What really scares me is that someone somewhere should decide that the process we have isn’t working for them, and instead invite the government to step in and implement a process where rich...
What really scares me is that someone somewhere should decide that the process we have isn’t working for them, and instead invite the government to step in and implement a process where rich people get first pick.
I’m pretty confident that this hasn’t already happened.
I also think those involved right now are doing great. My friend was a cystic fibrosis patient and got a double lung transplant at 17. He made it ten years with those lungs before the anti-rejection meds stopped working. He got those lungs even though his family was desperately poor, his mental health wasn’t great, and he wouldn’t make it to 30 no matter what they did. I’m so thankful that committee decided that we got to have those extra ten years together.
I'm a child of a parent who received a major organ transplant back in 2022, making this a subject near and dear to me. Ethics in healthcare are something that are very difficult to pin down well....
I'm a child of a parent who received a major organ transplant back in 2022, making this a subject near and dear to me. Ethics in healthcare are something that are very difficult to pin down well.
To draw a parallel example: In the United States, if a patient has suffered a major emergency and has a very poor prognosis, the decision is often put on the family at bedside to make the call as to if resuscitation should continue or not. This hinges entirely on what the family says the patient would want, or more often, what they think the patient would want. But this can often be clouded by that conversation never having happened, or by personal desire to overrule the patient's wishes (An elderly parent who feels they have lived a full life wishes to not receive CPR, but in the heat of the moment, the child "is not ready for [them] to die").
In contrast, in much of Europe, the decision is put on the physician. If the physician determines that the patient is unlikely to survive, or unlikely to have any quality of life, they often make the decision to withdraw care with or without the approval of the family. In contrast to the way this is handled in the US, it takes the emotion of someone who knows the patient personally out of the equation, and inserts the weight of someone with walking around knowledge of survival and outcome rates of the problem in question. In theory, the ethics here come across as "more sound", to me at least. But in practice, I wonder if the outcomes are as reliable as the system is designed to try and be.
Ultimately, I think the best solution we have right now are multi-member boards with subject matter expertise in the circumstances and technicalities surrounding such decisions. As it relates to the article, I can only hope that those subject matter experts continue to grow and refine their knowledge of the pathology of mental illnesses and outcomes they could have on organ transplanted patients. Thanks to organ donation, I still get to talk to my dad regularly, and there are no words for how grateful I am for that. It would be very sad for someone else who feels the same way to lose that loved one in their life, because of poor application of ethics due to stigma around mental health.
I think things get difficult with the second part - doctors often significantly underestimate quality of life of disabled people compared to disabled folks themselves. Doctors are just as...
If the physician determines that the patient is unlikely to survive, or unlikely to have any quality of life, they often make the decision to withdraw care with or without the approval of the family.
I think things get difficult with the second part - doctors often significantly underestimate quality of life of disabled people compared to disabled folks themselves. Doctors are just as susceptible to ableism (if not more so because of their education), so their clinical determinations in that context might not be as objective as one would hope.
This is fascinating, thank you for sharing. Perhaps the US should pivot to this system as well. It is such a challenge to "say goodbye," but of course families are going to be emotional and biased...
If the physician determines that the patient is unlikely to survive, or unlikely to have any quality of life, they often make the decision to withdraw care with or without the approval of the family.
This is fascinating, thank you for sharing. Perhaps the US should pivot to this system as well. It is such a challenge to "say goodbye," but of course families are going to be emotional and biased if faced with this decision. It's simply impossible not to be. It also comes with guilt - did you make the right call to ensure they didn't suffer further? Did you make the right call even though they can no longer speak or recognize their loved ones? Putting this in the hands of the doctor takes the burden from the family members as well.
Yeah, it can be a controversial opinion, that families should not have the ultimate decision to proceed or withhold resuscitative efforts of their loved ones. My point of view has been shaped not...
