Should people sell their organs?

Growing up in a poor country I witnessed first hand people lining up at the hospital to sell their blood and organs for money to support their families. Evidently the O blood type made out the best as it is the universal donor! Even though donating blood is a much less invasive procedure and your body automatically replaces itself it still is a personal decision for each individual to make.
I admire people who are willing to take personal risks to save the lives of others, These people should be able to get a reward or payment of some kind. There are two primary arguments in favor of allowing the sale of organs. First is the fact that a person's organ belongs to them and they should be able to do with them as they wish. The second is that there is a huge shortage in organs available for transplants so if paying money for them will result in saving more lives then this can be justified.
The removal of live organs is difficult and painful for the donor. like any surgery the process itself is dangerous. It is possible the person undergoing surgery will not wake up and if they do make it through the surgery there is still a chance of post-operative infection wich could potentially kill. The donor should also be provided with proper health care and counseling before and after the organ removel.
In selling organs for money the one problem that needs to be addressed is the sale through underground markets and the donor and tehir vital organs are treated as commodities. Hown can we impose stricter regulations on theses " vendors" that are making money off the donors?

Assisted Suicide

In Depth Assisted Suicide –“The Fight for the Right to Die”, CBC News Online Sept 27 2004. CBC online September 27, 2004 at HTTP:www.cbc.ca/news/background/assisted/sucide/ is the web site.

The article discusses the age old controversy of does a person have the right to end their life. In this article, Sue Rodreges, dying already of a terminal illness, suffering and wasting away was fighting for the right to die. She fought in the Canadian courts arguing that to deny here this right was not constitutional. She based this argument around the premise that it curbed her personal life freedoms. However, this was not accepted by the Canadian supreme court and here case was lost. This court decision however, has not lead to the end of this controversy.

As the article continues, the fight for personal choice to end a life with help is becoming a well supported ideal. It is gaining support not only in Canada, but in many countries. The support is been seen that there may even be a possible motion for a change to the Canadian law as this concept has gained support.

The opponents of this fight however, argue that old frail people may be cohersed into choosing such an option for the wrong reasons. There is fear that if legal people may make the decision to end a light for as much as to limit financial debt and not for medical or personal suffering reasons. This poses a moral and legal dilemma which continues to rage on.

As this controversy rages many people have decided to help no matter the consequences of the law. This has a result of court cases which have exonerated and convicted people of aiding in assisted suicide. The outcomes of the trials have been more based on jury opinion and decision then case law.

In closing regardless what country, the controversy rages with little end in sight due to strong opposing views each with the morals of society trying to be achieved. The right answer may not exist.

Anorexia and Forced Hospitalization

Anorexia Nervosa and Forced Hospitalization

Jessica Peluso

Should a physician be allowed to hospitalize a patient suffering from anorexia nervosa against his/her will? Anorexia nervosa is a multifactorial psychiatric disorder that manifests as a very low body weight and distorted body image. More than 90% of the cases are seen in young women (typically teens to young adulthood). Long term mortality can be as high as 10% resulting from starvation, suicide or electrolyte imbalance.

Consider a young teenage girl (18 y/o) whose mother has come to you requesting your assistance in dealing with her malnourished child. The patient is described as a 5’6”, 75 pounds who was 120 pounds six months prior. The patient’s lab work reveals some electrolyte disturbances. However, the patient denies that she is anorexic and is refusing any treatment.

Of course the problem arises in determining whether autonomy should supersede beneficence. This can be a very difficult situation because the patient is refusing treatment and to enforce her into something she is unwilling to do would infringe upon her ability to exercise autonomy. However, the patient’s body (suggested by the lab work) and family are obviously crying out for help. Would it be considered assisted suicide if nothing was done to deter this behavior?

Unfortunately this situation was all too real for me and my family. I suffered from anorexia nervosa from 16-22 years old. During that time I dropped down to 75 pounds at my worst and was hospitalized three times many times with mixed emotions. I, too, never admitted to being anorexic and many times my hospitalizations provided me with ways of becoming a “better” anorexic. The fear of gaining weight was real. More importantly, though, gaining weight was a fear greater than just pounds. The fear of gaining weight for me, as for many others, meant giving up control. It was not until I learned about a “miracle” named Madelyn (my first child) that I decided to deal with this life threatening issue.

