Should doctors have given organ to someone else on long waiting list?
Article Source: msnbc.com
from:msnbc.comMany outraged as accused murderer gets liver transplant
Seeded on Mon Jul 26, 2010 6:32 PM EDT (msnbc.com)
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If the doctors don't make ethical judgments, then this POS should have gone to the bottom of the list. It was his choice to take the poison.
He should never have received a transplant. This is a sign of the twisted insanity of our times masquerading as "ethics". This is no ethical choice.
The core of this case is that by giving him that liver, those doctors killed someone else. That is what they will have to live with. Of course, most doctors get pretty thick skins.
Some poor bastard has been murdered by political correctness. A cowardly group of doctors made the decision to kill someone else by saving this murderer's life.
I doubt that out of nearly 17000 men women and children waiting on that list the liver was the only match for this bastard. Im sure there were thousands who were eligible for that liver or were the perfect match. I understand that doctors treat patients despite who they are or what they did but in this case the bastard wanted to die. A good Samaritan saw a man down and did the right thing by calling for help but it was up to the doctors to see who truly could get better use and maintain proper care of the new liver. A man in jail with not true medical care is a waste of a liver he'll be dead because of infection or a million other reasons. The doctors failed to see if this bastard would be able to maintain the new liver and i dont care if now he can face trial i'd rather him dead jails are overcrowded as is and our taxes will pay to maintain this monster.
Like the article says, it is not the doctors' that were a part of the transplant that were the issue. If they had passed it to someone who had not tried to kill themselves and was not an accused murderer, they would have faced an ethics board and quite possibly lost their license. They are not allowed to discriminate.
I forgot to add that I think the bastard didn't deserve the transplant. I was just saying that I understand why the doctors involved gave him the liver.
The doctors did the right thing. Remember that the list of those who need transplants is ordered by their health without a new liver (i.e. if someone needs a new liver, but is able to live in some sort of degraded condition, they are lower on the list than those who will die soon if not transplanted).
The doctors understood that this individual was going to die immediately without the transplant (effectively, he deserved to be at the top of the list).
The author of this story prescribes that legislation should help prevent this from happening in the future. I ask you this, what if this man was innocent of the murder, would your opinion change? What if someone else poisoned him, would your opinion change? This is the danger of changing the "need" of transplant from a health perspective, to identifying who we think is worthy. Slippery and dangerous slope.
I just feel sorry for the poor slob who would have gotten a liver if this clown hadn't shown up.
Prisons doctors should be the ones that have been thrown out of their profession and no prisoners should ever be considered for any life saving measures. Don't like it, don't care.
The irony of life. Keep him alive with a new liver long enough to convict him and then fry him in the electric chair. The only problem is that an innocent on the transplant list probably died during this process.
cutlass, Are you human? I guess you never done anything wrong in your life! Ye without sin.....
This was lousy journalism at best, with the only aim to incite readers to jump to conclusions, and blame politicians, whoever else is conveniently in the way. As a PhD educated individual, I would have though maybe you have gone into the nuanced history of how medicine has advanced and bioethics-legalities have not kept paced with such advances. But there was no such elaboration or evidence of such research in this mini-"article." You also failed to discuss how the US legal system and the foundation of it- innocent until proven guilty, all individuals have due process rights was what allowed him to receive a transplant and receive the same medical treatment as any other individual. I applaud the doctors in this case, who were called upon to make a very difficult decision, and chose to provide the best care to their patient regardless of the circumstances. I don't think many doctors would be able to make the decision to not save their patient's life if they were able to. Even if they were under what criteria do you then deny certain care (rationed care such as non-living organ transplants)- no one who is a convicted felon, no accused murders, etc.... where is the line???
I find it interesting when as a society we find it compassionate to put a suffering animal out of its misery, but if a human is suffering, this is not the case. Likewise, if an individual has attempted suicide, let their choice be the final one. I agree it isn't a perfect system and there has to be some rules to play by for it all to work, but on a case by case basis, saving someone who has attempted suicide only to find them guilty for murder and sentenced to death or life in prison just doesn't make sense, especially when someone more deserving is still waiting. Should the person who has continued to drink even after the doctors told him to stop, get a kidney before the mother of 2 kids who is just trying to stay alive long enough to see her kids grow up. As much as we say Justice is blind, we know it is not, and to say medical ethics is equally blind is just untrue. We should have a system which treats the desearving, not just the needing.
