, you've got to promote some games. You've got to promote Discord, because everybody that games probably has a Discord account as well. So there's some proprietary software that they're pushing here, but you really can't fault them for that because the software is all proprietary software under the create category. I'm assuming this is all the content creation stuff, because other than this being a distribution designed for gamers, it's also, it touts itself as being for content creation. So it's pushing things like OBS Studio, Dementia Resolve, and Dementia Resolve is also proprietary software, but hey, you know, if you want to use it, I understand it's kind of a standard as far as video editing me personally. I edit all my videos on free and open source software, such as Caden Lime, which I'm assuming is here as well. You also have things like dark table and raw therapy for those of you that need to do any kind of image editing, and things like that. GIMP is also here for that as well. They also have a lot of art tools, paint tools, graphics tools, such as Krita, and Penta, and Inkscape. Lightworks is also here for video editing. It's another proprietary video editor, but it's very popular. Although they mention it's free. Lightworks is free and costs. Same thing with Dementia. You can install them and use them for free, but they are limited on the features as far as the free version. I think the free version of Lightworks, you can only export to certain resolutions. I don't think it exports to 1080p by default. You actually have to pay for a license to actually be able to really use it. You have to pay for these pieces of software. I think the Lightworks license, the last time I looked at it, it's been a few years. It's like $300. But of course you have your free and open source alternatives, such as Kaden Live as well. For audio editing, you have things like Audacity. They've got pretty much all the content creation related applications you would expect to be here. Let me close out the app store. Let's get back into the menu system. Under the multimedia category, we don't have much here. VLC. So, VLC it makes sense if you're trying to be kind of minimal because there's not a lot of things installed. If you go through this menu system, there's not much here. And it makes sense under multimedia just to install VLC because it's kind of a jack of all trades. VLC can be an audio player.  And it has all the various multimedia codecs that come with it out of the box. So, you've got your Blu-ray playback and all of that stuff. Under the office category, there's nothing here. Ocular, the PDF viewer is here. And a printer configuration tool as well. Under settings, so this would be settings for basically the system settings like the plasma system settings here. So, you know, if you wanted to, for example, if you wanted to change the theme from dark to light or light to dark or whatever it is you're trying to do, you guys have seen the plasma settings manager before. So, let's just discard all of that. Some other things under settings, you do have line tricks because some of the games you're going to want to install will be windows-only games that you could install in a wine wrapper. So, that's cool that that's there. You also have YAST for administration settings. Remember this is based on OpenSUSA. So, that's why we're using YAST in this case. YAST has to be run as root. So, I had to enter a sudo password. So, this is some of the system settings here. For example, you've got some software configuration, hardware configuration, system configuration including configuring the bootloader. Well, that could be dangerous. Probably don't want to do that. Network services as well. Security and users. So, this would be things like your firewall, for example. We have a miscellaneous category as well. Let me go ahead and close out the YAST control center. Getting back to the menu, we have a system category. So, this will be your system tools such as your archiving tool, which is KDE's ARC. So, that is for zip, unzip, things like that. We have Wine here. We have Dolphin, which of course is KDE Plasma's file manager. Really nice file manager. Also under system, we have our firewall configuration. We have console with a K. That's KDE's console. That's our terminal emulator. Zoom in a little bit. Let me do a uname dash R. Let's see what kernel version we are on. We're on kernel 6.4.10. Now, let me do a where is pipe wire. Let's see if they're using pipe wire for the audio server. They are because the where is did return something, right? You can see the location to the pipe wire binary. Let's see how many packages are installed out of the box here. So, I'm