Yeah, it can be a controversial opinion, that families should not have the ultimate decision to proceed or withhold resuscitative efforts of their loved ones. My point of view has been shaped not only by my experiences with my dad, but from the decade I spent in the field as a firefighter/paramedic, and my now six plus years in a hospital. There's a reason we trust experts to do expert things, and healthcare is no different. The stress and emotion in a spur of the moment emergency can bring out the worst in anyone, but often not in those who live in that space every day they go to work. As you point out, the survivors guilty of "Did I make the right decision" is also (in my opinion) greatly mitigated when the decision is being made by someone who had good education and understanding of things like rates of survival, recovery, and quality of life. Of course I don't want my dad to die, but he also never wants to live a life where he can't be himself and do the things he does. To condemn him to a sedentary life in a home hospital bed being fed by a G tube and breathing via ventilator would have been the worst possible outcome for him (in his own words).
More than anything, I think it's important for people to have a plan. Talk to loved ones about what kind of care and decisions you would want if you're unable to make them for yourself. Even better, put those talks into words with legally actionable documents describing one's specific wishes, such as a "Living Will" or "Do Not Resuscitate" order. And that way, should it ever come down to it, it can help guide those ethical calls and hopefully alleviate any guilt that may stem from wondering "Was it the right call?"
And above all, as it relates to this article: Please consider agreeing to be an organ donor. The biggest counter argument I've heard is people who say "If you're an organ donor, they won't try as hard to save your life". I'd like to clarify from a background of expertise that this argument is USDA prime Grade A 100% all natural organic farm raised bullshit. In the field, if someone is critically ill or injured, I'm not looking at their ID until after I've already dropped them off at a hospital and I'm beginning to write my after-the-incident patient care report. And even then, all I care about is the name/address/DOB, there is nowhere in an EMS report to denote if a patient is an organ donor or not, we don't care, it makes no difference in our actions. And in the hospital, no physician is making decisions about their patient's well being based on their status as an organ donor or not -- We often have no idea if a patient is an organ donor or not, because if they are that badly ill or injured, the priority is to do our best to treat and stabilize, not ask questions to see if we could try less hard to treat and stabilize. What a litigious nightmare that would be, let alone ethical nightmare. In an emergency, the only thing your team is worried about is providing the best care possible.
Everyone dies, eventually. But if you're an organ donor, it could mean that you save a life on the way out. I'll never know the person who lost their life in northern France that summer of 2022, but I'll forever be grateful that they were willing to give me many more good years with my dad, that he gets to see and spend time with my kids, and the memories that person allowed us to have will have me honor their life and memory for the rest of mine.
I think this has inspired me to go register to be an organ donor. At one point I was contemplating the whole "donate your body to science" thing (and for those who still are - it looks like you...
I think this has inspired me to go register to be an organ donor.
At one point I was contemplating the whole "donate your body to science" thing (and for those who still are - it looks like you can do both). But I've read a couple horror stories about how those bodies have been (mis)used and would much rather my organs go to those in need.
Article with disturbing details on bodies donated to science in one "worst case" scenario
I think this is a good idea in theory, but just adds more red tape to the healthcare process that’s already full of them. What do you do if a decision needs to be made ASAP? Defer to the primary...
Ultimately, I think the best solution we have right now are multi-member boards with subject matter expertise in the circumstances and technicalities surrounding such decisions.
I think this is a good idea in theory, but just adds more red tape to the healthcare process that’s already full of them. What do you do if a decision needs to be made ASAP? Defer to the primary doctor on the case?
I do like the idea of physicians taking a more active role and making the choice. I’d rather that physicians focus on the people they can help.
I'm surprised to see so many replies advocating for this. In my opinion, no doctor should get a final say in whether or not somebody deserves resuscitation or continued care. Doctor's are just...
If the physician determines that the patient is unlikely to survive, or unlikely to have any quality of life, they often make the decision to withdraw care with or without the approval of the family.
I'm surprised to see so many replies advocating for this. In my opinion, no doctor should get a final say in whether or not somebody deserves resuscitation or continued care. Doctor's are just people, and people are biased. Obviously, they should give their professional opinion and it should be strongly valued - but to have the final say feels like it would be opening quite a big can of worms.
Decisionmaking fascinates me. Almost by definition, the only important decisions (ethical, moral, practical..) have no clear right answer. This short article discusses how transplant committees...
