Surprise! We “Saved” Your Life!

What if you were in a terrible car accident, and sustained life threatening injuries to your heart. In an effort to save you, doctors went to extreme measures, and implanted a left ventricular assist device, also referred to as an LVAD. What is an LVAD you ask? Well, it is a surgically implanted heart pump that is attached to one of the main pumping chambers of the heart and the aorta. The pump is attached to a tube that extends to the outside of your body, and attaches to a battery pack that you must carry around for the rest of your life. However, despite the fact that the LVAD has “saved” your life, what if you were paralyzed? What if you had burns over your body as a side effect of the accident? What if your body was altered in such a way that you no longer had the same quality of life as you did prior to the accident?

As bioethicist Katrina A. Bramstedt said, “Anytime you create new forms of life support, you create the possibility for new ethical dilemmas.” With the development of LVADs, a host of new ethical dilemmas have surfaced, especially for older patients who are actually affected negatively by the implantation of the LVAD. These cases typically deal with the debate about euthanasia. And in those cases, one can argue that the patient entered into the surgical procedure under fully informed consent (or at least as much consent as one can have in today’s society), and therefore they should not be granted the right to request that the pump be turned off by a physician because they were aware of the risks going into the procedure, and desired the continuation of their lives. But what about those that did not provide consent? Patients that were admitted as a result of emergencies, and then awoke to find their lives significantly altered, and saved only by the implantation of an LVAD.

Are these individuals allowed to then make the choice of whether they would like to end their lives? Perhaps this is simply a small detail in the greater argument of euthanasia, but then again maybe this difference is all that is needed to justify their request for their own death.

http://www.washingtonpost.com/wp-dyn/content/article/2008/04/23/AR2008042303534_pf.html

DNA Tests Violate 5th Amendment?

In 1974, a man who came to be known as BTK strangled a family of four. He continued to kill for the nest 17 years claiming 6 more victims. However, he went silent after that, disappearing. He reappeared in 2004, hinting that he was about to strike again. Police managed to zero in on a man named Dennis Rader as their primary suspect. They had been able to obtain genetic samples from the crime scenes, and they hoped to link this DNA to Rader. Unfortunately they could not get DNA from Rader himself. However, Rader's daughter had had a pap smear in college, and the authorities subpoenaed it to obtain DNA. In the end, they used this as well as further evidence to convict Rader.
Most people see this as a triumph of genetic technology. However, privacy advocates see it as a dangerous trend that is continuing to violate our rights to privacy. When Rader's pap smear was subpoenaed, she was not consulted. Beyond violating her right to privacy, I believe that these actions also violated the 5th amendment. Since the evidence was something that only a family member could provide, the authorities would have had to get permission before using the evidence.

Lost In Translation?

We often discuss the ethics of medical experimentation. However, there are ethics involving human health beyond just the simple experimentation. Many do not have direct access to most studies in order to learn about the progress that has been made. The same holds true for scientific journal articles that can be very important to an individual’s health. The great majority of the population relies on journalists to honestly relay this information to them in terms they can understand.

But what happens when this is lost in translation? A famous case of this is a 1990’s story by Gina Kolata in which she speaks of a possible cancer cure. The study to which she refers, in which a cure for cancer had been found in mice, had been published months before and there was even a previous New York Times article on the topic. What was her motive for writing the article? Well, at a dinner earlier she overheard Nobel laureate James Watson say, “Judah’s going to cure cancer in two years!” This created a front pages story, where as the original was buried away in the inside of the paper. Her language in combination with the placement of the article seemed to create a rush of people to believe that a cure for cancer had been indeed found.

Was it ethically correct for her to write this article? She must have known that it would be misleading, as did the editors when they put it on the front page of the New York Times, the journalistic standard for the world. She had no incentive to write the story other than financial gain, a front- page story, and ONE new quote. It seems her motives were not sincere, in that she didn’t want to tell the public what they needed to know but instead chose to mislead them for her own gain. She even received a million dollar book deal on the topic. So my question is, do journalists, as simple “translators” have a moral responsibility that is unique to them, as doctors and researchers do? I personally do believe so.

Genetic Discrimination: Good or Bad?

After reading Alana’s research essay, Alex and I (not surprisingly) debated whether genetic discrimination is good or bad. As Alana’s paper suggests, genetic discrimination does not actually exist, meaning that the arguments proposed for and against genetic discrimination are completely theoretical and hypothetical. Whereas Alex believes that genetic discrimination would not necessarily result in a negative outcome, I disagree and contend that genetic discrimination can cause great harm.

As Alex suggests, the act of discrimination in itself is not immoral; the ethicality of discrimination and whether it is moral or immoral depends on the intent and source of the discrimination. By Alex’s view point, insurance companies stand to make a profit and have a right to assess the risks of acquiring a specific customer. Furthermore, insurance companies have no obligation to help people acquire medical care. Although I agree completely with Alex that genetic discrimination is a positive action from the viewpoint of the firm, I feel that genetic discrimination greatly harms the public.

As we all know, health insurance helps countless people afford expensive medical treatments and procedures that they would otherwise not be able to afford. Subsequently, as a result of health insurance, not only are many lives saved, but the quality of many lives is drastically improved. If people were denied health insurance, two problems would arise. First, because fewer people would be able to acquire health insurance, the quality of their health and subsequently the quality of their lives could be compromised. Secondly, people who are allowed to apply for health insurance would have to pay larger payments in order to compensate for the smaller number of consumers.

