A speech given by George Soros on November 30, 1994 for the Alexander Ming Fisher Lecture Series at Columbia Presbyterian Medical Center.

I am somewhat embarrassed giving this speech because I am not an expert on dying. Many people connected with my Project on Death in America are much more qualified to talk about dying than I am. But there seems to be a kind of strange attraction on the part of professionals and academics to hear from men of the world like myself -- businessmen, the doers, the actors on the public stage. At the same time, of course, many businessmen have an exaggerated esteem for academics. And I may well be one of them. So I approach this audience with some trepidation.

The first question I must answer, why have I sponsored a Project on Death in America. There are two reasons: one is very abstract, the other very personal. The abstract motivation derives from a basic insight which has been at the root of both my money-making and my philanthropic activities and which I have elaborated into a not-yet-properly-understood philosophical theory. The insight is that there is always a divergence between the views and ideas that guide people in their actions and the actual state of affairs. I call the divergence the participants bias. Since the participants actions help shape reality, there is a two-way feedback mechanism between the participants bias and the events in which they participate. I call this two-way feedback reflexivity.Sometimes the participants bias is quite small and there are forces at play which tend to bring the participants views and the actual state of affairs closer together. But at other times the bias can be quite enormous without any tendency to correct itself. On the contrary, the two-way feedback mechanism may help validate and reinforce the bias until the situation becomes untenable and there is a reversal in the self-reinforcing process.

Everybody has experienced such far-from-equilibrium situations in his life, but I have specialized in them. I lived through Nazi persecution in Hungary as an adolescent; then I had a taste of communism and when I went to England I cam under the influence of Karl Popper, the philosopher of science, and began to develop my theory of reflexivity. When I became involved in the financial markets I specialized on boom/bust sequences and did rather well out of them. And when I made more money than I could use for my personal needs I set up a foundation devoted to the idea of an open society. Without going too deeply into it, open society is based on the principle that we all act on imperfect knowledge and nobody is in possession of the ultimate truth. A society based on the recognition that we may be wrong is preferable to a society which denies that its leaders may be wrong.

I set up foundations which tried to help open up closed societies and I become rather intimately involved in the revolutionary process which led from one kind of far-from-equilibrium situation to another; from the rigidity of the Soviet System to the chaos of its collapse. For the last five years, I have been very busy because one can do many things in the heat of the revolutionary moment which would be impossible in normal times, but as the revolution began to cool off I began to think what I could do to make our own open society more viable; because according to my theory, open societies also suffer from deficiencies which need to be recognized and corrected for open societies to remain viable. I focused on two problem areas where misconceptions played a particularly important role, making the problems worse than they would be if they were better understood. One is the problem of dying which I will talk about tonight. The other is the problem of drugs where the remedy is worse than the disease.

Due to our imperfect understanding, our actions have unintended consequences. Nowhere are they more glaring than in the war on drugs. By treating drug abuse as a crime we have created crime, corruption and violence which are much more destructive than drug abuse by itself. I should like to see the false identification between drug and crime broken without necessarily advocating the legalization of drugs. A third problem area I should like to do something about, but I don't yet know how, is the distortion of our electoral process by the excessive use of TV advertising. All three areas have one thing in common: Distortions and misconceptions aggravate the problem. I chose the problem of dying as one of the areas because of some very personal experiences in connection with the death of my parents, both of whom I was very devoted to and loved dearly.

I chose the problem of dying as one of the areas because of some very personal experiences in connection with the death of my parents, both of whom I was very devoted to and loved dearly.

My father died at home in 1963. He was terminally ill. Although he agreed to an operation, he didn't particularly want to survive it because he was afraid that the combination of the illness and the operation would invade and destroy his autonomy as a human being. Unfortunately, that in fact is what happened. After the operation he had very little time left. I'm afraid I kind of wrote him off at that point. I was there when he died, yet I let him die alone. I could see him, but I wasn't at his bedside. The day after he died I went into the office. I didn't talk about my fathers death. So I kind of denied his dying, I certainly didn't participate in it. Afterwards, I read Kubler-Ross and learned that I might have maintained contact with him if I tried. Had I read Kubler-Ross earlier I would have probably held his hand, because I did love him. I just didn't know that it might make a difference. I forgave myself because I did not know any better.

My mothers death was more recent. She had joined the Hemlock Society and had at hand a means of doing away with herself. I asked her if she needed my help; I offered it, although I wasn't particularly keen to do it. But I would have helped her because I felt that I owed it to her. At the point of decision, however, she did not want to take her own life, and I'm glad she didn't. Her decision gave the family a chance to rally around and be there as she prepared to die. And this time we did maintain good contact right to the end.

She had this experience, which is described in Kubler-Ross, of walking up to the gates of heaven, and I was accompanying her. She told me she was worried that she might drag me with her. So I reassured her that I was firmly ensconced on this earth and she should not worry. Her dying was really a very positive experience for all of us because of the way she handled herself and the way the family, not just me but particularly my children, could participate in it.

These two personal experiences made me realize that there is a need to better understand the experience of dying. In my initial research in the issue I was assisted by a friend, Patricia Prem, who as a social worker had dealt professionally with dying. She brought together the people who helped create the Project on Death in America. She is on the Projects advisory board now, as are:

Susan Block of Harvard Medical School, Robert Burt of Yale Law School Robert Butler of Mt. Sinai Joanne Lynn of George Washington University Velvet Miller of the New Jersey State Department of Human Resources David Rothman of Columbias College of Physicians and Surgeons Attorney William D. Zabel, and Kathleen M. Foley who is the chief of pain service at the Memorial Sloan-Kettering Cancer Center and Director of the Project on Death in America.

The mission of the Project is to promote a better understanding of the experiences of dying and bereavement and by doing so help transform the culture surrounding death. To do this, the Project will support initiatives in research, scholarship, the humanities and the arts, as well as innovations in the provision of care, public education, professional education, and public policy. I have committed $5 Million a year to the Projects work for the first three years. The board has decided to use the money in two ways: by developing its own programs and by holding itself open for grant applications.

The first major program is to establish a number of faculty scholarships. We hope to identify outstanding faculty and clinicians who are committed to the Projects goals and to support them in their work of developing new models for the care of the dying and new approaches to the education of health professionals about the care of dying patients and their families. The scholars, who will receive two- to three-year fellowships for projects that explore critical aspects of the care of the dying, will become the academic leaders on this issue, the role models, and mentors to future generations of health professionals. Each year the project will select ten faculty scholars. In three years we will have a leader and role model in place in one-fourth of the country's medical schools.

George Soros' speech continued>