assuming they're using zipper because that is the package manager for open SUSE. So, if I do a zipper search space dash I for installed. So, search for all the packages that are installed and it should give me a list a list each package on its own separate line. Which that then makes it really easy to then up arrow and then pipe that information into WC space dash L. WC the word count program dash L. Give me a line count instead of a word count and that will tell me how many lines of output were in that command and 2,995 programs are essentially are installed. That's what that tells me. Now, I could update the system with the graphical software center, but if I did a sudo, I haven't used zipper in a while, but assuming it's sudo zipper is an update let's give it the sudo password. I don't use open SUSE very often at all. Sometimes I go many, many months between running open SUSE or in this case open SUSE based distribution, but I do have a lot of updates available. The ISO obviously was not that new. It looks like the following 49 packages will not be installed and I'm assuming the following 802 packages will be upgraded. So if I run a system-wide update right now it's going to update 802 packages I'm actually going to decline that because that would take forever and I don't want to waste time with the update. One last thing I want to check is let's see what kind of wallpapers ship with Regata OS. So let me right click on the desktop and choose Configure, Desktop and Wallpaper and let's see if they have a custom wallpaper pack or if they're just using some of the standard wallpapers that ship with Plasma. Yeah, there's really nothing here I believe I've seen some of these before. Looks like just some abstract art although these are kind of nice although this picture is actually really, really dark. A really, really dark wallpaper though would look great if you use a light Plasma theme. This one here is a little lighter. This one here little lighter yet still because I'm using a dark theme, Plasma Dark it looks like a light wallpaper would work best. Yeah, that's kind of cool. I'm not crazy about the colors. That's not bad either. I could probably just go with that. So that was just a quick and cursory look at Regata OS. There's really not much to it as far as installed programs. It's quite minimal actually out of the box as far as the number of programs that are installed. Again, Regata OS it's claim to fame. What they're trying to be is a distribution for the gamer and for the content creator. Now before I go I need to think a few special people. I need to think the producers of this episode. And of course I'm talking about Daniel Gabe James, Matt Paul, Royal Wes, Armored Dragon, Commander, Ingrid George Lee, Methos, Nate, Erion, Paul, Peace, Archon, Fedora, Realiteats4Less, Red Prophet, Roland, Solastry, ToolsDevillar, Wardgint2 and Ubuntu and Willy. These guys they're my highest tiered patrons over on Patreon without these guys. This quick look at Regata OS would not have been possible. The show is also brought to you by each and every one of these fine ladies and gentlemen. All these names you're seeing on the screen. These are all my supporters over on Patreon. I depend on you guys, the community. If you like my work and want to see more videos about Linux and free and open source software, subscribe to Distro Tube over on Patreon. Peace.


Russian artist and musician who replaced supermarket-priced tags with demands for an end-to-conflict in Ukraine appeared in court on Monday. Alexandra Skokolenko, 33, known to her friends as Sasha, has spent over a year and a half in prison in St. Petersburg as the Russian legal system deals with her case. Critics say it is part of a crackdown on anyone who speaks out against Moscow's special military operation. Authorities have detained nearly 20,000 people for propice activity and opened over 800 criminal cases against propice dissidents, according to the OVD Info Rights Group. The Justice Ministry has designated the rights group a foreign agent and its website is blocked in Russia. Russia tightened its laws on dissent after sending its troops into Ukraine on February 24 last year, deepening its action against critics. Critics Moscow regards as unacceptably divisive as the country is locked in what President Vladimir Putin has portrayed as an existential struggle with the West. The judge did not like it. She decided to remove all of them. And she did not have the authority to remove all of them. The law says that she can remove the face of the person who has been violated. Do you understand that this is not about everyone? Because by removing all of them, she violates the principle of justice.