Generally people who abuse alcohol need a liver before they need a kidney and abstinence/sober recovery is actually a requirement of almost every liver transplant listing center that I know of...
It is a requirement. They won't put you on the list if you aren't clean.
Hey MH, or whatever you call yourself, for someone who is "so educated" you would think that you would check your grammar and spelling before posting such an idiotic comment. Your parents must be so proud.
Roman: I see one grammatical error in his post (I may be wrong as I'll explain). So what? Perhaps he got his PhD in something other than English. I'm an educated engineer and will be the first one to admit my English is horrible. When you study math and science for your major, there is little room to study anything else.
So please show us all these "grammar and spelling" errors. I see on the second line he wrote "though" instead of "thought". (OH NO! What a retard!)
"As a PhD educated individual"
What fatuously snotty drivel. You, sir, are a poltroon. You haven't got the wit or the sanity to simply write your mean little rant. You must tell us all that you have a PhD. Oh, my! We must accept your words of wisdom then!
Fella, lots of us have PhDs. I have one. And my friends tell me to "go !@#$ myself" whenever I deserve it. I don't trot it out except where it is meaningful. As my father used to say, "A donkey with a PhD is still a donkey."
The reality is that because this suicidal self-confessed murderer got a transplant, someone else who committed no crime has died for lack of one. Anyone who can't comprehend that basic fact is a heartless moron. But more than that, by giving your blessing to the amorality of the physicians who threw away a liver transplant on someone who did not deserve it, you have given your blessing to two murders.
You see, MH, the killer who received the transplant did commit the murder. He said so. There is no question about it. He is not "innocent" he is guilty. Only a man bereft of sanity would say otherwise. Saving the murderer's life instead of the life of someone deserving that wants to live is a monstrosity. But it is compounded, because the law recognizes multiple criminal causes. The obvious is death caused by commission, but there is also death caused by omission, an actus reus. An unknown stranger's death was caused by the actus reus of the transplant that should have gone to them.
Roman and John T. and others seem to have misunderstood MH. MH is referring to the Ph.D. of the author, listed as Arthur Caplan, Ph.D.
Nobody, including doctors, can be vigilantes, nor can they predict if an accused person who may have attempted suicide in some extreme set of circumstances will ever do so again, or be freed from prison at some point, or even be convicted in the first place (temporary insanity, false confession, etc.). I would assume that is how the attempted suicide issue could get past a hospital's transplant committee! Also, the odds of another possible equal (without suicide attempt) medical match or a better medical match would not have been passed up, or at the least would have shared the liver, which I believe can regenerate from a sufficient portion. It is just very difficult to achieve a match.
This article is a commentary piece, i.e. an opinion, and everyone is entitled to one. In law, and many other things, the majority vote rules! My impression from the article is that nothing improper happened.
Such a dangerous statement. By whose standard do we define "deserving", yours, mine?
What is all these posts flaring someone for having a PhD? A lot of people tell about themselves - their political incline, their family, their profressionm their military career, financial standing etc - to reinforce their opinions written here. And I have not seen this mcuh insults about any of those. That it is a PhD, and that it is a big deal to get one, it must be jealousy that is so shamelessly displayed in the responses - its appalling! Whether he said he has one or he was referring to someone else, it is not shameful to have a PhD - disgusting responses.
You certainly don't type, spell or use puncuation as a PhD educated person would.
So how many doctoral thesis have you edited so far - it would have helped back up your assertion. But then, it would be too pompous to declare that and these other commenters, including yourself would pick on it for want of an opinion on the news at hand; just write a 1 line insult with just one mistake - spelling or grammar, depending on your proficiency.
...and Toradze, an arse is still an arse. You expect for us to believe that you have a PhD when you missed the entire point of the post?
While I most certainly do not approve or condone what this man may or may not have done (remember he is accused not convicted, and belive it or not we do still hold true to the principle that one is innocent until proven guilty) but it is NOT the job of doctors to make moral judgements about who does or does not receive organs. If doctors were able to make moral judgements they could decide, for example, that they will only report people who are Christians for organ transplants, or any woman who has had an abortion or uses birth control is not eligible to receive organs.
It is not the job of doctors to decide who is worthy of organs, and when that starts becoming their job, we will live in a very scary world.
P.S: I work at my University's Women's Center and work tirelessly to end violence against women, and am disgusted by what this man may have done, but that doesn't give me, or anyone, the power to decide if this man is moral enough to receive an organ donation.
Certainly it does. The man had confessed. He was a suicide because of it. All that was required was the simplest kind of moral judgment.
Someone else has died because this murderer lives. Two lives are now on his debt, but the second was put there by the amoral cowards who "don't make judgments".
What a shameful example of poor judgement!
I must agree, very poor judgement indeed.
How many people aren't even on the waiting list because they don't have insurance to pay for the organ let alone the procedure?
Waiting lists are heavily weighted with those who have the ability to pay and there aren't enough charitable organizations to help the rest.
Why is it that prisoners get free, and better medical care than poor citizens who have done nothing wrong?
It is this lack of judgement spilling over into the medical profession from our legal system and morass of insurance red tape that cheapens us in the eyes of the world and with each other.
That's not true about not having insurance. Often it is covered by the gov't. if you can't pay.
No kidding. It was beyond poor judgment. It is tantamount to murder to give him the liver instead of someone who deserved it.
Lively Wrote: "That's not true about not having insurance. Often it is covered by the gov't. if you can't pay."
Lively the key word you used was "OFTEN" so the statement made about not getting the proceddure done becuase of no insurance is in fact a true statement. Hence why you have som many folks who lose everything due to Medical bills. Remember Odumbo preached that to all of us when he crapped the health care bill down our throats. He stated his Mother fought with the Insurance Companies on coverage until she died. If the Government picks up the tab then why would anyone get medical Insurance????
i have to agree with Michelle - doctors are not there to judge, if that were the case, then most criminals would never make it out of a hospital alive. despite knowing that he's guilty, he still is allowed by law his right to a trial. so though there are thousands in need of organs, and i'm sorry that someone lost out becuz of this moron, karma is at work. so here's hoping he gets the death penalty.
Total nonsense. Making a judgment on who gets one of the most scarce medical procedures there is has nothing to do with rendering ordinary care. If he has a gunshot wound, fine. If nobody else will die because of such a decision, there is no reason to withhold reasonable care.
That has absolutely nothing do do with this case. This case is very clearcut. The man confessed to the killings, then tried to kill himself.
Never forget that when one person gets a scarce resource, another dies for lack of it. Don't give me that karma bull@!$%#.
Sure Doctors and Pharmacies choose who they will help. It is done all of the time with regards to Abortions and hell even birth control methods are preached to patients by some Doctors.
I have to agree with John on this one....Did anyone read the article? The man confessed to committing the murders what else is there to say and then on top of that tried to kill himself because he is such a coward. I say this liver should have gone to an individual who deserved it; this man in my opinion did not. He not only confessed to killing his wife but now another innocent individual is dead because of his actions..What a shame when this society believes that those individuals who confess to murdering someone are considered more worthy of life than someone who have not! That is just my opinion! Good Response John!
I'm sorry, I don't remember the article saying someone else died because he got the liver. Nowhere did I see, "Mary, a mother of 2, passed away because a murderer got the liver instead." You're jumping to conclusions.
That MAY have happened, but it's certainly not a fact that someone else died because he got the liver instead (other than, of course, the person that donated the liver). Just saying. . .
It might well be appropriate to regulate transplant lists relative to those CONVICTED of certain crimes. But because this individual had not even been to trial yet, he should receive the same consideration as everyone else needing a transplant.
Ridiculous. He had confessed. He tried to kill himself. And because he got the transplant, someone else has died.
That's two murders now.
I know all of you who are judging these doctors are currently making phone calls, writing letters, etc., to your local politician in order to have these laws/issues addressed accordingly.
And of course, you've already signed your organ donor card, right?
The writer tries to make the point that the doctors don't make the ethical decision, when in fact, they did make one. They decided to move 16,000 already on the waiting list, down, to make room at the top for this worthless low life. Highly unethical, in my opinion!
I think you may have missed the point of the article. The doctors have an obligation to do all they can to preserve life. If your loved one accidentally (or intentionally) consumed rat poison, they'd "make room at the top" for them too. The whole point is it's not the doctor, acting in the heat of the moment to save a life, who should be responsible for making these judgement calls.
Also, as many have noted, its a little disingenuous to relegate a guy to the status of "worthless low life" before he has been convicted in a court of law.
I agree Atheismo - if the guy had been convicted I would be furious had he got the transplant, but he wasn't and in this country the courts say you are innocent until proven guilty. For kicks and giggles, lets say he didn't kill his wife - that he was mentally unstable after seeing her killed... and decided life wasn't worth living without her.
That said, I wish the 911 caller had delayed the call, the courts might say he's innocent until after a verdict...I don't have to.
Longtalisman is completely right. And that is the crux of this that this absurd article avoids. Any decision on this case is a judgment to leave someone to die. He had confessed, he tried to kill himself.
Think of what you would think if your son died because this murderer got the liver that would have gone to him? That is the reality for someone.
I agree with longtallsam in that the doctors did choose to skip the line to favor a murder suspect.
I don't know who sifts through the line to find the next in line that match the organ available for transplant, but I don't think it is upto the doctor to 'do the right thing', as he deems it. I am thinking that it might have been that the police forced the doctor to save this person's life because theyr were probably pretty sure he would be convicted and they have a case closed for their credit. Completely and totally unfair - everyone lined up for a transplant is critically in need of it.
I believe this confessed murderer chose his own path - death by suicide. Unfortunately, someone intervened TWICE...the second time, someone who obviously wanted and needed that liver didn't get it.
Doctors should never be allowed to make choices that fly in the face of the path that their patients have already opted for, I believe these doctors have done just that.
They should be prosecuted for their choice...or at the very least, be forced to pay for this person's medical upkeep for the rest of his miserable, useless life....
The person that receives the organ is decided by a committee. Not the surgical team.
"Under the National Organ Transplant Act, organ transplantation in the United States is overseen by the U.S. Department of Health and Human Services (DHHS). Specifically, the Division of Transplantation (DoT), which is part of the Health Resources and Services Administration (HRSA), is in charge of a federal contract that established and maintains the national waiting list and distributes cadaveric organs fairly."
Source: http://www.med.umich.edu/trans/transweb/faq/q25.shtml
Somoene in the slammer may take that puppy right back out of there! Government can't seem to use common sense, so let's vote for less government and we'll save big time!
This has nothing to do with government or law, but rather a medical decision made by doctors who were not influenced by the patient's non-medical circumstances.
And I applaud that, as many have said, the process should be 'blind', otherwise we can truly devolve into a judgement-call-by-doctor chaos (discrimination by religion, race, etc etc).
What I find amazing is the usual knee-JERK reaction by, let me guess, another tea-party nut, that the answer is less gov't. Well, in this case, in order to get the results Uncle Sammy wanted, we'd actually MORE gov't, in the form of legislation or oversight board that would decide the 'eligibility' of a transplant candidate - otherwise known as a 'death panel'?
Or did I miss something...
Consuming rat poison in an attempt to commit suicide and causing the liver failure is in my opinion a "medical curcumstance".
I'm sorry but the law was VERY much involved. Incarcerated individuals (and even though the crime was only a suspicion at this point the individual was in custody) are guaranteed, by law, proper medical care and living conditions. The doctors were performing a procedure in accordance with the law paid for by the taxpayers. I doubt if the judgement of the doctors ever came into play; I doubt if they were given much choice at all.
The doctor's do not have a choice in these circumstances. Would we all like to see the guy rot to death in his cell and allow someone else more deserving the chance for a new liver? Most likely we would. Personally, I don't believe he deserves anything at all and if I were the judge and jury he would die a slow, painful death. He has made it clear that he does not have any respect for human life so why should we care about his?
the maggots running the funny farm need to be put in the slammer or worse----get them out of power--they are nuts
the doctors have no choice??????? pull your head out of the nasty place it's in. this is just a cop out like how our government covers theirs.
The decision to give him the liver could easily be a death sentence for the next in line.
I understand that doctors don't judge and his crime could therefore have no part in his transplant list placement. I have more of an issue with giving an organ to someone who is suicidal.
Interesting perspective! I see where you're coming from...May I suggest that for better or worse, suicidal patients have the same rights to donor organs? The Hippocratic oath is quite clear.
"...Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."
Seems to me doctors have no business with the morals of their patients; they are enjoined to do all they can to save lives, not to judge them. Nevertheless, I'm glad I'll never have to face such a dilemma. Understandably, it can be really hard to put your personal views aside and do the right thing. No, I take that back. It is almost always difficult to do the right thing when doing so goes against your personal convictions.
Have a good one.
Kaizaro, you are correct. No matter what our thoughts are regarding this, the Hippocratic oath is the criteria for physicians. Granted, it is not always followed by some doctors but then again, doctors are human beings first and are subject to the same faults as anyone else.
I have a great appreciation for the dilemma this story posed. My husband is a liver recipient almost 17 years out and is now awaiting a kidney. We are very well versed in the qualifying process. Not easy or quick. This story has presented a quandary which hits home to us personally.
I love when physicians use the Hippocratic oath when and how they choose....usually to cover their own a**es.
Doctors do play 'God'...they do it every day - ever hear of 'triage'?
Its when someone (usually the physician) decides that nothing more can be done....in my mind, that pretty much well puts them on the 'God Pedestal'.
The last thing we need is doctors 'playing God'!! That's Obama's job!
(Okay...ready for the hissy-fits)
You all have GOT to be kidding! As a recent recipient of a kidney, I waited ONLY 4 years for a compatible one. Being familiar with the nuances of the transplant program, there are multiple criteria for determining an eligible candidate. Someone who exhibited both criminal and self-destructive tendencies should NEVER have been considered for an organ transplant.
I consider it a gross breach of (medical) ethics and etiquette that this completely amoral (barely) human being got to jump the line and deny someone else a chance to have/continue a much more positive and productive life.
The only thing that could have made the situation any worse woulde be if Tony Hayward had made that decision.
What is even more outrageous is the fact this news article even got published. The NY Post reporters never checked their sources. And the rest of the media is just following suit. What an outrage indeed!
Guys, I don't understand this at all? Suddenly Dr's are not trained or allowed to make treatment decisions based on "Moral Beliefs"? They have been doing it for years. They do it every time they refuse a desperate woman a safe and legal abortion. But they Can't decide to withhold an organ transplant to a murderer when there are thousands of deserving people on the waiting list? How do you spell HYPOCRISY?? Oh I see, the murderer is a man and deserves the medical tratment without judgement. Where as the women don't have the ability to make their own moral choices. It is about time the medical profession either acts altruistically to all without moral judgement or show their God like moral insight to make the moral choices all the time.
The root of this dilemma is not that he might be a criminal, but is instead that he knowingly caused the injury that resulted in him needing the kidney. Giving priority to someone who was trying to end their life over someone who is just tying to have a life is just wrong, no moral judgement needed.
In some respects one might suggest that common sense in our great nation left the building at the same time Elvis did, and so far it has not returned for an encore at the dawn of the early-21st century . . .
And like the nonsense last week about Shirley Sherrod and the "white farmer", one might suggest that instead of asking and then getting the factual answer to the key question--"Did the 'white farmer' lose his farm?"--most folks simply shot from the hip and in so doing effectively inserted their feet firmly into their mouths, since the reality was that the "white farmer" did not lose his farm and over twenty years later both he and his wife credit Shirley Sherrod with getting them in touch the the attorney who ultimately saved their family farm, where the attorney was someone with whom Shirley Sherrod had worked before and specifically contacted . . .
So, in this instance, what is the important bit of information?
Great question!
The answer is that this is the key question:
Were there any other ready, willing, and able candidates within the medically acceptable transportation and time windows of opportunity for liver transplants who were good or better matches for the donated liver?
