In Memorium

Art Galston
Arthur GalstonArthur William Galston, a Yale plant biologist who did early research that helped lead to the herbicide Agent Orange, then helped raise awareness of the military’s use of it in Vietnam in the 1960s and its devastating effects on river ecosystems, died on June 15, 2008, in Hamden, Conn. He was 88.

In letters, academic papers, broadcasts and seminars, Dr. Galston described the environmental damage wrought by Agent Orange and traveled to South Vietnam to monitor its impact. From 1962 to 1970, American troops released an estimated 20 million gallons of the chemical defoliant to destroy crops and expose Viet Cong positions and routes of movement.

Dr. Galston asserted that harm to trees and plant species could continue for an untold period, and perhaps for decades. He pointed out that spraying Agent Orange on riverbank mangroves in Vietnam was eliminating “one of the most important ecological niches for the completion of the life cycle of certain shellfish and migratory fish.” Then, in 1970, with Matthew S. Meselson of Harvard and others, he made a case that Agent Orange presented a potential risk to humans. The scientists lobbied the Department of Defense to conduct toxicological studies, which found that compounds in Agent Orange could be linked to birth defects in laboratory rats. The revelation led President Richard M. Nixon to order an immediate halt of spraying.

In the 1980s, Dr. Galston helped introduce popular courses in bioethics for undergraduates at Yale and in the 1990s was instrumental in founding the Interdisciplinary Center for Bioethics at the university. He explored the risks and rewards of genetically modified plants and crops, pesticides, stem-cell research, cloning and other issues as co-editor of two textbooks, “New Dimensions in Bioethics” (2000) and “Expanding Horizons in Bioethics” (2005).

In other important work in plant physiology, Dr. Galston experimented with the nutrient riboflavin and its role in enabling plants to absorb blue light, making a connection that he advanced and published in 1950 in the journal Science. He also wrote a book, “The Life of the Green Plant” (1961).

In 2003, Dr. Galston reconsidered the arc of his research. “You know,” he said, “nothing that you do in science is guaranteed to result in benefits for mankind. Any discovery, I believe, is morally neutral and it can be turned either to constructive ends or destructive ends.” He concluded: “That’s not the fault of science.”

Jay KatzJay Katz

Yale Law School Professor Jay Katz died Monday, November 17, 2008, in New Haven. Katz was the Elizabeth K. Dollard Professor Emeritus of Law, Medicine, and Psychiatry and Harvey L. Karp Professorial Lecturer in Law and Psychoanalysis at Yale Law School. He died of heart failure.

Professor Katz made profound contributions in the area of law, medicine, and ethics. He was a leader in the area of reproductive technology law and ethics. His scholarship focused on psychoanalysis and law, family law, and law and medicine. Katz was a member of a committee that prepared the Connecticut law governing the privilege between patient and psychotherapist, enacted in 1961, which served as a model for the Federal Rules of Evidence for all 50 states. Working with Joseph Goldstein in the mid-1960s, he did groundbreaking work on the areas of both family law and psychiatry and law.

Katz also served on the national panel that studied and exposed the Tuskegee Syphilis Experiment, which began in 1932 and was not uncovered until the 1970s. Katz was a passionate proponent of the concept of truly informed consent and wrote extensively on the subject. He was an outspoken opponent of the use of data obtained from Nazi experimentation and was the first to call for a national board to oversee human experimentation. He was appointed by President Bill Clinton ’73 as a member of the Presidential Advisory Committee on Human Radiation Experiments. He was a leader in the area of reproductive technology law and ethics and was an outspoken opponent of the criminal prosecution of pregnant women, citing privacy and equal protection concerns.

“Jay Katz was a man of great wisdom and compassion,” said Alexander M. Bickel Professor of Law Robert Burt ’64. “He had a profound influence on biomedical ethics, on his students during his long tenure at Yale Law School, and on his friends. Jay’s passionate respect for the autonomy of individuals coupled with his deeply empathic understanding of individuals’ psychological vulnerabilities was the foundation stone for this influence in every case.”