Bob Trug is professor of medical ethics, anesthesiology and pediatrics at the Harvard Medical School and is a senior associate in critical care medicine at the Children's Hospital in Boston. Bob received his medical degree from UCLA and holds a master's degree in philosophy from Brown. Dr. Trug is the director of the clinical ethics program in the division of medical ethics and in the Department of Social Medicine at the Harvard Medical School and he also directs the Institute for Professionalism and Ethical Practice at the Children's Hospital. Bob is widely published in the field of bioethics. He recently wrote some national guidelines for providing end-of-life care in the intensive care unit and is the principal investigator on an R1 grant from NIH to improve end-of-life care in pediatric ICU's. I could go on. I think time restrains me. Please join me in welcoming Bob Trug. Thank you, Mark, for inviting me and for putting together this panel. I'd like to thank the McLean family for your support over all the years in creating this wonderful center and in particular for making today possible. Art and Jim, thanks for being here with me as well. I was surprised at really, we agree on so many things, but I think there'll still be a few key points where we're going to have something to talk about here. So I'm going to talk about some of the issues and determination of death in the context of organ donation and I thought I would divide my comments here into two parts. Act one, if you will, to lay out the problem and then act two to talk about what we should do about it. So let's get started here. What is the problem? Jim very nicely reviewed this, but I'm going to do it briefly again. Remember that we have two pathways for organ donation. There's the brain death pathway on the left and the DCD pathway on the right. We're premised on determining that the patient is dead, the dead donor rule. In the brain death pathway, we determine the death on the basis of the irreversible loss of all the brain functions and on the DCD pathway on the irreversible loss of circulatory functions. Now, again, this is all premised on the dead donor rule. I want to emphasize that this isn't actually a law. This was a phrase that was coined by John Robertson in 1999 to express a sort of general ethical assumption that underlies how we think about the ethics of organ transplantation. And there's various ways of putting it. A couple of options are that vital organs for transplantation may only be procured from patients who are dead or a little bit different. Physicians may not cause death when procuring vital organs for transplantation. And so, as Jim said, we now have these enshrined in our law in the Uniform Determination of Death Act, which lays these two things out clearly.  One, spelling out circulatory death supporting DCD donation. So let's talk first a little bit about brain death and what it means. Now, in 1981, when the UDDA was created, people said, well, one of the things that's nice about it is that it's pretty clear. But no one's really laid out a philosophical foundation for why these findings should mean that a person is dead. And that same year, Jim and his colleagues published this paper, which I believe is one of the most important papers that's published in the Ethics of Organ Transplantation. It's a remarkable paper, and I agree with really all of the way that it is structured. And it provided what was needed, a sort of a philosophical basis for why these tests would show that a person was dead. And let me just review what I think were some of the key points that Jim and his colleagues made in this paper. He said, we define death as the permanent cessation of functioning of the organism as a whole. I continue to believe that that's the best definition of death that anyone has put out there.  That individual subsystems may be replaced, such as by pacemakers, ventilators or pressers, without changing the status of the organism as a whole. So for example, if a patient's on a ventilator, it doesn't matter that the breathing is being supplied by a machine. What matters is whether the breathing is occurring. So it's function, not mechanism. Jim also said that death is considered a biological occurrence, not unique to humans. So it needs to spread across species. And I think that that's true and very important. At this point, he was pushing back on those who were saying the human death should be something special. That we should say humans are dead when they have permanently lost consciousness, or they've lost personhood or something like that. And Jim was saying, no, this is a biological phenomenon. And I think that that's true. And he also said that death is an event, at least in theory, not a process, that the moment can be determined. And I think that all of these things were brilliant in 1981, and I think that they hold again today. Now let me expand on Jim's thesis a little bit, because he was actually reaching back to a line of thinking that went back to Claude Bernard, the French physiologist in the 1800s, through Walter Cannon in the 1930s at Harvard. The idea that life and death can be understood and defined in terms of thermodynamic concepts. And so Walter Cannon coined the term homeostasis. And if you follow this line of reasoning in short, it says that living organisms are distinguished from the inanimate world by their use of energy-consuming processes to oppose entropic forces and maintain homeostasis. And this, I think, is where Jim really captured this nicely in this phrase that life is the integrated functioning of the