Decisionmaking fascinates me. Almost by definition, the only important decisions (ethical, moral, practical..) have no clear right answer. This short article discusses how transplant committees select who gets approved for an organ and who doesn't - and some of the biases and complications that creep in to those decisions.
I am optimistic this decision making will evolve as organ transplant options continue to. The concepts of transplanting animal organs, bionic organs, and other technologies will allow more people...
How should hospitals decide who gets an organ?
I am optimistic this decision making will evolve as organ transplant options continue to. The concepts of transplanting animal organs, bionic organs, and other technologies will allow more people than ever to extend their lives after a traumatic event.
It is a slowly developing field, as it needs to be done morally. But maybe one day in the future organ shortage will no longer be the cause for holding up transplant surgeries.
What really scares me is that someone somewhere should decide that the process we have isn’t working for them, and instead invite the government to step in and implement a process where rich people get first pick.
I’m pretty confident that this hasn’t already happened.
I also think those involved right now are doing great. My friend was a cystic fibrosis patient and got a double lung transplant at 17. He made it ten years with those lungs before the anti-rejection meds stopped working. He got those lungs even though his family was desperately poor, his mental health wasn’t great, and he wouldn’t make it to 30 no matter what they did. I’m so thankful that committee decided that we got to have those extra ten years together.
Realistically, rich people probably just got to another country where they can buy their way to the top of the list.
I’m sure they do, I’m just glad I live in a country where at least the organs donated in this country are distributed based on more than just wealth
I'm a child of a parent who received a major organ transplant back in 2022, making this a subject near and dear to me. Ethics in healthcare are something that are very difficult to pin down well.
To draw a parallel example: In the United States, if a patient has suffered a major emergency and has a very poor prognosis, the decision is often put on the family at bedside to make the call as to if resuscitation should continue or not. This hinges entirely on what the family says the patient would want, or more often, what they think the patient would want. But this can often be clouded by that conversation never having happened, or by personal desire to overrule the patient's wishes (An elderly parent who feels they have lived a full life wishes to not receive CPR, but in the heat of the moment, the child "is not ready for [them] to die").
In contrast, in much of Europe, the decision is put on the physician. If the physician determines that the patient is unlikely to survive, or unlikely to have any quality of life, they often make the decision to withdraw care with or without the approval of the family. In contrast to the way this is handled in the US, it takes the emotion of someone who knows the patient personally out of the equation, and inserts the weight of someone with walking around knowledge of survival and outcome rates of the problem in question. In theory, the ethics here come across as "more sound", to me at least. But in practice, I wonder if the outcomes are as reliable as the system is designed to try and be.
Ultimately, I think the best solution we have right now are multi-member boards with subject matter expertise in the circumstances and technicalities surrounding such decisions. As it relates to the article, I can only hope that those subject matter experts continue to grow and refine their knowledge of the pathology of mental illnesses and outcomes they could have on organ transplanted patients. Thanks to organ donation, I still get to talk to my dad regularly, and there are no words for how grateful I am for that. It would be very sad for someone else who feels the same way to lose that loved one in their life, because of poor application of ethics due to stigma around mental health.
I think things get difficult with the second part - doctors often significantly underestimate quality of life of disabled people compared to disabled folks themselves. Doctors are just as susceptible to ableism (if not more so because of their education), so their clinical determinations in that context might not be as objective as one would hope.
This is fascinating, thank you for sharing. Perhaps the US should pivot to this system as well. It is such a challenge to "say goodbye," but of course families are going to be emotional and biased if faced with this decision. It's simply impossible not to be. It also comes with guilt - did you make the right call to ensure they didn't suffer further? Did you make the right call even though they can no longer speak or recognize their loved ones? Putting this in the hands of the doctor takes the burden from the family members as well.