For arguments sake, however, let us assume that “healthy” individuals (those that do not have “diseased” genes) continue to apply for health insurance while “diseased” individuals cannot obtain health insurance. Currently, according to American laws, if a “diseased” individual without healthcare were to go to the hospital in need of healthcare, doctors would have an obligation to care for the patient regardless of whether the patient could afford the treatment. If the patient had health insurance, the doctor would receive the appropriate payment for his services. If the patient did not have health insurance, however, and could not afford the procedures, the doctor essentially loses a profit. In such a scenario the existence of genetic discrimination creates a negative externality that can severely harm physicians. Even if the government were to step in and provide more health insurance (beyond Medicare and Medicaid), although the doctors would benefit, the economy could suffer; in order to increase finances, the government would need to siphon money from some other program or raise taxes, two situations that could be avoided if people were allowed health insurance.

Although I concede that genetic discrimination from some view points (namely the viewpoint of insurance companies) is a good thing, I believe that genetic discrimination from the point of view of a patient and from the point of view of a physician has negative consequences. I realize that genes are not completely deterministic and that the degree of genetic discrimination may not be as great as I portray it, but nonetheless patients would feel violated and immorally treated if they were denied health insurance on the basis of their genes.

Quarantines in the US

Idea from http://www.wired.com/medtech/health/news/2007/06/quarantine_law: 

After reading about the quarantines of XRS-TB carriers in Africa, I wanted to find out more about the quarantine laws in the US.  This recent article stated that the meat of our quarantine laws has not changed from the 19th century, when quarantines were much more common because of the prevalence of some dangerous infectious diseases and because of the lack of medicine to treat some diseases.  

Now the controversy is over whether our government should be allowed to gain more access to flight information in order to potentially inform people if they have been infected with something.  Though the ACLU has some problems with the government having access to this information and the airline companies are worried that the increased bookkeeping will drastically increase their functioning costs, I think that the government has a right to demand these records in an effort to protect it's people.  

Even though it is never the best idea for a government to have all the information on all of its citizens, in this case the government would only be able to access the information if the crisis arose.  It's a win-win situation: if they need to know who was on a flight and this information would help more people, they could get it, but otherwise no one's privacy is invaded.  The problems will arise in enforcing the restriction of access to flight information, but I feel that airlines will have an economic incentive to protect their passengers' privacy.  I think that if the enforcement is in the airlines' hands it will go much smoother than if it is in the government's hands.  

On the Legality of Waterboarding

War is undoubtedly one of the largest fronts under which unethical practices are carried out. Historically, both prisoners and soldiers have unwillingly and unknowingly been used as human guinea pigs, testing anything from nuclear fallout to mustard gas. While we would like to think the mistakes of the past are long gone, such ethically questionable practices still exist today. Take for example the case of waterboarding. Waterboard is a process wherein a prisoner is strapped to a board and has water poured into their mouth and breathing passages. This simulates the experience of drowning and elicits a gag reflex instantaneously, causing severe psychological pain to the victim. The experience is so severe and real that some victims could no longer take showers or walk in the rain. Although waterboarding does not necessarily cause permanent physical damage, it can lead to lung or brain damage or death.

Currently, President Bush is defending the use of waterboarding in obtaining information from captives. Although torture is illegal according to the Geneva Conventions, Bush's administration has redefined what constitutes torture to exclude waterboarding, rendering it lawful (it is now an 'enhanced interrogation technique'). The use of torture to obtain information can be a tricky issue. In times of war, if one side is using torture to obtain information and the other side is not, the side using torture will naturally gain an information advantage. However, this should not be an issue in modern times, when the U.S. has the strength to lead the world without resorting to practices such as waterboarding. In fact, the U.S. has been setting a worldwide example for over 200 years by habitually treating captives with humanity and dignity. There's no reason why this should change now.

Articles:
http://www.catholic.org/diocese/diocese_story.php?id=27616
http://www.guardian.co.uk/world/2008/apr/18/usa.terrorism

Lemon Organs

Previously, the term “lemon” has been applied primarily to used cars that the buyer only discovers to be of an unsatisfactory quality after the purchase has occure. Well what if you receive a transplanted organ that turns out to be not exactly what you signed up for?

This is exactly what happened to the four people who received 15-year-old Alex Koehne’s pancreas, liver, and two kidneys. Alex’s parents agreed to donate Alex’s organs when they discovered that his death was imminent. It was originally believed that Alex died of bacterial meningitis, but only upon autopsy did Alex’s parents and doctors discover that his actual cause of death was a rare form of lymphoma. Subsequently, the two people who received Alex’s liver and pancreas died of the same lymphoma, and the two people who received his kidneys are being treated for the disease.

Other recent organ transplant mishaps include a man who received a cancerous lung, and people who have received organs infected with West Nile Virus, hepatitis C, and even HIV.

How can this have happened?

The organization that organizes organ donation in the United States, the United Network for Organ Sharing, requires that all organs be screened for cancer, HIV, and other infections prior to donation. In addition, the Center for Disease Control mandates tests for HIV, hepatitis, syphilis, and other bacterial or viral infections on organs from “high-risk” individuals, as well as having a doctor determine from medical records whether the organ donor might have cancer.

Most organ transplants are safe: out of the 230,000 transplants performed between 1994 and 2006 on 64 recipients developed cancer because of receiving a “lemon” organ, as I have termed it.

However, there is always the possibility of some cancer or infection going undetected. I would urge hospitals to increase the strictness of their organ donor standards, as they are free to do. Such a move would benefit everyone because the minor inconvenience of running a few more tests and doing a more thorough background check is far smaller than the hassle of getting entangled in endless lawsuits over whose fault it is that someone received a “lemon” organ.

Sources:
http://blogs.discovermagazine.com/discoblog/2008/04/08/organ-transplants-gone-horribly-awry/
http://discovermagazine.com/2008/apr/16-how-do-transplant-patients-wind-up-with-deadly-diseased-organs