organism as a whole. And I just want to say a little bit more of that, because I think that there's an important element here that we need to remember. So if you look at this little yellow circle as an organism of some type, could be an amoeba, could be a tree, a dog, a human being, there's two sorts of forces that are active. There's these entropic forces, which are going towards chaos and disorganization. And there's these opposing forces that are maintaining homeostasis. And an organism is alive when these two forces are in balance. And then when the time comes that those forces that are maintaining homeostasis shrink, then the entropic forces take hold, we reach a point of no return, that moment of death, if you will. And then we say that this organism has died. I think that this is a unifying way of thinking about life and death that has origins now going back well over a hundred years. So now let's go back to Jim's paper in 1981. What did he say about this? He said, the criterion for cessation of the functioning of the organism as a whole is permanent loss of functioning of the entire brain. This criterion is perfectly correlated with the permanent cessation of functioning of the organism as a whole, because the brain is necessary for the functioning of the organism as a whole. And the data he cited was that destruction of the brain produces apnea and generalized vasodilitation. In all cases, despite the most aggressive support, the adult heart stops within one week and that of the child within two weeks. Now at the time Jim wrote this, drawing on data from the 1970s, it was true. And I think at that point it constituted a very robust defense of brain death as death. The problem is, it is no longer true.   And that's true. And that's because with our understanding of brain death in this country, that diagnosis has become a legally enforceable definition of futility. So that we don't have to keep these patients on ventilators in the ICU any longer than we want to. But there have been cases over the years where families have convinced their clinicians to let them go home on ventilators. And when they do, we see that they're integrated just fine. They can live for years. In some cases over 14 years. Now why is that? Why does the data that Jim was drawing from in the 1970s differ from what we know today? And this will be the most technical part of my talk. So tune out for a second if you're not interested in that. But what I think is the difference is that intensive care has improved over the last several decades. And Alan Schumann has made a very nice analogy here between brain death and high cervical cord transaction, as when somebody is in an accident. Now in both cases what happens is the body is rather acutely separated from any sort of neural input.  But even then they're not out of the woods because now they go into a condition called spinal shock where they're extremely unstable, hemodynamically. And in the 1970s we couldn't keep these people alive. They died no matter how hard we tried. But intensive care has gotten better. And now what we know is that if you get these patients through the first days or weeks of instability that the body kind of gets used to the fact that the brain's not telling anything. And they stabilize out and they can live for years. And I think this is really a change in the science that has very, very much undermined the original rationale for why brain death was death. To summarize Schumann's work, he said, what is clear from a comparison with spinal cord injury is that the mainstream assertion that brain death represents the biological death of the human organism as a whole is untenable. And I do believe that's the best state of the science right now. Jim was right in saying that death is where we lose the integrated functioning of the organism as a whole. That's true, but brain death is not that. I want to say a few words about DCD. The donation after circulatory death pathway. So Jim's talked about this. Let me see if I can try to focus my comments on response that way. So we know we declare these patients dead two to five minutes after the onset of pulselessness. Now I would say that everyone agrees, and Jim would agree here too, that at least some DCD donors could be successfully resuscitated after two to five minutes of pulselessness. You know, this happens every day on the streets of our cities. The paramedics go out, somebody's had a pulseless arrest, and they are successfully resuscitated. So in this sense, their pulselessness is clearly not irreversible after this time frame. And in fact, Jim, in writing in 2006, said this. He said the DCD donor is dying, but is not yet dead after only five minutes of a systole. Now as Jim explained, more recently he has argued that permanence should legally substitute for irreversibility. I have a lot of concerns about this, and I'm going to be brief here. Maybe we can get to more in the discussion. As I understand permanence, what Jim means by it is that if the heart has stopped permanently, it means that since we're not doing anything, it soon will be irreversible. I think this is just a simple category mistake.  