Professor Katz’s family has asked that those wishing to make a gift in his name contribute to the Faculty Memorial Fund at Yale Law School. For more information, please contact the YLS Development Office at 203 432-1664.

Charles McKhann

Charles McKhannDr. Charles Fremont McKhann, professor emeritus of surgery at the School of Medicine, died of prostate cancer on November 14, 2005, at his home in North Haven, CT. McKhann was a leading investigator in the field of tumor immunology and surgical oncology. Later in his career, he also became an outspoken advocate for legalizing physician-assisted suicide.

Born in Boston in 1930, McKhann graduated from Harvard College in 1951 and the University of Pennsylvania Medical School in 1955. He did his residency at the Massachusetts General Hospital and was on the faculty of Harvard Medical School and the University of Minnesota Medical School, where he was primarily involved in cancer research. He was a Macy Foundation Fellow at the Swiss Institute for Experimental Cancer Research in Lausanne, Switzerland, and a Special Research Fellow at the Karolinska Institute in Stockholm, Sweden.

He came to Yale in 1980 as professor of surgery and was executive director of the Comprehensive Cancer Center 1981-1990 and vice chair of the Department of Surgery 1991-1993. He retired in 2001. At Yale, his work was in clinical surgery, mostly with breast cancer patients. He pursued his great interest in bioethics and founded the Committee for the Study of End-of-Life Issues. He was also the longtime chair of the Medical Futility Study Group here at the Bioethics Center. In addition to his many papers and abstracts, McKhann wrote two books, The Facts About Cancer: A Guide for Patients, Family and Friends (Prentice Hall, 1981) and A Time to Die: The Place for Physician Assistance (Yale University Press, 1998).

He served on many scientific advisory committees including the General Motors Cancer Research Foundation Kettering Award Assembly, and was on the editorial boards of numerous publications. During the last few years of his life, he talked to first-year medical students about his own illness and his thoughts about dying, encouraging them to ask questions which he answered very frankly.

Sherwin Nuland

Sherwin NulandDr. Sherwin B. Nuland, a surgeon and author who drew on more than 35 years in medicine and a childhood buffeted by illness in writing “How We Die,” an award-winning book that sought to dispel the notion of death with dignity and fueled a national conversation about end-of-life decisions, died on Monday, March 3, 2014 at his home in Hamden, Conn. He was 83. To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity. “I have not seen much dignity in the process by which we die,” he wrote. “The quest to achieve true dignity fails when our bodies fail.”

In “How We Die, ” published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital. It won a National Book Award. Dr. Nuland wrote that his intention was to demythologize death, making it more familiar and therefore less frightening, so that the dying might approach decisions regarding their care with greater knowledge and more reasonable expectations. The issue has only grown since the book was published, prompting discussion and debate in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy. Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, “How We Die” was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.

Dr. Nuland received his bachelor’s degree from New York University in 1951 and went on to study medicine at Yale. Dr. Nuland received his medical degree from Yale in 1955. Electing to specialize in surgery, he set his sights on becoming chief surgical resident at Yale-New Haven Hospital. In 1958, Dr. Nuland won the coveted appointment. From 1962 until 1991, he was a clinical professor of surgery at Yale, where he also taught bioethics and medical history. He was a surgeon at Yale-New Haven from 1962 to 1992, when he retired to write full time. Dr. Nuland’s books include “Doctors: The Biography of Medicine” (1988), “The Wisdom of the Body” (1997), “The Doctors’ Plague” (2003) and “The Uncertain Art” (2008). He was a contributing editor to The American Scholar and The New Republic.

“How We Die,” which won the National Book Award for nonfiction in 1994 and was a finalist for the Pulitzer Prize in nonfiction in 1995, has sold more than 500,000 copies worldwide. In its concluding chapter, Dr. Nuland confessed that he, like many of his readers, desired a death without suffering “surrounded by the people and the things I love,” though he hastened to add that his odds were slim. This brought him to a final question. “And so, if the classic image of dying with dignity must be modified or even discarded,” he wrote, “what is to be salvaged of our hope for the final memories we leave to those who love us? The dignity we seek in dying must be found in the dignity with which we have lived our lives.”