Yeah, it can be a controversial opinion, that families should not have the ultimate decision to proceed or withhold resuscitative efforts of their loved ones. My point of view has been shaped not only by my experiences with my dad, but from the decade I spent in the field as a firefighter/paramedic, and my now six plus years in a hospital. There's a reason we trust experts to do expert things, and healthcare is no different. The stress and emotion in a spur of the moment emergency can bring out the worst in anyone, but often not in those who live in that space every day they go to work. As you point out, the survivors guilty of "Did I make the right decision" is also (in my opinion) greatly mitigated when the decision is being made by someone who had good education and understanding of things like rates of survival, recovery, and quality of life. Of course I don't want my dad to die, but he also never wants to live a life where he can't be himself and do the things he does. To condemn him to a sedentary life in a home hospital bed being fed by a G tube and breathing via ventilator would have been the worst possible outcome for him (in his own words).
More than anything, I think it's important for people to have a plan. Talk to loved ones about what kind of care and decisions you would want if you're unable to make them for yourself. Even better, put those talks into words with legally actionable documents describing one's specific wishes, such as a "Living Will" or "Do Not Resuscitate" order. And that way, should it ever come down to it, it can help guide those ethical calls and hopefully alleviate any guilt that may stem from wondering "Was it the right call?"
And above all, as it relates to this article: Please consider agreeing to be an organ donor. The biggest counter argument I've heard is people who say "If you're an organ donor, they won't try as hard to save your life". I'd like to clarify from a background of expertise that this argument is USDA prime Grade A 100% all natural organic farm raised bullshit. In the field, if someone is critically ill or injured, I'm not looking at their ID until after I've already dropped them off at a hospital and I'm beginning to write my after-the-incident patient care report. And even then, all I care about is the name/address/DOB, there is nowhere in an EMS report to denote if a patient is an organ donor or not, we don't care, it makes no difference in our actions. And in the hospital, no physician is making decisions about their patient's well being based on their status as an organ donor or not -- We often have no idea if a patient is an organ donor or not, because if they are that badly ill or injured, the priority is to do our best to treat and stabilize, not ask questions to see if we could try less hard to treat and stabilize. What a litigious nightmare that would be, let alone ethical nightmare. In an emergency, the only thing your team is worried about is providing the best care possible.
Everyone dies, eventually. But if you're an organ donor, it could mean that you save a life on the way out. I'll never know the person who lost their life in northern France that summer of 2022, but I'll forever be grateful that they were willing to give me many more good years with my dad, that he gets to see and spend time with my kids, and the memories that person allowed us to have will have me honor their life and memory for the rest of mine.
I think this has inspired me to go register to be an organ donor.
At one point I was contemplating the whole "donate your body to science" thing (and for those who still are - it looks like you can do both). But I've read a couple horror stories about how those bodies have been (mis)used and would much rather my organs go to those in need.
Article with disturbing details on bodies donated to science in one "worst case" scenario
https://www.nbcnews.com/news/us-news/dismembered-body-parts-sewn-together-frankenstein-donation-center-fbi-found-n1035131
In a perfect world, donated organs would cost recipients nothing, but I know this is really a fault of the US healthcare system vs organ donation.
Thank you for registering to be an organ donor ❤️ You've given yourself the potential to change someone else's life in an immeasurable way, one day
It's hard enough making this decision for a pet, I can't comprehend how difficult it would be for a person you were really close to.
I think this is a good idea in theory, but just adds more red tape to the healthcare process that’s already full of them. What do you do if a decision needs to be made ASAP? Defer to the primary doctor on the case?
I do like the idea of physicians taking a more active role and making the choice. I’d rather that physicians focus on the people they can help.
I'm surprised to see so many replies advocating for this. In my opinion, no doctor should get a final say in whether or not somebody deserves resuscitation or continued care. Doctor's are just people, and people are biased. Obviously, they should give their professional opinion and it should be strongly valued - but to have the final say feels like it would be opening quite a big can of worms.
Decisionmaking fascinates me. Almost by definition, the only important decisions (ethical, moral, practical..) have no clear right answer. This short article discusses how transplant committees select who gets approved for an organ and who doesn't - and some of the biases and complications that creep in to those decisions.
How should hospitals decide who gets an organ?
I am optimistic this decision making will evolve as organ transplant options continue to. The concepts of transplanting animal organs, bionic organs, and other technologies will allow more people than ever to extend their lives after a traumatic event.
It is a slowly developing field, as it needs to be done morally. But maybe one day in the future organ shortage will no longer be the cause for holding up transplant surgeries.