That's what permanence means. But they're dying. They aren't dead yet. I mean it's confusing a prognosis for a diagnosis. I think it is deeply flawed. And there's more to say about it, but this is fundamental to me. Another is what it means for how we think about death. So let me give you a little hypothetical here. Consider a DCD donor who has been declared dead after two minutes of pulselessness. So he's in the operating room with intention to donate, and he's been pulseless for two minutes. The surgeons say you are now dead and they are about to make skin incision and procure his organs, but in a moment of grief, his wife insists that he must be resuscitated. And whether or not it was a good thing to do, let's just imagine that the physicians do it, and let's imagine that they are successful, which would not be an unlikely outcome. What else can we say but that this person has come back from the dead? He's been diagnosed as dead, at least dead enough to have skin incision and organ procurement, and now he's alive. I think that this convoluted way of looking at it just tortures our common sense understandings of what it means to be dead. And as Jim himself said, he has acknowledged this. Because no mortal can return from being dead, he wrote, any resuscitation or recovery must have been from a state of dying, but not from death. And that seems very inconsistent with the way that permanence is being used. This is sort of the end of my first part of my comments. I do want to ask you to engage with me in just a little imagination. Imagine we lived in a world where the immunological hurdles to transplanting organs from pigs were overcome. Now, you know, pig organs are very much like human organs, and it would be great if we could transplant them into humans because we would have an unlimited supply of transplantable organs, but we haven't been able to overcome the immunological hurdles. But let's imagine we did, and I say this is an imaginary world, but it's not unthinkable that in the next 10 or 20 years, we could achieve this. And then the ethics of organ donation would really kind of devolve into the ethics of whether we should be eating bacon or something. You know, it would be really, I mean a question maybe, but not a question on the order of what we're talking about here. Now, in this world, which like I say maybe is not too far in the future, when we would not have a need for dead patients with live organs, would anyone really argue that our patients currently diagnosed as brain dead or our DCD organ donors are dead? I mean, I don't think so. I don't think that the arguments are at all compelling. And it leads me to question, is our understanding of the facts driving our conclusions, or is our desire for certain conclusions driving our interpretation of the facts? Are we gerrymandering the lines between life and death solely to meet social goals important as they are? And then the question is, in the long run, is this more likely to bolster or erode the confidence and trust of the public in the organ donation enterprise? Now, and just finishing here, Jim and I read this document differently. This is the 2008 report from the President's Council on Bioethics under the former President Bush shared by Edmund Pellegrino, one of the giants in our field. I read this actually. I mean, everything that I have told you up to now is pretty much affirmed in this report. So much so that they felt they needed to come up with yet another explanation for why brain death is death, which, to be honest, no one who's read it finds any more convincing than the ones that went before. So I don't take this as a ratification of what's gone before quite the opposite. Okay, let's turn to, now that we understand the problem, what should we do about it? And let me begin by saying I'm not really sure, but I'd like to think with you a little bit about it, and I'd also like to say that the public is looking to us as bioethicists for guidance. This is really where we do have our expertise as bioethicists. This is where I think we need to be accountable to the public. And so let me put it right out there. What's the big worry? The big worry is that if we acknowledge the truth, and I put truth in quotes because it's the truth as I see it, I acknowledge that, but if we acknowledge the truth about how death is defined for organ donation, we will destroy the public's trust in the organ transplantation process and that this will lead to the unnecessary death of many patients. This is possible. And if this is indeed so, then perhaps this is a situation where the consequences must trump the truth, where we must say, you know, we've got to come up with other ways of talking about this because we need to preserve the life-saving enterprise of organ transplantation. Now, in the book that I recently published with my friend and colleague Frank Miller, we provide a sort of a philosophical response to that worry. I'm not going to do that here. I'm not going to give you an ethical argument. If you're interested in that, I encourage you to read the book. I'm just going to have a few reflections about how this has evolved sociologically over the past few years that may give us some insights. And go back to a comment that the great anthropologist Margaret Mead made in 1963 where she said the greatest contribution of the Hippocratic of is that it separated the role of healer from that of killer, separated white magic from black magic. And so as I tried to put there in the graph, made a complete separation between the roles of causing death and allowing to die. And this has been a strong theme in medical ethics. So here's an article which Mark Siegler authored along with Edmund Pellegrino and other giants in the field that said this in the strongest possible way a few years ago, doctors must not kill. This is a deep theme in bioethics. But I'd like to suggest to you that sociologically we have been shifting away from that more towards what we might say as gray magic. And we might think that