Thursday, April 24, 2008

Medical Technology and the Ethics of Life-Ending Decisions

This morning’s online edition of the Washington Post has an interesting article discussing the intersection of new and experimental medical technology with the evolving ethics, morals and duties of healthcare professionals. The article focuses on the increasing use of heart pumps in what is becoming a rather large elderly population; in doing so, it addresses the question of what is to be done when these heart pumps fail to work, and possibly increase the health problems of these elderly users.

As a point of reference, the Washington Post article discusses an individual who had one such heart pump implanted as a final effort to deal with his medical issues. However, upon implanting this device, his condition only grew worse as he experienced infections and other complications. Overall, this device has caused him to experience a lower overall quality of life, but removing the heart pump means certain, almost immediate, death.

Doctors are caught in a legal and moral dilemma when such problems arise. As one member of the ethics committee at New York-Presbyterian Hospital states, “[t]urning it off would be ‘tantamount to removing the patient's heart’”. While the article states that most requests are honored, there have been several instances where such patients have apparently turned to self-help and deactivated their heart pumps themselves.

Such heart pumps appear to be just the beginning of potential issues with replacement organs. Artificial organs are being seen as “destination therapy” for many new patients; instead of ultimately receiving a transplant, these artificial organs will be the final answer for many patients. It is expected that researchers will continue to develop other such artificial organs other than just hearts.

The use of technology to aid the ever-aging population seems to be an ideal answer, especially in a time when it seems there is an insufficient supply to meet this demand. The question then becomes, as this article demonstrates, is what type of aid to provide to those who experience problems from such devices and eventually want them removed or shut off. Hospitals have both legal and moral concerns to observe. It is the business of the hospital to save lives and cure disease, not to assist in the ending of these lives. Hospitals then also have to consider potential litigation from family members who are unhappy with any such life-ending assistance.

The removal of these “organs” does not appear to fall within already settled hospital procedures. When the proverbial “plug” is pulled for those in permanently vegetative states, it is the family or holder of a power of attorney who comes in and makes the decision; the patient is not in a position to make their own decision as they apparently are in cases such as the one mentioned in the Washington Post article. Even in such situations, there are strict procedures to be followed by the hospital even before getting to the point of speaking with the family regarding their options. The problem with implementing procedures such as these for those wishing to have their medical devices removed is that it may still not remove the stigma on such procedures by people who will assuredly view these deactivations as nothing more than assisted suicide, which will inevitably lead to further issues and potential litigation.

No comments: