Means hardly justified
by end result.
Artificial hearts can
be "bridge" for those awaiting human heart, but no permanent solution.
AbioCor Implantable Replacement Heart approved in 2006--still a temporary solution.
Currently (2013), Left Ventricular Assist Device (LVAD)--still temporary. Treating thousands--maybe as many as 50,000 could benefit
Costs of artifical hearts--12,000 patients: $1.3 billion (for 5 years). If all with end-stage heart disease treated: $3.8 billion.
Widespread use of LVAD: $10 billion per year.
Transplant operations are very costly--
$200,000-$1 million/transplant.
2016: Update on the artificial heart.
How should funds
for costly medical procedures be allocated?
- Artificial heart program
or anti-tobacco education program?
- Sustain life of premature
infants or invest in prenatal education programs?
- Who decides? The Health Care Industry?
Diagnostic
Technologies
- Stethoscope, X-ray machine,
ophthalmoscope, laryngoscope, EKG, MRI, and CT scan have taken mystery and "guess work"
out of medical diagnosis.
- No longer do we rely
on 4 humors.
http://www.calvin.edu/academic/medieval/medicine/overview/overview.htm
- These new technologies
have often created their own need.
- Fetal heart monitors
have no evident benefit, but number of Cesarean section deliveries increased.
- Doctors often over-prescribe
technology for fear of mal-practice lawsuits (MRI and CAT scans).
- Tests can make patient
worse than when they initially were--this is especially true for the elderly.
- Sociologically, diagnostic
tests and technologies helped to create an "objective disease."
- Physician: no longer
is it necessary to talk with the patient and obtain their account of their
illness.
- 10 Tests to Question. Choosing Wisely.
- Technology has objectified
and legitimated the medical profession.
- Technology doesnt account
for the psychological component to illness.
Medical Technologies and Medical Ethics
Medical technologies and the questions surrounding creating and preserving life.
New ways of making and sustaining babies
- 1978, first baby born that was conceived by in-vitro fertalization.
- Involves fertalizing multiple eggs--ethical questions, what to do with un-used embryos?
- Used when female's fallopian tubes block or male's sperm count is low
- In other cases, surrogate mothers implanted with embryo (may be from an egg donor) or artificially inseminated (issue of legal status of surrogate)
- What is a family? What roles do the multiple people involved play?
- Premature births: many do quite well
- Many suffer from major medical problems
- How long should life be preserved? At what cost?
- What about a focus on pre-natal care?
- Pre-natal tests: some conditions (PKU) can be treated, others cannot.
- Preimplantation genetic diagnosis (in-vitro): What to do if embryo has probability of major disease?
When does life end? When should it?
- Historically, major organ failure meant death. Today, not so true.
- At what point is preserving life pointless? When does death occur?
- Terry Schiavo case.
- What technologies should be used (feeding tube) and at what cost?
Halfway Technologies
- Medical technologies
often palliative--treats kidney disease but not the causes of disease.
- Technology has extended
life and made it more comfortable but has not addressed causes and conditions.
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Questions
(page 141):
- As noted in this chapter, about a quarter of Medicare and Medicaid expenditures are incurred during the last year of life. Given the increasing financial burdens
of both programs, should anything be done about this situation? If so, what? When the demand for a new medical technology exceeds the supply, what should he used to determine who gets it? A lottery? The ability to pay? The "merit" of the recipient? Might it be better to limit the development of new technologies in order to forestall the need to make these choices?
- Attempts at developing devices to completely replace human hearts have not been successful, but many technologies require a long development period before they are successfully employed. Should R&D for artificial heart technologies continue? If so, how should it be financed? Are there some ongoing medical programs that are less deserving of financial surport than the development of an artificial heart?
- Who should make the decision to terminate life support when a person is a permanent vegetative state, and has left no instructions concerning the indefinite prolongation of his or her life? Should government officials, elected or otherwise, have a role in making this decision?
- Some medical procedures can be characterized as "halfway technologies," while others are at least close to being completely effective. What accounts for the difference? What "halfway technologies" of the past have become much more effective today? Why has this advance occurred?