If the accused murderer was the only match for the donated liver, then the entire discussion is a frivolous waste of time, if only because (a) "accused" is distinctly different from "convicted" and (b) no matter what one's ethical, legal, moral, philosophical, and religious views might be, it is patently stupid to waste a donated liver when there is a good, better, or best match for it . . .
However, if there was another potentially good, better, or best match for the donated liver, then I think that a lot more questions need to be asked, one of which is focused on determining what caused the each candidate's liver to fail . . .
And in this respect, I agree with Dr. Caplan, since although current rules apparently prohibit doctors from considering the etiological aspects of organ failure, I think that it is cruel and unusual, as well as egregiously harmful, to put someone who intentionally tried to commit suicide with rat poison ahead of a child who did nothing other than inherit a particularly adverse set of genes or was an innocent victim of a devastating illness . . .
If there were an abundance of donated organs, to the point that there were no waiting lists, then there would be no need for committees and elaborate candidate selection criteria, but at present there are more people who need transplants than there are available organs, and this effectively creates the reality in which life and death decisions must be made based on some set of criteria . . .
Someone makes these decisions, and if doctors are not intimately involved in making the decisions, then the system is patently goofy . . .
In an Utopian world, one might expect reasonably that there was only one match for the donated liver, which makes the decision trivial, but if there were other matches, then (a) I think that doctors need to be involved intimately in the decision and (b) I think that there needs to be at least one psychiatrist in the group, because prior behaviors tend to be good predictors of future behaviors, and in my universe this clearly puts suicide attempts on the table, along with everything else . . .
Stated another way, while I am a huge fan of beliefs and in the grand scheme of everything am convinced firmly that if one could have either (a) beliefs or (b) facts but not both (a) and (b), then I would prefer to live in a world where one only had beliefs rather than in a world where one only had facts, but the reality is that science is driven by facts, and the best and only way to make good decisions based on science is to focus primarily on facts . . .
And fortunately, few if any people ever are put in the virtually mind-boggling situation of having no choice but to deal with (a) beliefs only or (b) facts only, especially when (a) and (b) are contradictory rather than complementary . . .
Additionally, even though apparently the folks making the organ transplant decisions currently are prohibited from considering suicide attempts, criminal history (alleged or convicted), and so forth and so on, there are other way to consider these things, where for example I see no problems with considering the systemic aspects of "overdosing" on rat poison with respect to the likely outcome of an organ transplant, and I think this information can be characterized or packaged in a way that specifically excludes all the apparently troublesome aspects that wander into ethics, morality, philosophy, and religion, because for example a child might have accidentally "overdosed" on rat poison, while an accused murderer intentionally "overdosed" on rat poison, and so long as "accidentally" and "intentionally" are excluded from consideration, this introduces sufficient balance and makes it much easier for the doctors to make the best scientific decision based on facts rather than beliefs . . .
Explained yet another way, I have no problems with the concept of removing beliefs from the set of criteria, but I have a huge problem when the otherwise logical goal of removing beliefs from the equation is done at the expense of restricting the full disclosure and consideration of facts . . .
Believe whatever you want, and God bless you for having beliefs and faith, but when you don the organ transplant decision-making hat, I think that you need to focus on facts, because while one can argue with beliefs, there is no arguing with facts, which is the beauty of focusing on facts when doing science . . .
In other words, I want to know all the fact, and unless society has decided sua sponte that emotional behavior simply cannot be defined, described, measured, and understood, then it is a key component of the set of facts to the point that ignoring emotional behavior is patently goofy . . .
For example, when a patient has a well-documented and verified history of suicide attempts, this probably maps to the patient either (a) being on some combination of antidepressant, anti-psychotic, or other types of medications or (b) needing to be on such a regiment of medications, and this is important to know, because some of these drugs specifically might be contraindicated for patients who have liver failure or have received a liver transplant, hence if (a) doctors, including at least one psychiatrist, as well as perhaps a neurologist, are not involved in the decision-making process and (b) nobody takes the time to consider the most likely prognosis based on the specific combination of medications required after the liver transplant, then for the most part the decisions are being made based primarily on what only can be described as "goofy magic", which is mind-bogglingly ignorant . . .