(adapted from the New York Times Obituary page)

Howard SpiroHoward Spiro

Dr. Howard M. Spiro, who served as the founding section chief of gastroenterology in the Department of Internal Medicine at Yale from its start in 1955 until 1982 and as the director of the Yale Program for Humanities in Medicine from 1983 until his retirement from the faculty in 1999, died on March 11, 2012 in Branford, Connecticut, after a brief illness.

Spiro was born in Cambridge, Massachusetts, on March 23, 1924. He graduated from Harvard College in 1944 and received his medical degree from Harvard Medical School in 1947. Upon graduation, his first impulse was to pursue a career in psychiatry. However, it is said that he felt he could not spend the rest of his life “just talking.”

Acknowledging the relationship he believed to exist between visceral symptoms and the psyche, he decided to pursue a career in gastroenterology. After completing an internship at the Peter Bent Brigham Hospital (now the Brigham and Women’s Hospital), he remained there to pursue research in that field. During this early period, he focused his research primarily on gastrointestinal physiology. His interest soon began to turn to the relationship between the mind and the gastrointestinal tract. After serving for two years (1951–1953) in the military as chief of gastroenterology at Madigan Army Hospital, he returned to Boston to spend two additional years in research at the Massachusetts General Hospital along with his wife, Marian Spiro.

In 1955, Spiro was recruited to Yale by Dr. Paul Beeson to establish the first full-time academic Gastroenterology Section at Yale. His ambition at that time was to establish a nationally recognized academic research section of gastroenterology, and to incorporate both medical and psychological concerns in the teaching and provision of patient care. The activities of the West Haven Veterans Administration became part of this new division, adding a wide variety of patients and research opportunities. Spiro was well known for his strong dedication to patients and bedside teaching. Teaching communication skills was a major part of his education of fellows, residents, and students. Interactions with other specialties were also of key importance to Spiro, as evidenced by weekly teaching rounds between the surgical and gastrointestinal trainees and a dedicated social worker in the clinic.

In 1965, Spiro established the Yale-Affiliated Gastroenterology Program, a unique educational collaboration between fellowship training programs in south-central Connecticut. Spiro traveled to these institutions with fellows from Yale accompanying him, allowing his trainees to observe a master clinician and diagnostician eliciting a complicated history from a patient and synthesizing it into a coherent picture. Spiro’s straightforward style, wit, maverick opinions, and love of repartee were known nationally and internationally.

Spiro was a prolific writer (bringing him back to his origins as an English major at Harvard), with contributions ranging from his single-author textbook “Clinical Gastroenterology,” to scientific peer-reviewed papers, to the popular books “Doctors, Patients and Placebos,” “When Doctors Get Sick,” and “Facing Death.” He also served as the editor of several journals.

In 1982, Spiro deepened his interest in the relationship between the humanities and medicine. Along with Enid Peschel, he established the Yale Program for Humanities in Medicine. Students, faculty, and members of the public would gather weekly for sherry and to listen to speakers address topics breaching the boundaries between medicine and realms of the humanities, including art, music, and politics. The program developed the Howard Spiro Lecture Series in the Humanities in Medicine. In 2010, he founded the online Yale Journal for Humanities in Medicine to “foster discussion about the culture of medicine, medical care, and experiences of illness.” He remained active in the Humanities in Medicine Program until his passing.

Spiro was known widely as a skilled, caring, humanistic physician, who placed his patients at the center of his efforts. Like his mentor Paul Beeson, Spiro was especially known for — and took great pride in — his keen ability to listen to his patients. After becoming professor emeritus, Spiro continued to see patients as a consultant. He also continued to attend Medical Grand Rounds at Yale until the time of his passing, and he always reflected on the broader aspects of the topics, often asking thought-provoking questions, often of an ethical nature.

