Matters of the Heart
Once again medical technology outpaces society’s thinking and pushes against unanswered ethical, social and economic questions that need to be addressed--and soon. As the cost of medical care soars, decisions have to be made about how vast sums of money will be spent and whether the nation can afford to give everything to every patient or must ration its medical resources.
The latest incident involves a 33-year-old automobile mechanic who died last week after receiving two human-heart transplants and an unapproved artificial-heart transplant in less than two days. The immediate question concerns the use of the unapproved Phoenix heart, which was rushed to Tucson and implanted in Thomas Creighton’s body after his first human transplant failed. The Food and Drug Administration is now pondering whether to take action against Dr. Jack G. Copeland, the surgeon who used the plastic heart to keep Creighton alive for 11 hours until a new human heart could be found.
The regulations governing medical experiments on humans protect people from overly enthusiastic doctors more concerned with their careers and reputations than with patients’ lives. The government needs to reaffirm how important those rules are. At the same time, the rules should be flexible enough to allow for unusual circumstances when the interest of a patient is best served by breaking them.
It would be very hard to argue that a doctor should let a patient die in order to observe regulations.
There is a broader issue here than the case of Thomas Creighton, and it needs to be addressed systematically. Medical technologies have made possible many life-saving procedures, and will make more of them possible in the future. Can we afford them? Would the money spent on developing the artificial heart, which has consumed about $200 million of federal money in the last 20 years, be better spent providing primary medical care to millions of people who do not now receive it? Would it be better spent on preventive programs to forestall heart disease?
The British have thought about these questions, and have come to very different answers than we have. In their socialized system the government limits what it will and will not pay for by the age of the patient. The older a person is, the fewer procedures, such as dialysis, he will receive. In this country the government pays for dialysis for every person who needs it. Are we prepared to accept less? But are we prepared to pay the staggering cost of full medical care for everyone? If not, how will it be rationed?
Even if the government doesn’t pay for those things, as it does in Britain, society pays in many cases through private medical insurance. If the government doesn’t make these decisions, insurance companies and large employers will. Either way, there needs to be a national debate on these matters that sooner or later will affect everyone.