I can honestly say that I believe that the physician should have the ability to exercise his /her judgment in these situations to promote life even if it means sacrificing the patient’s autonomy. I can say that when I was wrapped up in this disease, my state of mind was altered as I believe many of these patients with similar situations are. If the provider does nothing, I believe we are allowing suicide to occur in front of our eyes. Even if it means multiple hospitalizations, I believe, life needs to be promoted so that hopefully, eventually, these patients may also be given a chance for a “miracle”.

References:

http://www.cpa-apc.org/Publications/Archives/CJP/2002/april/briefCommunicationTreatmentResistance2.asp (Accessed 10/06)

Cord Bood Banking

Cord Blood BankingCord blood is a topic of great interest to me. When I had my children I was given a pink form with numbers on it one being the medical record number the other number of a cord bank. I was told blood was collected from my newborns umbilical cord i never asked why and I was not told how important it could be. What is cord blood? It is the collection and storage of stem cells found in a newborns umbilical cor. It offers lifesaving treatments for the newborn or a family member. we see how stem cell research is a major issue that scientists are pondering with in laboratoris worldwide as couples and families try to concieve or save alredy born children all possible with cord blood banking.Cord blood is collected after the baby is born but before the placenta is delivered.A needle is injected into the umbilical vein and the blood is collected it takes about 2-4 minutes.The collected blood is stored in a cryopreservation chamber a specialized freezer where cells are stored at -196 degrees celsius ,-321 degrees F.Cord blood can be used to treat over 40 life threatening diseases including a wide range of cancers,genetic diseases, immune deficiences and blood disorders.I was drawn to this topic because earlier this week in a medical journal this topic was spoken about. Until this time i never understood the clinical importance of why the newborns blood is collected and that the number on the form is phone number if you as a parent need to access your cord blood for e.g in illness your doctor can do so with this information.

THERAPEUTIC CLONING

Imagine brain stem cell cloning from one embryo to alleviate or erradicatelon-standing pathologies which have ended a multitude of lives? What would it be like to end diabetes mellitus, leukemias, tissue dysplasias, glaucomas, immnosupressive disorders, arthitis and hypertension. For one medicine's focus would have to change.
What would it take to find enough production beta cells, abort tissue or fluid autoimmune destruction, abort optic nerve atrophy or even graft it? Or even allow for control of vasdilation and vasoconstriction of vessels thru the natural physiologic process without pharmacological aid?
The regulation of benefit for the wide variety of individuals would have to fall on a governmental agency, private agency or who would be in control of the multiple how's? How would the medical perspective influence handle patient selection? What about those transplant wating list patients with diseased organs? Reimbursement: private or public? If it would resemble anything like our present system what an oppurtnity for colossal confusion and frustation!
Mal-beneficience vs benefit to humankind. Faiths of all creeds vs the premise to benefit all. Conservatives alleging "play god " and obstruct science. Radicals advance science and aid humankind as whole. What about the middle of the these cross-roads? Are we not on top of the list as a industrialized nation? Are we not a culture with a meltdown from several other roots? And we profess the pursue of liberty and happiness to all. And if we have created human form in the laboratory already? What about pursuing technology for therapeutic cloing exclusively?
An opthalmic perspective on therapeutic cloning goes without elaborating on the idea about grafting or regenerating optic nerve fibers for open angle glaucoma. What about regenerating macular degeneration or annihilating diabertic macular edema? As sad as it is truth our patients are losing sight despite our best intentioned efforts to prevent these pathologies. Yes, of course we have pharmaceutical agnets to increase/reduce introcular flow, laser beams to interfere with the trabecular meshwork and its outpour of intraocular flow. And last but, not least we have valves transplanted to scleras to obtain a definite device to control introcular pressure. However, we are still encountering endstage glaucoma and BLINDNESS. What about our present early prophylaxis for macular degeneration: sunglasses, vitamins and wide brim head coverage. Someone tell me that therapeutic cloning for the retina would not alleviate this pathology? Our worst case scenario surgery or intravitreal injections to absorb and reduce inflammation. And diabetic retionpathy: laser vs intravitreal cortisone or other anti-inflammatory agents.
Advances, most definitely, however full resolution a dream!

