Clinical & Medical Ethics

Please UNOS--Transplantation is a Fragile Public Trust

It has been said that, “. . . it takes years to build up trust, and it only takes suspicion, not proof, to destroy it.”[1] The words themselves tell us something about human nature, and unfortunately, are prescient in the context of organ transplants. At a time when a severe shortfall in donation has become emotionally palpable—approximately 18 people die every day while waiting—transplantation survives, imbedded within a fabric of trust. Those who donate their or their loved one’s organs expect that certain precepts will be honored. For example, there is the dead donor rule. If someone has agreed to donate organs after they die, either by whole brain or heart criteria, they must be dead and not merely dying when organs are retrieved. As a result, fiction like Robin Cook’s Comacan send a shudder throughout the transplant community. Similarly, in the mid 1990s, when newspapers intimated that cardiac criteria for death may have led to premature organ retrieval, concern was immediate and intense. Americans also respect a “level playing field.” Remember the public outcry surrounding Mickey Mantle’s liver transplant? Allowing the famous or rich to jump ahead of the vulnerable is not the American way. Finally, in an era of quality and safety concerns, the lifesaving process of transplantation should be transparent, compassionate, just, and as safe and quality laden as possible. There are diverse “patients” involved: donors, recipients, and both families. The public should continue to be very sensitive to potential abuses. This necessary vigilance represents transplantation’s critical check and balance.

Podcast Episode: 

End of Life Decisions 101

The care of patients near the end of life can be ethically challenging. Physicians and other health care professionals may find certain concepts vague and hard to understand. Furthermore, there must be a balance between two extremes: a treat-at-all-costs vitalism on the one hand, and a too-rapid withdrawal of potentially beneficial treatments on the other. The purpose of this article is to provide some conceptual clarity.

Podcast Episode: 

The Future of Medicine: When Will Quality and Safety Become Job Number One?

Let’s face it, providing medical care in an era of advanced technology is both a prohibitively expensive as well as an error-prone proposition. For example, the Leapfrog Group, comprised of 150 public and private organizations organized from the Business Roundtable, an association of Fortune 500 companies, has defined some statistics directly related to the cost and safety of medical care.[1] The benefit packages of these organizations include providing healthcare services to 34 million Americans at a cost of $62 billion dollars a year. Since the Leapfrog members pay that bill, they want to have some say in what their constituencies receive for the considerable monies spent. The Leapfrog group is not alone in this regard. They have been joined by a host of significant others including the Institute of Medicine, the Institute for Healthcare Improvement (IHI), the Center for Medicare Services, and another consortium called Bridges to Excellence, to name a few from a rapidly growing number. Lest one think that this is solely a business venture, the concern is not just dollars and cents. Did you know that if the airline industry committed as many errors as healthcare does, the equivalence in lives lost would equal a passenger jet crashing every one to two days? Contemporary medicine is in a fine mess. How should it go about fixing these potentially fatal problems?

Podcast Episode: 

Medicine's Intrinsic Good (Podcast)

What is good medicine? Who counts as a good doctor? These are very large questions that cannot be fully addressed here. I want to focus on a basic aspect of these two questions and on the ethical idea of "the good." The term "good medicine," as I have just used it, is not intended to be contrasted with "bad medicine." Rather it is meant to bring to the fore that medicine is something good in itself, a worthwhile and honorable human activity, a "profession" with a specific object of activity, a human good, to which so many men and women devote their lives; an endeavor full of value and capable of fulfilling a person's life with interest, effort and achievement.

Podcast Episode: 

Cost-Benefit Ethics: The Case of Tirhas Habtegiris


Tirhas Habtegiris was dying of cancer. The 27 year-old legal immigrant was being kept alive on a ventilator at the Baylor Regional Medical Center in Plano, TX. Tirhas was desperately hoping to hang on until her mother could arrive from East Africa, but a joyful reunion and sad goodbye never took place.

Podcast Episode: