I just watched My Sister's Keeper and I did like the movie- I enjoyed watching it and felt it was a thought provoking story- but the glaring in-accuracies threaten to send the wrong message regarding the use of Pre-Implantation Genetic Diagnosis and the ethics surrounding solid organ transplant.
Now, Pre-Implantation Genetic Diagnosis (PGD) is a technology that can be used to select certain embryos for implantation in the mother. Just as described in the movie, a sibling may be "created" in this manner and specifically selected to be an HLA match to an ailing child.
But, normally, the cord blood is harvested, and that's typically where the use of the new sibling for "spare parts" ends. Once the cord blood has been used in a transplant, the sibling would not typically serve as a bone marrow reservoir. If the bone marrow transplant failed the sibling would NOT be a repeat donor.
Also, from my limited experience with transplant medicine, I've seen that PGD is NEVER used for the purpose of solid organ transplants. The doctor in the movie seemed that he would be on-board with the transplant, and the use of the younger sibling for this purpose. In real life, a doctor would NOT agree to this. Kidney donors are carefully selected, not just for their biological compatibility, but also for the emotional ability to cope with being involved in the transplant process. Organs are NEVER taken from an unwilling individual.
So, it was a sad and moving story, and I enjoyed the move for that, but it sends the message that PGD is used to create "spare parts" and gives the illusion that this technology presents ethical quandaries that in fact do not exist. Anyone reading this blog can be assured that American children are not currently being forced to give up their spare kidneys. Even if a (minor) child begged to give his or her kidney to an ailing sibling, the kidney would not change hands (abdomens?).
Friday, January 29, 2010
Monday, January 25, 2010
Health Care Issues
I watched a Dateline episode yesterday; the subject was Healthcare and the detrimental effect it's having on patient care. It really brought to light some of the actual problems with an insurance industry hell-bent on profits, but it also brought to light some of the problems that surround end-of-life care and the expectations of families.
There was a heartbreaking case- a man with cancer wanted to enroll in a study that promised cutting-edge treatment unavailable through other channels. Of course, the study covered costs directly related to the study, but outside of that, the man's insurance was supposed to kick in. And, his insurance company refused to pay for expenses related to the desired experimental treatment. There were some appeals, and the insurance company ultimately decided to cover him. But, by that time, the man no longer qualified for the study as he had gotten sicker.
The patient got sicker and sicker, and his wife spoke of a traumatic day when he took a turn for the worst, and she was supposed to make decisions regarding his code status.
The insurance company managed to avoid paying some potentially large bills by delaying the man's care. But, the wife seemed under the assumption that this care would be life saving, and that the insurance company had in essence killed her husband. And then, for reasons unknown to me (based on the fact that I was only watching this on television and have only one side of the story), the wife seemed unfamiliar with DNR/DNI and code status. She described the day her husband took a turn for the worse; a "crash cart" had appeared and she was reportedly asked to make some fast decisions.
From being in the hospital, I remember talking to the family of an end-stage cancer patient. They did not want to make the patient DNR DNI because the patient's daughter had seen a code when she was with her mother in the emergency room, and as she said, "It really works!" Her mother was virtually comatose, and a code was likely to bring nothing more than broken ribs and more heartbreak. The family saw DNR DNI as equivalent to doctor assisted murder.
The insurance companies are so hell bent on profit that care is often refused or delayed; but millions are spent every year on end of life care for patients for whom a medical code is more cruel and pointless than anything else.
But, as someone who believes that discussion of a patient's code status is important, and furthermore that DNR/DNI is sometimes a good thing as opposed to a failure of medical care, I am a card carrying Death Squad member.
I feel terrible for the woman on Dateline; while I think that the case illustrated important issues surrounding code status, it also shows that families of the critically ill are forced to argue and fight with insurance companies. A lot of wasted time and heartbreak, and the big picture is lost.
There was a heartbreaking case- a man with cancer wanted to enroll in a study that promised cutting-edge treatment unavailable through other channels. Of course, the study covered costs directly related to the study, but outside of that, the man's insurance was supposed to kick in. And, his insurance company refused to pay for expenses related to the desired experimental treatment. There were some appeals, and the insurance company ultimately decided to cover him. But, by that time, the man no longer qualified for the study as he had gotten sicker.
The patient got sicker and sicker, and his wife spoke of a traumatic day when he took a turn for the worst, and she was supposed to make decisions regarding his code status.
The insurance company managed to avoid paying some potentially large bills by delaying the man's care. But, the wife seemed under the assumption that this care would be life saving, and that the insurance company had in essence killed her husband. And then, for reasons unknown to me (based on the fact that I was only watching this on television and have only one side of the story), the wife seemed unfamiliar with DNR/DNI and code status. She described the day her husband took a turn for the worse; a "crash cart" had appeared and she was reportedly asked to make some fast decisions.
From being in the hospital, I remember talking to the family of an end-stage cancer patient. They did not want to make the patient DNR DNI because the patient's daughter had seen a code when she was with her mother in the emergency room, and as she said, "It really works!" Her mother was virtually comatose, and a code was likely to bring nothing more than broken ribs and more heartbreak. The family saw DNR DNI as equivalent to doctor assisted murder.
The insurance companies are so hell bent on profit that care is often refused or delayed; but millions are spent every year on end of life care for patients for whom a medical code is more cruel and pointless than anything else.
But, as someone who believes that discussion of a patient's code status is important, and furthermore that DNR/DNI is sometimes a good thing as opposed to a failure of medical care, I am a card carrying Death Squad member.
I feel terrible for the woman on Dateline; while I think that the case illustrated important issues surrounding code status, it also shows that families of the critically ill are forced to argue and fight with insurance companies. A lot of wasted time and heartbreak, and the big picture is lost.
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