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The Waiting Game
Organ Transplant Controversy January 2, 1998 |
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Questions answered
in this forum:
Is one way to avoid the ethical mess is to have a "National" society of organ donations? What is the difference between heart and brain death? Is it necessary to use Regitine to preserve organs, and what are its dangers? What is the research/clinical status of alternatives such as artificial organs, animal organs, etc.? Is there something wrong with this constant prolonging of life? George Lewis of Boonton, NJ asks: With the world's population getting to the breaking point, and the approval of Dr. Jack K., don't you think that something is wrong with this constant prolonging of life?
Dr. Michael DeVita responds:
George,
You are not alone. Many people have argued that even if transplantation is feasible, it is not reasonable to do because the cost is so high. You should know that it is cheaper to transplant a kidney than to put a person on dialysis for life. Still transplants cost alot, and perhaps the money is better spent elsewhere. Doctors are not responsible for this determination, the public and our elected leaders are. Right now, it seems we as a society like the idea of prolonging life this way, so it will continue. I think doctors should continue to try to prolong and improve life.
Regarding Dr. Kevorkian, I think we should first try to figure out whether assisted suicide is appropriate (and it seems most physicians and legislators are opposed) before we determine what to do with the bodies. If assisted suicide becomes acceptable, then a discussion about organ donation is probably reasonable.
Ms. Renee Fox responds:
It has been my privilege to have spent forty-five years as a social scientist observing, chronicling, and analyzing the development of organ transplantation. From this long-term, first-hand point of view, I feel appreciation for the capacity of organ transplantation to save and sustain human lives: esteem for the biologist, physicians, and nurses who have shaped and implemented its scientific and clinical development: awe for the sacrificial gift of themselves to others that countless donors have made over the years: and gratitude for all that organ transplantation has taught me. Nonetheless, like George Lewis, I do think, to use his words, that "something is wrong with this constant prolonging of life." And I also think, as medical historian Judith Swazey and I wrote (in the final chapter of our co-authored book "Spare Parts: Organ Transplantation in American Society"), that "the missionary-like ardor about organ replacement that now exists, the overidealization of the quality and duration of life that can ensue, and the seemingly limitless attempts to procure and implant organs that are currently taking place have gotten out of hand." In this connection, some of the concomitants of the drive to procure organs from non-heart-beating donors point to what I regard as a very slippery slope down which transplantation is in danger of sliding as a consequence of the complex mix of passionate commitment to the endless perpetuation of life and to repairing and rebuilding people although organ replacement, and the search for organs in order to do so.
We have problems accepting limits in our society. In fact, we are raised not to do so. Consider the message contained in some aphorisms and exhortations that come from the wellsprings of our culture and our worldview: "If at first you don't succeed, try, try again;" "Don't give up the ship;" "Climb every mountain;" and of course, "We shall overcome!" From a certain point of view, the field of organ transplantation optimizes our societal reluctance to accept the biological and human condition limits imposed by our ultimate mortality. In 1970, in his book "The Patient as Person," Protestant theologian Paul Ramsey argued that we need to "recover a religious sense that death is not an evil that ought always to be opposed." Referring directly to organ transplantation, he went on to say: "That outlook might save men and doctors today from the triumphalist temptation to slash and suture our way to eternal life."
This does not mean that I approve of what Dr. Jack Kervorkain is doing. Quite to the contrary! But the Kervorkain phenomenon goes beyond the boundaries of this forum discussion about organ transplantation. In any case, I cannot answer the question of whether it is ethical to procure organs from Dr. Kervorkain's "patients." To begin with, I would not call them his patients because he has never taken care of them; they are strangers who come to him simply for the purpose of ending their lives with his assistance. I would have to know much more about the nature of the relationship he establishes with them, and whether without coercion he obtained their fully voluntary consent to make such a donation. However, logistically, I don't see how such persons could become donors. Characteristically, the act of physician-assisted suicide that Kervorkain performs takes place in a hotel to motel room, after which he or his lawyer inform relevant officials where the deceased person's body is, or transport it themselves to the door of a hospital. I doubt if the organs of a person who died under these circumstances could be kept viable for transplantation. And the prospect of procuring organs in this way seems to me to be ghoulish.
Dr. William Ritchie responds:
Mr. Lewis:I disagree with your statement that the actions of Dr. K have been approved. On December 4, 1997, the Michigan State Senate passed a new ban on the practice of physician assisted suicide by a vote of 27-8, one day after Dr. Jack Kevorkian was present at another death. The bill marks the strongest move taken by state legislators to stop the retired pathologist since a temporary law expired in 1994 and since the U.S. Supreme Court ruled in June that state governments may outlaw doctor-assisted suicide. The new bill would make assisting in a suicide a felony punishable by four years in jail and a fine of $2,000. The Michigan State Legislature will vote on the measure later this spring.
If a person is suffering from a terminal illness, in all likelihood that person's organs would not be suitable from transplantation. Additionally, if the organs were potentially viable for transplantation, the process and equipment used by Dr. Kevorkian would make them unsuitable.
Finally and most importantly, transplantation is not designed to prolong life, but to save lives and enhance the quality of life for others. God gave us the knowledge, skills and abilities to help our fellow man with the use of advance medical technology. We would be remiss as human beings not to use it to save and enhance the precious gift of life, notwithstanding any perceived concerns about overpopulation.
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