Physician-Assisted Suicide vs.Euthanasia

The first thought that come to my mind " two topics one result, intentional death.By definition Physician assisted suicide refers to a practice in which the physician provides a patient with a letal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life.In Euthanasia generally means that the physician would act directly,for instance by giving a lethal injection,to end the patient's life.As a health care provider since fourthteen years ago in a durable medical equipment industry, I had the opportunity to visit ( in hospital or home) a lot of patient with mechanical ventilators,enteral nutrition ( feeding tube),patient with quadriplegia that developed other problems and others with "terminal illness".But the intentional termination of life is not ethically justifiable.A degree of acceptance by the patient.Acceptance doesn't mean that the patient likes what is going on,and it doesn't mean that the patient has no hopes; it just mean that he can be realistic about the situation.A medical undrestanding of the patient's disease.One great physician does not equal great care,it takes a coordinated system of providers.Death is not usually an individual experience;it occurs within a social context of family,significant others, friends and caregivers.
I don't want to enter in some issues but arguments like respect for autonomy; justice; compassion and individual liberty are not ethically justifiable offer to physician assisted suicide and euthanasia.Furthermore,the physician's duty to alleviate suffering may,at times, for many people justify the act of providing assistance with suicide.Remember the traditional duty of the physician is preserve life and we have,as a health care providers a social and moral responsability .

My Take On The Missouri Stem Cell Initiative

By: Ray Manuel U. Paguntalan

Sunday morning as me and my family was coming out of church, my oldest daughter asked, “hey dad! What is that amendment number 2: Vote NO To Stem Cell Initiative?” After explaining to her what the stem cell is all about, my daughter (who is a very conservative person by the way) quickly dismissed the idea as absurd and unethical in the eyes of God. I too, felt the same way and somehow agreed with her …. But let’s back up a bit and think about it for a while, I asked her…… is it really?

(The nation’s eyes are focused on the senatorial race in Missouri mainly because of the two senatorial candidates who both have the stem cell issue as one of their main campaign agenda. Senator Jim Talent is anti-stem cell while Claire McCaskill is pro- stem cell. Each candidate has expressed their views and has reasons for supporting or rejecting it.)

Stem cells are primitive cells that can be manipulated and coaxed into developing into the 220 different human body cells. Scientists have found ways of developing these stem cells into most types of human cells, such as blood, brain, heart tissue, nerve cells, bones, etc. These researchers are confident that they will lead to treatments to many diseases such as bone loss, broken bones, brain damage due to oxygen starvation, severe burns, some forms of cancer , diabetes, Lou Gehrig's disease, heart disease, hepatitis, incomplete bladder control, Huntington's, leukemia, lupus, muscular dystrophy, multiple sclerosis, osteoarthritis, Parkinson's, spinal cord injuries, and stroke!

There is not much ethical concern related to the adult stem cell research as long as there is consent obtained. However, I read that stem cell lines from adults have limited usefulness compared to the stem cell line from embryos. During the time when a woman undergoes in-vitro fertilization, she is given medication to help her produce at least a dozen mature eggs which are then fertilized by sperm. She then gets 2-4 eggs implanted on her womb (2-5 days after fertilization) in the hope of getting pregnant. So what happens to the other embryos? They are frozen for future use (which I read is very expensive), used for research, or destroyed.

So if we leave the rest of the embryos to die or destroy them (which at times happen in fertility clinics), are we guilty of murder? What if we use it for research (once the stem cell is extracted, the embryo dies)? Is that also murder? This is what it’s all about anyways, right? Pro-life people give emphasis on the stem cell research as unethical, but believe or does not really argue much on the ethical issues on discarded embryos in fertility clinics. They apparently believe that leaving the embryos to die is letting it take its normal course of dying and does not constitute to murder.

I believe this is just plain hypocrisy. How can one address one as such devious act and not consider the other? One can certainly not make an excuse for one, though done with different process, the outcome is still the same. Wouldn’t you think that if someone is anti stem cell research should also be anti in-vitro fertilization? Isn’t it more prudent to go after the source than just focusing on its end results? After all, isn’t that where it all started? I guess the argument there is….
In-vitro fertilization was discovered to bring in life and can’t be seen as unethical due to its full benefits to life. So where do we actually draw the line?

After some major brainstorming, I guess I got my daughter confused. Don’t worry, I told her. I’m confused too myself. More so that I am to vote soon on this issue. I always consider myself as pro-life, but also believes in pro-choice. I guess I’ll just have to sort this thing out. After all, I have till November to figure this out.

Fetal Abuse

Fetal Abuse (blog entry by Christine W. #AI107304-9FM)

We have heard of spousal abuse, child abuse - even animal abuse. Many laws exist to protect these different victims. Most of these laws have been in practice for a number of years. I had not heard of the term 'fetal abuse' until recently. However, one could say it is a new name for an old problem.

What is society to do with a pregnant woman who will not take responsibility for the health of her unborn child? In the recent past, the majority of women that fell into this category would have been those who continued to drink alcohol even though they knew it would harm their unborn son or daughter. Now, with illegal drugs being available almost anywhere and creating new addicts on a daily basis - there are now many more ways for the pregnant woman to jeopardize the health of the fetus.

