Showing papers by "Arthur L. Caplan published in 1983"

Organ Transplants: The Costs of Success

Abstract: Just thirty years after the first kidney transplant between identical twins was undertaken in 1954, organ transplantation has come of age. Today many transplant surgeons have attained success rates of over 80 percent survival for at least five years among those who have received kidneys from live related donors. The survival rate for recipients of cadaver kidneys five years after surgery is 60 percent. More than 95 percent of cornea transplant recipients have their sight restored. Aided by new immunosuppressive drugs such as Cyclosporin, better tissue-matching capabilities, and improved surgical techniques, medicine has also made great strides in the past ten years in transplanting bone marrow, hearts, livers, lungs, pancreases, and spleens. In the course of one recent week at the University of Minnesota transplant center, says Chief Surgeon John Najarian, "We transplanted eight kidneys, two hearts, two pancreases, and one liver."

Can applied ethics be effective in health care and should it strive to be

Abstract: A number of philosophers, theologians, and others with a major interest in ethics have, in recent times, found themselves plying their trades in the confines of a hospital or medical center. The extent of their involvement has grown to proportions which are sufficient to permit an inquiry into what exactly it is that these persons are supposed to be doing in such settings. This inquiry leads inevitably to a further and more significant question: are philosophers and others engaged in what has come to be called "applied ethics" in the "real world" of medicine able to do anything useful there? In mulling over such questions, it may be useful for the reader to ponder two examples which stand out in my own mind as the occasions upon which, through my involvement in a medical center, I felt I was most effective with reference to matters of applied ethics. The first incident occurred in the course of teaching in the hospital of a large urban medical center. The elective was entitled "Ethics Rounds" and was team taught with a psychiatrist and an internist. The course consisted of visiting various patients selected by students, interviewing the patients, and discussing some of the moral issues that the students and teachers felt were raised by the cases. Early on in the course, the students had selected a 90-year-old woman with a fractured arm for an interview. She had no relatives, and the students were worried about what might happen to her upon discharge from the hospital. I came to the class fully prepared to discourse on theories of distributive justice at a moment's notice, since I rather naively believed the students might benefit greatly from a disquisition on Mill, Rawls, and Nozick in trying to figure out what to do with the old woman. As soon as the medical instructors and students had gathered together, we hurriedly set off to find and interview the old woman. We all burst into her room just as she was in the process of defecating. To my surprise, no one was deterred by her behavior, and both the psychiatrist and the internist proceeded immediately to interview the woman about her life plans, goals, and personal aspirations. I remained uncharacteristically silent during this exchange, and it was only when the class had returned to the confines of the psychiatry lounge to discuss the

Beastly conduct: ethical issues in animal experimentation

Abstract: There has been a great deal of argument in recent years over the subject of animal experimentation. Few topics are able to elicit the degree of moral vehemence and passion that this topic does. Accusations of moral blindness fly back and forth between vivisectionists and antivivisectionists. Bills are submitted almost willy-nilly at both the federal and state level, lobbying efforts on both sides of the issue are best described as fierce, and the disputants seem to delight in holding meetings and conferences at which their opponents are persona non grata-on both sides opponents are rarely invited, and, if they somehow manage to appear, they are made the object of calumny usually reserved only for criminals or even politicians.I2 Despite the political and sociological vortex surrounding the issue of animal experimentation, it would be wrong for those on either side to underestimate the sincerity and thoughtfulness that can underlie much of the noise and rhetoric characteristic of current public debates over the issue. In recent years a rather rich philosophical literature'O," has developed on the subject of the moral responsibilities of human beings toward animals, and this literature surely must be reckoned with by all parties to the debate. Just as it is wrong to suppose that all vivisectionists are callous brutes, unconcerned about the effects of their work on their animal subjects, it is also wrong to assume that all antivivisectionists are misanthropic kooks who are too emotionally unstable to recognize the benefits that derive from research involving animals. Before considering some of the moral questions that arise in the context of the practice of experimentation involving animals, it is important to make a distinction between two issues that are often conflated by parties on both sides of the issue. Oftentimes scientists go to great lengths to demonstrate to each other and the general public that they take every possible precaution to assure the humane treatment of any animals that may be used for experimental purposes. Scientists often note with pride that they have, through their own voluntary efforts, established clear codes of conduct about the care and handling of laboratory animals. Moreover, most reputable scientists in America and other nations go to great lengths to minimize, through the use of anesthetics, anesthesia, and other means, the pain or suffering that animals endure as a result of the process of experimentation. The many efforts now made to reduce animal suffering and to ensure the proper care and handling of animals used for research purposes are often brought forward in response to criticisms leveled by antivivisectionists concerning the enterprise of animal research. Unfortunately, persons who question the moral legitimacy of animal experimentation are not likely to be dissuaded from their view by demonstrations of the care and concern shown by those engaged in the practice.