the beginning of this really goes back to the onset of mechanical ventilation several decades ago. Now clearly when we put patients on a ventilator, we are acting in the role of healers. We are trying to benefit them. But the question comes up then, when we stop ventilation, are we now killers? Now most of you who work in medicine would say, well that's crazy, we do this all the time, of course not. But it wasn't always that way. If we go back to the famous case of Karen Ann Quinlan in 1976, the reason the physicians didn't want to take that ventilator away at the request of her family was because they said to do so would be killing her. It's against medical ethics. And indeed the judge got it. The judge wrote, it seemed to be the consensus not only of the treating physicians, but also of the qualified experts, the bioethicists of the time, who testified that removal from the respirator would not conform to medical practices, standards, and traditions. She said, okay, I get it. She also said something very interesting. Even if it were to be regarded as homicide, it would not be unlawful. I'd like you to remember that phrase. And so what the Quinlan Court concluded was that the patient's right to privacy took legal precedence over physicians' concerns about the ethics of causing death. And so I would say from that case forward, an act that is causing death by withdrawing the ventilator was reframed as an omission, therefore in allowing to die, which made it acceptable in this Margaret Mead scheme. And again, I just do want to have come back to this phrase because over and over again I hear people say that, well, Bob Trug, no matter what you're talking about, if it comes to being a homicide, it's obviously illegal. I just want to say that the Quinlan Court did not necessarily think that way. Let me suggest a little bit more. So I've talked about mechanical ventilation. What about the palliative care that we do at the end of life? We all agree that patients have a right to be made comfortable at the end of life, even if that means receiving medications from us that hastens their death and provided certain conditions are met, the doctrine of double effect, et cetera. But what you can see is that these two circles now are starting to come together and we're starting to have little areas of gray between them. We've had the withdrawal of mechanical ventilation carve out. We've had the palliative care carve out where, well, yes, we are kind of causing death, but under certain circumstances there are other reasons why it's okay. Extending that analogy to palliative sedation, this is where we sedate patients to the point of unconsciousness and then take away food and fluids. Now, we still justify that the same way. We still say, well, we're not intending their death, that makes it okay, but we started to bring those two circles even closer together. It's getting harder to see where we're not playing a causal role here. Extend this now to physician aid and dying. Legal in three of our states, narrowly defeated in my state just several days ago, here again we're saying, well, physicians were not really causing death, but you can see that that causal role starts to grow. Physicians can't say they really had nothing to do with this in writing the prescription, et cetera. And then, of course, when we move into voluntary active euthanasia, that distinction dissolves entirely. And when that happens, the ethical question now shifts from whether it's ethical for physicians to cause death to other questions such as, is this compatible with our duty of non-maleficence? Are we harming patients when we do this? Is this done with the patient's consent indeed at the patient's request? And here we are also seeing a sociological shift. If we look at Gallup polling around the question of euthanasia, we see that in 1947, 37% of the population thought that under some circumstances they thought euthanasia would be ethical. In 2005, that has more than doubled, including 61% of individuals who identify themselves as evangelical Christians. So society is moving. So let me turn now to the hardest one. What about actually procuring organs then before death? We'll call it DPD, donation prior to death. I'll point out, first of all, that organ procurement is occurring in tandem with euthanasia in Belgium. So euthanasia is legal in Belgium, and there they are taking patients to the operating room for euthanasia, and they are donating their organs, all of their organs, just like in a brain-dead organ donor. And, you know, remember, I mean, Belgium is a civilized Western European country, shares many of the values and traditions that we do in our own country. Here in the United States, organ procurement in tandem with withdrawal of life support is also being actively considered. And let me just tell you about a case from last month that occurred. I do have permission to say where it was and the family and everything else, but I'm not going to do that. I'm just not quite comfortable with that. But I'll tell you, this was a large transplant center, and it wasn't in Boston. It involved a 52-year-old man who had a devastating stroke after really doing a lot to try to get him better. And he said, this isn't, you know, he's just not going to improve. We need to withdraw life support. But this was somebody who always wanted to donate his organs. But he wasn't brain-dead, and he wasn't thought to be a good D.C.D. candidate because he wasn't going to die soon enough after they withdrew his ventilator. So they were initially told no, and the family said, there's got to be some way. There's got to be some way that he can donate his organs. Why can't he be a living donor?  Well, they said, well, let's do the same thing. Let's have him go to the operating room, let's take one of his kidneys and one of the lobes of his liver that can be donated to somebody else.  Well, the hospital ethics committee looked at this. They thought it was fine. The hospital administration thought it was fine. They thought it was compatible with the patient's wishes. They said there was no harm to him because he was going to be comfortable, and it conforms with the dead donor rule. They weren't causing death by taking his organs. So it all seemed to be fine. Now, this just played out over the last few weeks, but in the end, the transplant was denied. Why? Because we have a practice with living donation, not a law, but a practice that first person consent is required. I think it's generally a good idea. Don't get me wrong. But the patient, you know, him or herself has to say, I want to be a donor. This person couldn't do it. But I think we would agree that it's sort of a regulatory technicality. I mean, if this person would have been able to speak for himself, he probably would have agreed to the donation. But the point I want to make with this case is really look at what's happening sociologically. We are now coming up with strategies to do an end run around the dead donor rule. And, you know, take this a step further and people are talking about this. What if we took this gentleman to the operating room and put him on cardiopulmonary bypass?  He could come back then to the ICU alive on cardiopulmonary bypass. He could have life support withdrawn and then he would die. Now, we would be observing the dead donor rule in letter, certainly not in spirit. But people are talking about things like these and I think it's increasingly showing how the dead donor rule does not seem to quite fit with how many people view what should be the core of transplantation ethics. I just want to give you one example from my own experience. This concerns a little girl that I took care of in my ICU, an eight-year-old little girl who, unfortunately, strangulation at home. We did everything we could to try to get her to recover. She did not and her family reached the point where they said, let's withdraw life support, but we really want her to be an organ donor. So we tried. We took her down to the operating room to be a DCD donor. Life support was withdrawn, but she did not die within the 60-minute window that was necessary. So we transported back to the ICU and she died a few hours later and was not a donor. Darshak Sangabi, a physician and reporter, wrote this case up in the New York Times magazine and he interviewed her father.  She could not have been put under general anesthesia, undergone surgery to donate her organs, and then been declared dead. And when they explained to him, well, yeah, but that would have violated the dead donor rule, he said, well, there was no chance at all that our daughter was going to survive. I can follow the ethicist's argument, but it seems totally ludicrous. So in closing here, let me sort of summarize where I was at in the first part of my talk. I believe that the arguments claiming that brain dead and DCD donors are dead are simply not coherent. They are tortuous and they don't fit with the science, they don't fit with logic, and I think they're misguided. And I also would say out of that that our current practices violate the dead donor rule. The transplants that I'm sure are occurring here in Chicago today and every other city in the country, I think are violating the dead donor rule. They're perfectly ethical, but not because they're conforming with the dead donor rule. I think that the line between allowing to die and causing death is not absolute. I mean, I think that things have changed over the last decades. Empirically, many of our end-of-life transplantation practices currently cross this line in various ways. And I've tried to say about how palliative care and other things work that way. I think that the dead donor rule may thwart legitimate desires by patients to donate organs, as we saw in the cases I described. Now that would be fine if we said, look, it's unethical to donate organs this way. So if it thwarts your desires, then that's just the way it has to be. But I don't think that's necessarily true. Primitively, these practices may be justified by appeal to other ethical principles, such as non-reliance and voluntary consent. And sociologically, I would say, these practices appear to have increasing public support. So what should we do now? Well, the question is, is the dead donor rule the ethical lynchpin in organ donation, as John Robertson said it was in 1999? If that's true, and it's really something that we cannot do without in terms of open public discussion, then perhaps the consequences must trump the truth. But I'm not sure that this common wisdom is correct. For one thing, it has really not been empirically studied. And any empirical studies that have been done tend to run in the other direction. And I think that our current practices, an end-of-life care and organ transplantation, cast doubt on this assumption. But in closing, I would say that the public is looking to... Well, normally they just look to art for guidance around the ethics of organ transplantation. But I think they're looking at the bioethics community more generally. And I think that we need to ask ourselves, where do we as bioethicists stand? So with that, I'll stop. Thank you very much for your attention.