At what point should the law step in? This behavior certainly seems to quality as child abuse. Do we arrest her and put her in jail? Do we charge here with a criminal offense or just a misdemeanor? Or do we force her to participate in a rehab program?

Well, guesss what - states are already enacting laws that allow these women to be arrested. In recent months, pregnant women have been arrested and jailed in South Carolina, New Mexico, Arizona, Alabama, Colorado, Georgia, Missouri, North Dakota and New Hampshire (among other states) claiming that pregnant women can be considered child abusers even before they have given birth.

South Carolina has been the toughest so far. Their Supreme Court declared in 1997 that drug-using pregnant women can be prosecuted criminally - and sentenced to as many as 10 years in prison. The attorney general there says that he will only prosecute pregnant women that use illegal drugs - not alcohol. (However, alcohol is still the leading cause of preventable mental retardation in infants.) It was the Medical University of South Carolina in Charleston, that started a program of testing pregnant women for drug use, and turning over their findings to police. It was done as a 'last resort' because they were seeing more and more pregnant drug users.

So, will this solve the problem? Many say absolutely not. Public health and child welfare groups say that most of these women want to stop using, but cannot; and threat-based approaches will not deter women from using drugs but will only prevent them from seeking prenatal care and any voluntary treatment programs that could be abailable for them.

And then one has to consider the health risks both mother and child face if she is forced to give birth in prison. Whil researching this, I read some shocking and extremely sad stories of women giving birth in prison. Sometimes the conditions would be deplorable. Sometimes the women would be left alone by custody to have the child without help from anyone. Although international law and treaties signed by the United States prohibit the shackling of pregnant and birthing women, Amnesty International USA reports that only two states - Illinois and California - have banned this practice here at home in the United States.

So, is rehabilitation the answer? It has been around for a while. Would this problem have been worse without it? The educational materials about the dangers of drug and alcohol use while pregnant is certainly available. And we know society supports rehab programs - is there enough money out there to do this successfully though? Is education at a very early age possibly part of the solution? I wish I had the answer, or even part of it.

(I would like to acknowledge Lynn M. Paltrow; Vince Beiser; Julie Ehrlich - authors of various articles that I used for this blog.)

Ethical Issues Associated with Bariatric Surgery

John Alioche’s Blog Entry
Ethical Issues Associated with Bariatric (Weight Loss) Surgery
October 21, 2006
The United States is experiencing an epidemic of obesity. Under the widely used classification developed by the National Institutes of Health, 34% of the adult population is "overweight" (BMI 25-29.9) and another 27% meet criteria for "obesity" (BMI>30). The overall prevalence of obesity has increased more than 75% since 1980. Obesity is associated with increased type II diabetes, cardiovascular disease (especially hypertension), osteoarthritis and multiple conditions. An obesity-related process called "Syndrome X" or "metabolic syndrome" that includes insulin resistance, abdominal obesity, hypertension, and diabetes and lipid abnormalities.
Bariatric surgery is a textbook example of an area of health care calling for evidence based management of utilization and ethically guided deliberation about coverage policies. At one extreme bariatric surgery can be seen as a life saving, medically necessary intervention that potentially reverses the inevitable trend to sometimes fatal medical conditions. At the other extreme it can be seen as a technical fix for a subjectively distressing result of choices with regard to eating and exercise. The surgery has risks and represents a significant cost (approximately $15-20K). In the past year alone the number of patients that are having Bariatric Surgery has doubled.
Bariatric surgery has risk. Mortality from the surgery itself is less than 1% but post-surgical leakage into the abdomen or malfunction of the outlet from the stomach pouch can require further surgery. Vitamin deficiencies, gallstones, and osteoporosis are among the other complications that can occur. With regard to the basic objective of weight reduction the surgery is not foolproof-some patients ultimately regain the weight they lost, through varying combinations of enlargement of the stomach pouch and return to compulsive patterns of eating.
1. In a culture that is deeply conflicted in its approaches to weight and obesity, how can we best pursue the mission of "improving the health of the population we serve and the health of our society?
2. Should we seek cost effective opportunities to support "upstream" services aimed at shifting the trajectory of obesity earlier in the clinical course with the objective of reducing suffering and medical morbidity and possibly obviating the need for surgery itself? or Encourage optimal education so that members can make well-informed decisions about surgery with full understanding of and commitment to the lifelong post surgical requirements?