And regarding the specific legal status (accused, alleged, convicted, innocent, suspected, or whatever) that might apply to a candidate for organ transplant, I think that none of these should be considered, since all of them are subject to review by appellate courts and ultimately by the Supreme Court in one way or another, so even if a candidate has been convicted and is on death row; has exhausted every appeal, including appeals to the Supreme Court; and is scheduled for execution within 48 hours, so what . . .
So what!
No matter how unlikely it might appear to be at the time, it always is possible (a) that the candidate could be granted a stay of execution, reprieve, or pardon by the respective state Governor or at the federal level by the President or (b) a bit of compelling factual evidence of innocence might be discovered, all of which is the purview of attorneys, courts, judges, juries, parole boards, and high-level political executives (Governors and the President to be specific) . . .
And toward the goal of being as clear as possible regarding facts and beliefs, what about race (or "ancestral origin", if you prefer)?
Great question!
If it is scientifically and medically relevant to post-transplant medications and outcomes, then it is on the table for consideration, because one of the key factual realities is that post-transplant patients at present often--if not nearly always--need to take a variety of prescription drugs to prevent organ rejection, and this needs to be part of the decision-making process, although recently there have been some cases where various strategies certainly appear to have solved the "organ-rejection" problem for some patients, where as I recall one case involved doing something with bone marrow that changed the immune system of the transplant recipient in such a way that her body no longer arbitrarily rejected the transplanted organ, which mapped to her no longer needing to take organ-rejection medicines . . .
Summarizing, I think that there are enough facts available to make it virtually trivial to avoid wandering into the universe of beliefs (which is the universe where such things as ethics, morality, philosophy, and religion exist), and so long as decisions are made based on all the facts--with no facts being arbitrarily excluded--then, there is no problem, which is fabulous . . .
Fabulous! :)
As a bit of follow-up regarding the particular aspect of Dr. Caplan's opinion with which I expressed agreement, I was agreeing with what I perceive to be the overall perspective that doctors need to focus on medicine and the Hippocratic Oath, which now includes rather than excludes surgery, which is fabulous . . .
http://en.wikipedia.org/wiki/Hippocratic_Oath
Fabulous! :)
However, in reading the opinion piece a few more times, I take issue with this opinion expressed by Dr. Caplan, which in my view is patently goofy, if not downright ignorant, really:
[SOURCE: http://www.msnbc.msn.com/id/38419132/ns/health-health_care/ ]
Really!
Being a gracious fellow, it might be that Dr. Caplan did not express himself so clearly, and I suppose this could be a matter of semantics, but insofar as I am concerned medicine is precisely the field of science where illness and disease need to be considered with respect to all facts . . .
And I certainly hope that Dr. Caplan is not suggesting that doctors should not be allowed to conduct triage in disasters and other types of unusual events where there simply are not enough available resources (doctors, nurses, beds, medicines, medical devices and machines, and whatever) to treat everyone equally . . .
I have no problems with the concept that when the only factual difference in two patients is that one is a police officer who was shot and the other is an alleged criminal who was shot by the police officer, then you treat them with equal care, even if the alleged criminal was the one who shot the police officer, since all that stuff is a legal matter and is something for the justice system to handle . . .
But what if the gunshot wounds of both patients destroyed their livers and there is no option but to decide which patient will receive the only available donated liver?
To focus this as much as possible for purposes of a thought exercise, consider (a) that the two patients are identical twin brothers, (b) that everything medically is the same, including such apparently inconsequential aspects as both of them arriving at the emergency room at exactly the same time and so forth and so on, where the sole difference is that the police officer brother shot the alleged criminal brother, and vice-versa, (c) that only one of them can receive the donated liver transplant, (d) that there are no other candidates who are a match for the donated liver, (e) that both patients are unconscious, hence cannot express an opinion, and (f) that there are at least a few hours during which to make the decision . . .
Is resorting to flipping a coin the best solution that science allows?
If one arbitrarily stops gathering and considering facts, then I suppose that determining by flipping a coin which identical twin gets the liver transplant might be the best solution, but in the grand scheme of everything I think that making a life and death decision based on the outcome of coin toss nearly never is the brightest strategy from the perspective of science, since the fact of the matter mathematically is that the outcome of what specifically is defined to be a series of "fair" coin tosses never converges, which explained as simply as possible maps to the mathematical fact that if one "fairly" tosses a coin a trillion raised to the trillionth power number of times the outcome is not guaranteed to be half heads and half tails, which even in the quantum universe causes one to wander a bit too far into the "Schrödinger's Cat" dilemma . . .
In other words, is Dr. Caplan suggesting that doctors should not be allowed to lift the lid and to look inside the box, because by the very action of looking inside the box, they arbitrarily determine the life and death state of the patient?
I have no idea, but I certainly hope not . . .
Instead, I think that the doctors should devote however much time is available to discovering and to examining every possible medically relevant fact, while during the same time a group of other folks can ponder all the non-medical aspects, which might include flipping a coin . . .
Explained another way, if Dr. Caplan is suggesting that doctors do not need to making life and death decisions based on coin tosses, then I agree with him fully, since this is one of the reasons that there are astrologers, bookies, gurus, philosophers, political commentators, priests, spiritual advisers, talk show hosts, and a virtual festival of other folks who are quite skilled in making arbitrary decisions based entirely on their unique personal beliefs, which is fabulous . . .
Fabulous! :)
i agree that doctors are not or should not decide who is guilty anbd who isnt.. and as of the date of his transplant, he was still "innocent till proven guilty'
BUt, he tried to kill himself... that says it all... a doctor doesnt have to decide anything.. they only have to state the facts... he attempted to kill himself by ingesting poison...
that should be enough to put him on the bottom of the list...let the panel who decides who gets what look at the list and see who wants to live and who doesnt, and decide based on that.
the chances of success of transplant has a lot to do with 'psychie' and this guy obviously doesnt and wont have the will to survive if it comes down to it...
the doctors should and do constantly choose procedures based on 'chances of success' all the time...
our system, and i mean every system sucks out loud.. and it wont get any better as long as 'everyone ' gets thier say... we need a single branch that we trust emphatically, to do the right thing for everyone.. and yes, i understand that by itelf is / will be impossible to enact/establish
How rich...an accused murderer and suicide gets first crack at an organ, but other, more deserving patients get shafted. While I understand the ethical hurdle that doctors must face (they are tasked with saving all lives, good and bad after all), I think it's self evident that people like this should not even be considered saving. Now, not only does this jackhole get a new liver and lease on life that should have gone to someone else, but we as taxpayers now get to subsidize his life in prison for at least another 5 to 10 years (barring an incident).
We should have legislation in place saying that capital criminals should be banned from getting any transplants, unless they can provide a judges waiver (like a stay of execution). That way, the crook will at least get due process. If the judge or panel finds enough evidence barring him from getting a transplant (IE compelling evidence that he or she committed the capital offense) then its tough luck, see you in the afterlife. It's ironic that cons like Bernie Maddoff and Scott Roeder get better health care than the American public, AT OUR DIME!!!
If all else fails, make it a constitutional amendment...Killers, rapists and thugs don't get any dibs on any hearts, livers, or kidneys.
sorry dude, they have "rights", thanks to the bleeding hearts.
I'm with both of you, Wm & Yella...
Parents of children languishing on waiting lists should call congressmen and lawmakers and get laws in place to prevent this sort of thing.
Law abiding citizens should come first. Period.
When questioned, Concepcion stated, "Hey, how else was I gonna get her liver?"
I guess the doctors had summer camp bills to pay. No wonder we're going broke. Could have been worse, he could have been an alcoholic with hepatitis and over 80 years old, just to sweeten the story.
Wrong, they had to keep their premiums paid to avoid the trial lawyers.
This was just crazy. I can't believe he got one so fast! The article seems to be raising the question of "death panels" again. I don't believe death panels exist, it's just a harsh way of pointing out that SOMEBODY has to decide who gets what kind of medical help and when. I don't see how they justified this, though, with a waiting list that long, other than the fact that he clearly would have died immediately without a new organ.
A perfect example of our FAILED system. It's Bush's fault, right?
I am all for organ donation. But if that was my loved ones organ donated to a murderer, I'd be pisst.