If you're looking for the most surprising game on the Super Nintendo, you've found it with Coolspot, a game featuring the mid-90s mascot of soda brand 7up. Now seriously, a corporate branded video game is actually pretty good. Once upon a time, 7up had a charming cartoon spokesperson that was made up of the red dot in the logo, some arms, some legs, and sunglasses. Somehow it worked. He, well, I presume it's a he, starred in a multi-platform video game on Genesis, Game Gear, Amiga, Game Boy, and Super Nintendo. The gameplay here isn't anything new, it's a standard platformer where you make your way across levels to unlock your, uh, spot twins, I guess? With your attack being that you can launch soda bubbles at enemies, which is just as well because anytime I drank 7up, I remember the carbonated bubbles feeling like they were gonna melt my teeth. I don't drink soda, but I don't think I drank 7up at all as a kid for that reason. But hey, they sure kept trying desperately to make me drink their swill because believe it or not, there are at least four 7up games out there. At least four that I know of. There's Cool Spot, Spot the video game for NES, Spot the cool adventure for Game Boy, and Spot Goes to Hollywood for Genesis, Sega Saturn, and PlayStation. I don't know about you, but that blows my mind. And this game being pretty good also blows my mind. I'm not calling it revolutionary or even one of the best 60 Super Nintendo games or anything like that. But this game is fine, it's a good waste of time. And since it's a soulless, corporate branded game designed to sell soda, then naturally the player's expectations, no matter who is playing, are going to be absolute rock bottom. So that goes a long way toward explaining why this game is pretty decent. Buuuut make no mistake, Cool Spot is pretty flawed. There's no save feature and no passwords, jumping is kind of wonky and takes quite a bit to get used to. The sound effects also get kind of annoying after a while. However the music is great, again that's an unexpected surprise. The level design is adequate, the most fun I had playing this game really was with the bonus levels where you bounce up and down inside a 7 up bottle. And yeah if you haven't noticed you gather these red spots too, collect enough and you'll get access to these bonus levels where you can grab some extra continues. I will say one minor touch I really like is how your health is monitored by the spot character's face in the upper left. If you get hit he starts to deflate a little bit. So yeah Cool Spot is fine, it's easy to dismiss this game based on what it is at its core and I can't say I'd blame you for that, but it's a perfectly okay game. You know what I'd say the Genesis version is even better and I think a big reason for that is because the view screen is slightly zoomed out a bit, so you can see more of the level and that helps make up for the wonky jumping mechanics quite a bit and you're able to anticipate enemies and attacks much quicker. I also think this is an instance where the faster processor on the Genesis lends itself to this game's benefit because this version of Cool Spot is just a teensy bit faster and I ended up liking this game a bit more because of that. The sound effects are much more tolerable and also the music here, wow, it might be some of the best on the Genesis, seriously, that's weird to say but it is a great soundtrack. Anyway, Cool Spot is certainly worth playing today but it's not worth going out of your way to track down or anything like that and if you're hankering to play this game I'd say play it on the Genesis, it just plays better and the music is really well done.