Brave New World

Telling doctors how to practice medicine

 Brave New World, Health care reform, Welfare-police state  No Responses »
Sep 142007
 

There’s nothing like the opportunity to do some death and dismemberment to bring out all sorts of libertarian-sounding talk from people who ordinarily would be quite the opposite.   We got a lot of this during the embryonic stem cell debates.

Here’s a different instance from Thursday’s WSJ, in an article titled, “New limits debated for organ donation: Transplant group proposes barring donors who have certain health problems; balancing risk vs. need.”

These two paragraphs are a decent summary of the conflict:

The debate reflects a tension between the need for organ donors and concerns that doctors may be lowering standards for living donors too far or failing to catch problems that could put the donor at unacceptable risk. Many transplant programs now allow people to donate who would have been screened out a few years ago, including those who are obese or have high blood pressure or diabetes.

Often marginally qualified donors demand to be approved, contending the choice is their own to accept the risk when someone they love needs a transplant. Transplant surgeons have also loosened standards for deceased donors, accepting, for instance, organs from much older dead donors than ever before.

I suppose it doesn’t help that I’ve read of allegations of organ harvesting from China, where unwilling victims have possibly been killed in order to harvest their organs to be sold to  wealthy foreigners.   Listening to how these U.S. transplant doctors are opposed to limits on what they do makes the possibility seem not so far fetched.  I don’t think I want to be caught alone in a dark alley with these guys.

Here is where it starts to get spooky:

But some surgeons worry that insurance companies or juries will use the guidelines to penalize doctors who don’t follow them. Moreover, critics say that UNOS shouldn’t be telling doctors how to practice medicine.

(UNOS is the United Network for Organ Sharing.)

As for telling doctors how to practice medicine, that’s not really an accurate way of describing what UNOS is doing.  UNOS is attempting to define limits.  It is telling doctors what NOT to do, not what should be done.

And is it so far-fetched to think that limits might be needed?   Do doctors always have others’ interests foremost?  How about this, from Wednesday’s WSJ:  

…Federal Medicare officials want to crack down on arrangements like the one that was planned in Gainesville, where doctors refer patients to businesses in which they have a financial stake.

In recent years, many physicians have become wealthy by investing in magnetic resonance imaging, or MRI, facilities, surgery centers and diagnostic sites — and then sending their patients to them. A recent McKinsey & Co. study pegged doctors’ profits from this practice, known as self-referral, at $8 billion a year.

 Permalink  Brave New World  No Responses »
Aug 022007
 

There is an interesting post about abortion and eugenics over at Postmodern Conservative . Here is some of it:

Similarly, all the arguments about the sanctity of human life can remain accurate while still the fact remains that some genetic diseases are so awful that families ought to be able to prevent stricken children from coming into the world. Clearly the issue here is ‘the line’ to be drawn, the ‘gray area’ we blunder into. But we are already in that area. There is no way out of that area. The sanctity-of-life argument is tremendously powerful, but it is finally a moral position, and as such cannot be proven, and has to ‘win’, if it can, on other grounds, grounds outside of proof. I do not see how that can be accomplished at the national level today.

It reminds me of a discussion about abortion on a mailing list several years ago. In answer to a pointed question:

I said: “No, I don’t think abortion is the same as murder.”

She said: “I’m glad you’re finally beginning to see the difference.”

I said: “Similarly, I wish you would begin to see the similarities.”

That’s the way I like to remember it, anyway. I didn’t look through the archives to make sure I got it exactly right, word for word.

Over at Postmodern Conservative, I commented about a comparison with the Amish people. (BTW, a lot of my understanding about the Amish view of technology is what I’ve learned at the Menno-Hof museum in Shippshewana, Indiana.)

I like to ride my bike in Amish country, and when I tell people about such things as encountering a horse-drawn Amish buggy towing a fishing boat that has a small outboard motor, they sometimes act surprised, as though I caught them in some sort of hypocrisy. No, I explain, they aren’t anti-technology per se. They are against things that will break up the family. They don’t drive cars, because once you have cars, you have family members going off in all directions and not spending time with each other. If they adopt too much mechanization of agriculture, then people don’t need to work together in the fields, and they become isolated from each other. And to have control of such a powerful thing as a car will instill a sense of pride in the psyche, which will be harmful to the sense of humility that they value. (They seem to understand the advertising of cars very well.)

It’s not so much a matter of technology = bad, but of what technology will do to them as a community and as individuals. They are very selective in what they adopt. And not all communities make the same decisions about what is permissible and what is not.

Similarly, I think we need to view the abortion issue in the same way. It is not so much a matter of whether or not it falls into the categories known as murder or eugenics, but of whether it is something that could eventually make us into the kind of people who could be capable of murder or Hitler-style eugenics.

But maybe I’m putting too fine a point on it. I have the impression that some Amish people do just take the position of Technology = Bad, Luxury = Bad, without going into any deep agonizing over it. If I were to look for such Amish people, I would begin by making inquires in the community my wife and I encountered here, near Geneva, Indiana.

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