How Should Values Count in the Allocation of New Technologies in Health Care

Abstract: A few years ago Dr. Howard Hiatt, Dean of the Harvard School of Public Health, wrote a provocative article entitled “Protecting the Medical Commons: Who Is Responsible?”1 Dr. Hiatt noted that as the costs of medical therapy—in terms of time, money and manpower—continue to rise, physicians, health planners, policy analysts, and the general public are faced with a terrible dilemma: how should the finite resources available for health care in American society be allocated? Dr. Hiatt argued that the medical profession must take the responsibility for evaluating expensive new medical technologies and techniques prior to their being made generally available to consumers. His view is that the medical profession should be able to regulate the supply of medical services and technologies as a means of controlling the rapidly rising costs of health care. The numerous cases of expensive, ineffective, and ineffectual therapies scattered throughout the history of medical care provide solid empirical grounds for the policy Hiatt suggested.

Out with the “Old” and in with the “New”—The Evolution and Refinement of Sociobiological Theory

Abstract: Despite all that has been written about the subject of sociobiology during the nearly 10 years that have passed since the appearance of E. O. Wilson’s justly canonized Sociobiology: The New Synthesis (1975), the subject is still beset by controversy and confusion. It is not at all clear exactly what the content is of sociobiological theory. Nor is it evident whether sociobiology constitutes a radical break with traditional inquiries into behavior in such fields as ethology and comparative psychology, or, is merely an extension of the models and approaches used in these fields. Nor is there yet much agreement over the implications of sociobiological theorizing for understanding human behavior in general, and, in particular, those moral and sociopolitical activities which are often cited (Sahlins, 1976) as paradigmatic examples of humankind’s freedom from biological limits and constraints. Thus, this essay will have three major if somewhat immodest aims. First, the basic tenets of what I will refer to as the “old” and “new” sociobiology will be presented and discussed. Second, a critical assessment will be made of the “new” sociobiology. And, finally, some effort will be made to explain why sociobiological theorizing has been and continues to be a source of controversy by examining the implications of current sociobiological theorizing for morality.

Mrs. X and the Bone Marrow Transplant

Abstract: The case is presented in which a leukemia patient sought an order from an Iowa district court to compel the University of Iowa Institutional Review Board (IRB) to recontact, specifically on the patient's behalf, a potential bone marrow donor who had refused a general request to participate in the transplant program. Charles Lidz, Alan Meisel, and Loren Roth argue against judicial intervention, primarily on the grounds that a follow-up letter would constitute undue pressure on the potential donor. David Zimmerman agrees that it would be wrong for the ethics committee to recontact the potential donor, but bases his argument on a balancing of probable risks and benefits in the case at hand rather than on the issue of rights or coercion in informed consent.

Infanticide and the Handicapped Newborn

Abstract: This collection makes it abundantly plain that what abortion was to the medical ethics of the 1970s, infanticide may unfortunately be to the medical ethics of the 1980s. The battle lines concerning the treatment of defective and often premature infants have already become stark, unyielding, and intolerant. On one side are arrayed the right-to-life forces whose numbers populate this collection. These persons are determined through the use of courts, suits, Department of Health and Human Services inspectors, moral "flying squads" of like-minded physicians, review committees, and the use of shame, guilt, and threats to see to it that no newborn is allowed to go untreated in any American hospital. On the other side, without any representatives appearing in this collection, are the pro-choice advocates, who are determined by the use of courts, lawsuits, review committees, and shame, guilt, and threats to see to it that no child is ever treated