Medical Morals and Ethics.

Discussion in 'Et Cetera, Et Cetera' started by The Dragon, Jul 10, 2011.

  1. The Dragon

    The Dragon New Member

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    Doctors pleased with Hinch's recovery - Yahoo!7

    Notorious Australian shock jock Derryn Hinch is recovering from a liver transplant after all but destroying his through years of alcohol abuse and unhealthy living coupled with liver cancer.

    The question has been raised about the ethical and moral dilemma of "is it right to provide healthy transplant organs to someone who has so blatantly and knowingly engaged in behaviours that destroyed their health?"

    What do you say?

    Do they deserve a second chance?
    Should they be removed from waiting lists?
    Should these healthy transplant organs be given to people who are sick because of unfortunate events rather than from their own habits?
     
  2. B_stanmarsh14

    B_stanmarsh14 New Member

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    They said the same about 2 well known football greats in the UK, Brian Clough and George Best, especially with Best, after seeing the pic of him in News Of The World (Final edition today), as you will read in the wiki link.

    Tough call when you know you have intentional done harm to yourself, and know you need a transplant to live.

    All depends how much that person wants to live, and what they are willing to do to stay alive, and not insult the donor of received organ.

    You may think..... tough shit, you brought this upon yourself, but by the same token as a quote from the bible says..... he who is without sin, may cast the first stone. No one is perfect, and we do make mistakes.

    One thing is for sure, is that they should NEVER take preference over a person who needs a transplant, through no fault of their own.
     
    #2 B_stanmarsh14, Jul 10, 2011
    Last edited: Jul 10, 2011
  3. D_Tim McGnaw

    D_Tim McGnaw Account Disabled

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    I think it's unethical to make patients jump through hoops for organs they need just to live. It's why I think organs should be automatically harvested from the dead unless they've specifically opted out of doing so prior to their death.

    I mean it's not like alcoholics deserve to die just because they suffer with a substance addiction illness, and in the case in the OP the guy had liver cancer to boot. If we follow the line of reasoning that says if you engaged in a behaviour that caused your organ failure knowing that this could be the result of your actions then we end up denying a huge range of people treatment.

    Morbidly obese people would be denied resuscitation when they go in cardiac or respiratory arrest. Smokers denied treatment for lung cancer, motorcyclists left for dead after an accident, people who've attempted to OD wouldn't have their stomach's pumped, stab victims left to bleed to death for having got into a fight....

    I mean the list is endless, because human beings do things which carry fatal risks, they always have and always will. We don't treat only the "deserving" sick, because it's the right thing to do to treat everyone who needs to be treated.

    If you take out competition for organs by making them plentiful by the means I suggested then you take out the perceived necessity to demand that patients be deserving of the organs they get in transplant and you make the system far more ethical all round.
     
    #3 D_Tim McGnaw, Jul 10, 2011
    Last edited: Jul 10, 2011
  4. rob_just_rob

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    They have radio in Australia? :eek:

    On a more serious note, I'm seeing this sort of question asked more and more. Think about the people who try to solo sail the Atlantic, or hike to the North Pole, and the expense incurred to rescue them when things go wrong.

    That's on top of the money spent on medical help for the obese, the alcoholics, the people who have smoked 10 packs a week for 40 years, etc, etc.

    I tend to think that the former group - the people who put themselves out on a mountain, or in the middle of the ocean or the artic/antarctic - should be paying some sort of insurance premium to cover a possible rescue.

    The latter group, well... the problem is, where do you draw the line? You can't mandate healthy behaviour. And I don't believe it's so simple to say that one person deserves (for example) a liver transplant over another because he didn't abuse alcohol and the other guy did. What if the first man raises tons of $ for charity? What if the second has been jailed twice for spousal abuse? Start throwing morality and behaviour into the mix, and the whole process starts to get scary. Who gets a transplant should be a purely medical decision.
     
  5. VernalTiger

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    Thanks, hilaire. Your post basically summed up everything I was thinking.

    I strongly believe in an opt-out system for organ donation. A close friend has cystic fibrosis, and the stark truth is that he will die young without a heart & lung transplant. Because of the shortage of organs, he has to be on the precipice of death before he can even go on the waiting list, by which time he may be too sick to survive surgery, or the recovery process if a tissue match is found in time. Providing a system of universal organ donation would improve the lives of many people.
     
  6. nudeyorker

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    I know someone who was in exactly the same position and was not eligible for the transplant until he demonstrated that he was sober. (They simply told him they would not waste a healthy liver on him.)
    Long story short he had a successful liver transplant 10 years ago and has been clean and sober and is now living a happy and healthy life.
     
  7. Drifterwood

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    Do you give medical care to people who attempted suicide?

    It should not be a policy to withold care. The only question should arise when there is a shortage of supply; whom do you them prioritise?
     
  8. D_Miranda_Wrights

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    I agree with hilaire. However, I understand that sometimes triage is necessary; a chronic alcoholic, or one highly likely to relapse, is simply a much less efficacious use of a liver than a sober person.

    That said, I'm much more passionate about an opt-out system. People should at least have to take a conscious effort to make a decision to waste useful transplant parts.
     
  9. august86

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    Totally agree with organ donation being the default as it would help so many more people who need them.

    From my understanding, if you're still engaged in activity which would directly harm the new organ (i.e: drinking: livers, smoking: lungs, etc) then it would almost guarantee rejection by the body and render the organs useless, which deprives someone else from having their quality of life improved, so I don't think it's unreasonable to demand that a potential receiver stop such behaviour.
    It's too big of a risk to give someone an incredibly scarce organ who has no forseeable chance of survival, because of such actions.

    Absolutely, but then again you hear of politicians/celebrities getting bumped up the list. -which is a whole discussion on its own...
     
    #9 august86, Jul 10, 2011
    Last edited: Jul 10, 2011
  10. rob_just_rob

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    I understand the sentiment expressed in the rest of your post. However, the idea of reducing human beings to
    makes me a bit uncomfortable.
     
  11. D_Tim McGnaw

    D_Tim McGnaw Account Disabled

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    Of course it's reasonable to expect that the organ recipient be doing everything they can (including ceasing whatever activity may have contributed to the failure of their organs) to make the transplant viable in a system where organs and the resources to transplant them are scarce.

    My point was purely that having engaged in the activity which caused the organ failure shouldn't disqualify one for consideration for organ transplantation.



    Why does that make you uncomfortable? Just out of interest...


    To me a corpse isn't a human being anymore, the thing which made them human no longer exists. So to my mind its grossly immoral to dispose (in most cases simply leave to decay or obliterate with incineration) of a resource (corpses) which might otherwise be used to save and prolongue the lives of millions of gravely unwell but living human beings.

    The organ competition created by the scarcity of organs for transplantation is also deeply immoral and open to abuse.
     
  12. rob_just_rob

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    It doesn't make me uncomfortable. It makes me a bit uncomfortable.

    edit: Probably read too many Larry Niven novellas as a kid.
     
    #12 rob_just_rob, Jul 10, 2011
    Last edited: Jul 10, 2011
  13. Sirramm

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    I fall on a very slippery slope regarding such arguments. My background is the medical field (I will not expound on what exactly I’ve done or do within the medical field) but suffice it to say I have treated and cared for some very unhealthy people. Some of these people suffered from illnesses that were self-imposed death sentences while the vast majority suffered from the mere consequences handed down to us by whatever Creator you believe and became unwitting suffers of pain and agony.

    While I continue to argue that alcoholism is NOT a disease but merely the continued conscience effort of a repeated series of bad choices I as a “medical professional” must stand by MY reason to attempt to intervene and save these people from self-destruction; the Hippocratic Oath notwithstanding. I will grant latitude that alcoholism can be a “habit”, NOT a disease, handed down but you had the CHOICE to drink the first drink. With insidious diseases like cancer, the choice to contract it has never, nor will it ever, be a simple ‘choice’.


    So where does that leave this issue of a shock-jock who destroyed his liver and then was given this ‘second chance’ by receiving a ‘new one’? On the fence of course. Had his diagnoses of cancer become the reason for transplant, which I can honestly say is probably the reason more than sclerosis of liver from alcohol, then surely he falls well within the determining parameters of obtaining this ‘second chance’ at life. However, I can most undoubtedly assure you that if his physician is worth his salt the days of drinking for this chap are OVER!

    Just my two-cents worth…
     
  14. D_Tim McGnaw

    D_Tim McGnaw Account Disabled

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    So did you ever actually take the Hippocratic oath? And what's with the offensive presumption that everyone believes in a creator?

    I dunno something about your post seems fishy to me...
     
  15. Intrigue

    Intrigue New Member

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    I don't think its reducing humans to anything we aren't already when we are dead. When a person dirs the greatest thing they can do is bring life into this world with their death. They are nit being reduced, but rather elevated to a position of honor. People who chose not to donate are IMHO selfish. What does a dead body need with organs? These thoughts only disturb the living. So I definitely agree with Hil on this one. And i personally believe that there should be requirements for transplants, such as their already are. If your addicted to alcohol, and you need a liver transplant your best odds at not rejecting the organ would be to stop that destructive behavior. I don't want to deny any person care, but to not take precautions is to waste the valuable gift of a healthy organ.
     
  16. Sirramm

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    Sorry if the mere mentioning of a Creator offended you, or anyone else for that matter, but I think maybe you took the foundation of the statement out of context and perhaps even a little beyond my intentions. My statement was to illustrate that "choosing" to consume alcohol, with a possible known background of alcoholism in one’s family tree especially and I am not for a moment presuming this is the case in the original posters statement, is simply one’s own personal and moral decision. Unlike that of falling victim to insidious “diseases” like cancer, diabetes, and the like, which we, as mere mortals, have absolutely NO control over the contraction of. Regardless if one elects to believe in a Creator, I am confident we can agree that EVERYTHING has to come from somewhere and therefore by the very nature had to have been “created” by or from something. Matter is neither created nor destroyed…remember physics 101? So where did it ALL come from?

    I do not wish to debate creation vs. evolution here or anywhere. We all have our own personal beliefs and they are no one else’s business. The topic started to discuss whether an individual who chooses self-destructed behaviors deserves or has the right to organ transplantation. I made my point that this is a very slippery slope, at least for me. IF the “disease” of cancer was the first diagnoses and then followed by the alcohol abuse, but the cancer was/is the primary reason for the resulting failure of the organ then YES this individual is equally entitled to the modern miracles of medicine. However, if the role were reversed for many I am sure would agree, that no indeed this individuals self-destructive behavior(s) is the primary cause and should therefore possibly be excluded him/her from any form of life prolonging intervention.

    Enter the slippery slope for me. I by my own personal beliefs and career choice must defend both sides of this argument and intervene when possible. While I do not agree that anyone with self-destructive behaviors should be treated any differently medically than say even the Holiest of Holy’s, at the risk of offending I say, they both by the very nature of being a viable life deserve equal quality of care. This is one of those morally challenging predicaments that I am sure will be hotly debated for some time and while I don’t presume to have the CORRECT answer for anyone other than myself I just hope we all ultimately make a CHOICE we can live within our own minds, hearts and souls.
     
    #16 Sirramm, Jul 11, 2011
    Last edited: Jul 11, 2011
  17. spoon

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    last summer i took a course at harvard medical school, dept. of medical ethics. some decisions are difficult. emotions are involved. and it can be heartbreaking.
     
  18. D_Miranda_Wrights

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    Objectifying corpses makes me a lot less uncomfortable than allowing tons of people to die simply because apathetic people never got around to filling out a form before they died.

    I understand that some people do not like the idea of their bodies being used to save others after they die. I find that indefensible. However, I'm not arguing that they shouldn't have that option -- just that it shouldn't be the default choice for everyone.
     
  19. umami_tsunami

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    Good question. I think the emotional response is that the patient with a history of abuse should get less consideration, but I don't think it's practical or ethical to either deny or inhibit their opportunity to be treated. I do agree that anyone still engaged on the behavior that caused their condition would not find a doctor to perform the procedure.

    Addiction is a far more complex issue than Sirram posits. If it were that simple, there would be a fuckuva lot less of it. You would also have a hard time drawing lines all over the place. If we are going to mete out care according to levels of personal responsibility, that really is a slippery slope. Who gets to judge people on the consequences of their actions? You ate high fructose corn syrup?” – Back of the line asshole, you could have chosen not to eat that crap.

    The organ donation issue is separate and is tragic. Any and all my parts are up for grabs when I'm done. Great medical advance this week with transplantation of a trachea synthesized from the patients own stem cells. Of course, this happened in Europe. USA is a decade behind (thanks GeeDub) But I digress, the good news is that this type of medical technology will outpace people's religious or other objections to the postmortem endowment.
     
  20. Sirramm

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    I wholeheartedly agree you Umami tsunami that addictions are a very tenuous subject and issue. However, the discussion is relevant to “diseases” vs. addiction. To clarify “addictions” are also an overwhelming misguided choice of behavior vs. the unwitting contraction of a condition or illness that we have no choice but accept as part of our lives.

    Organ donation should be almost a mandatory requirement until some illnesses, ailments and diseases are eradicated globally. I am sure that will draw fire but before you start to fire off a response consider what I just purposed. You are dead, gone, no longer here and IF you have anything with your body that could save some one shouldn’t, wouldn’t, aren’t you suppose to, a Human (I stumble to use the word Christian in fear I may offend someone) leave it behind since you can’t use it? Sure you came in the world with it but who said you have to, or should, take it with you? Especially IF it could give someone else a better quality of life?
     
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