Has Our Technology Outstripped Our Ability to be Ethical, Cost Effective and Timely in its Delivery?
It has been a privilege and an honor to serve as the President of the American College of Chest Physicians this past year. I have learned a great deal about cardiopulmonary disease and the interrelationship oi government and medicine, and have made a number of long-lasting friendships with some very motivated and intelligent people in the American College of Chest Physicians. Seeking a subject for a Presidential Address, particularly in a College with so many diverse specialties, was a challenge. However, because of this diversity, many colleagues suggested that this College is a particularly good forum for discussion of high-tech health care and the ethical, financial, and logistic factors associated with its delivery. In other words, have our technologic capabilities outstripped our ability to be rational about it, to pay for it, and to deliver it? buy avandia online
Ethical Dilemmas in High-Tech Health Care
Should every member of our society, regardless of age, degree of infirmity, or prognosis, be treated maximally? Or should there be, or even can there be, limitations on the degree to which we support patients, cost notwithstanding? For example, when transplantation of the heart began in 1967 on a systematic basis at Stanford, there were very rigid criteria for performing an experimental operation. Younger patients were the best candidates, those who were not diabetic, those not on support devices, and so on. Now we are doing transplants on patients in their late 60s, and rising cyclosporin A, these patients are doing as well in the long term as younger patients (International Registry of Cardiac Transplantation). We now also use artificial support devices for patients in terminal cardiac failure as a bridge to transplant in critically ill patients. Although we often hear about the indignity of death, where resuscitation may be performed on the hopelessly ill without a chance for recovery we are now confronted with the occasional patient in whom LVA.D, RYAD, or even total artificial heart may be considered as a bridge to do something.