In 2000, Spiro was awarded the Julius M. Friedenwald Medal, the most prestigious award given to a member by the American Gastroenterological Association. The award is conferred in recognition of outstanding lifetime achievement in and contributions to the field of gastroenterology. On the 50th anniversary of the Yale School of Medicine section he founded, he was honored by his colleagues with a symposium and a crystal statue inscribed “To Howard M. Spiro, from his students.”

Florence Wald 
Florence Wald

Florence Schorske Wald, former Dean of the Yale School of Nursing and founder of the first hospice in the United States, died on November 8, 2008, at home, as she had helped many do before her. She was 91 years old.

In 1968, Wald left her ten-year position as Dean of the Yale University Nursing School and joined the team of health care professionals that founded the first hospice in this country. In preparation for that undertaking, she worked with dying patients and their families in Yale-New Haven Hospital and with Cicely Saunders at St. Christopher’s Hospice outside London. During this time she learned about the integrated work of nursing, medicine, social work, pastoral care, the arts and volunteers in providing total care for the terminally ill.

When the interdisciplinary team at the Connecticut Hospice accepted its first patients in 1974, much of the care received rested on the work of Florence Wald and her colleagues. She has continued her work in subsequent years developing the concept of hospice in this country. For the last several years of her life she worked with other colleagues to develop hospice programs for the incarcerated and their families. Wald was a mentor and role model to several generations of nurses, and a valued member of the End of Life Issues group here at the Bioethics Center.

Robert J. Levine, MD

Robert John Levine, M.D., a founder of the Yale Interdisciplinary Center for Bioethics and a giant in the area of research ethics, passed away on February 25, 2021. Dr. Levine, Professor Emeritus of Medicine at Yale, wrote his field-defining book “Ethics and the Regulation of Clinical Research” in 1981. Over his career he wrote over 300 articles, and contributed numerous chapters to books and to government and NGO reports. Bob’s journal and editorial work shaped the fields of medicine, pharmacology, and clinical research ethics. He was founding editor of the Hastings Center’s publication, IRB: a Review of Human Subjects Research (now Ethics and Human Research) and served Yale’s IRB for decades. He also served on more than 20 different data and safety monitoring boards.

Bob first came to Yale in 1962 from George Washington University Medical School as Clinical Instructor in Medicine and Pharmacology. He continued to teach at Yale until his retirement in 2016. In the early 70’s the primary focus of his teaching and and research shifted to research ethics. This work included co-teaching with Margaret Farley R.S.M. an interdisciplinary course in medical ethics for over 12 years. For 30 years Bob chaired Yale’s Human Investigation Committee. In 1985 he was a founding member of the hospital’s Ethics Committee; he served on that committee for many years. He was also leader of the Law, Policy and Ethics Core of Yale’s Center for Interdisciplinary Research on AIDS. Bob and Margaret co-founded and co-directed the Yale Program in Bioethics, the precursor to the Interdisciplinary Center for Bioethics. After overseeing the Program’s conversion to “Center” status, Bob remained chair of the Center’s Faculty Advisory Committee for several years.

Bob took seriously the education and mentoring of younger scholars and practitioners. Through the years he provided guidance to approximately 30 seniors in developing their theses. Many of these students became not only colleagues but friends.

Bob was a recipient of an Outstanding Achievement Medal from the US Department of Health and Human Services for his role in the groundbreaking Belmont Report. He received a Lifetime Achievement award for Excellence from the Public Responsibility in Medicine & Research organization (PRIM&R). His alma mater, George Washington University, gave Bob its Distinguished Scholar Award in 2008. In 2009 the Academy of Pharmaceutical Physicians and Investigators gave him Special Recognition for Outstanding Contributions in Research. He was a founder of the field of bioethics, and absolutely central to establishing programs in research ethics, clinical ethics and bioethics education at Yale.