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Tahmina Shima Section 002
Chapter 11: The God Committee
1.
The God Committee and Artificial Kidneys
a.
How did Kolff’s and Scribner's inventions create a new moral issue in bioethics? What was this issue?
Kolff’s and Scribner’s inventions created the issue of what criteria would be used to select who would receive the scarce machines. b.
Describe who constituted the Admissions and Policy Committee (aka the “God Committee”) and how they made their decisions.
The admissions and Policy Committee was established by King County Medical Center I order to determine who would receive a dialysis machine. A priest, a lawyer a housewife, a labor leader a state government official, banker and a physician were among the committee’s representatives from the community. The advisors included two doctors. They never interacted with patients and worked in secret. c.
How did the media dramatize the issues above and help start bioethics in1962? The start of the conversation on bioethics started in 1962 when the public learned about
the Admissions and Policy Committee. The rule of rescue is using the media when patients need organ transplants.
2.
How does the End-Stage Renal Disease Act guarantee all Americans kidney care? What problems did it solve and create?
The ESRDA provides a “one organ right to medical care” for all Americans, ensuring that they receive kidney care. They required every American who required dialysis to have one purchased by the government. It fixed the equipment allocation issue, but it left other populations like hemophiliacs without access to funded healthcare. 3.
What is the supply and demand issue about donated organs? Due to the fact that “organs available for donation have never matched demand” traditional supply and demand theories frequently falter in the fields of medical finance and organ donation. a.
What is mandated choice? Mandated choice is a requirement of adults to indicate if they would like to be organ donors on their driver's license.
b.
What is the difference between an opt-in policy and an opt-out policy?
While an opt-in policy presumes that only individuals who have voluntarily given their approval to donate organs are potentials donors can opt- out policy assumes that anymore who has not explicitly declined to be an organ donor consents to it. 4.
What is meant by “social worth criteria”? Describe in detail.
Shana Alexander wrote this story for Life magazine. Social worth criteria is criteria about person’s
worth to society. Evaluation standards are applied to determine the value of recommendations meant to address social issues that call for government intervention. The way a person assesses their value in the eyes of a spouse in another way to define social worth. In this instance, the individual determines whether the role that their partner assigns the fulfills their own objectives for engagement.
Tahmina Shima Section 002
5.
What is the rule of rescue? The rule of rescue is when we see someone in immense risk, we should help them, whatever the
cost. a.
Explain how Ernie Crow feather is an example of this rule.
Since Ernie Crow feather obtained treatment despite failing to seize his opportunity, his case serves as an illustration of the rule of rescue. b.
What are the opposing issues of whether alcoholics should get liver transplants for ARESLD? After a liver transplant, the survival rate of individuals with alcohol-related liver disease has increased gradually, reaching 80–85% a year later. Although the traditional liver transplant requirement—not drinking alcohol for six months before to transplantation—
has been widely implemented, there is insufficient evidence to justify using this rule as the only factor when choosing candidates for liver transplantation.
c.
What contradictory messages does the medical system send out?
There are instances when the medical community cannot agree on whether alcoholism is an illness or a choice. Priority is given to those who suffer liver failure rather than drinking. 6.
How would Kant criticize social worth standards of selection? What does he propose as the just distribution of a scarce liver?
He thinks people always have a choice and because alcoholism would not be seen as an illness under his ethnicity, Kant would be critical of societal merit norms of selection. Kant says that the less fortunate should be distributed evenly by lottery after those who lost their kidney due to genetic diseases. 7.
What is UNOS and what is its job?
UNOS is involved in many aspects of the organ transplant an donation process; Mnag9ing the national transplant waiting list, matching donors to recipients 24 hours a day 365 days a year. Maintaining the database that contains all organ transplant data for every transplant event that occurs in the U.S.
a.
What are the 2 major concerns with multiple listings?
Multiple listings are only attainable for people who can take time off work and afford to travel, and have generous medical plans can visit multiple surgeons. b.
How did Apple co-founder Steve Jobs take advantage of this loophole to get a liver transplant in 2009?
Steve Jobs utilized the system by having the money to travel to Memphis, Tennessee to get worked and be the sickest patient on the hospitals’ list. c.
How did the cases of Mickey Mantle and Governor Casey call into question how UNOS allocates organs?
Mickey Mantle had alcoholism and cancer yet received a liver in two days. He died three months later. Many thought he shouldn’t have received the liver. Governor Robert Casey
was allocated a liver about 10 years after entering the waiting list. Both of these events created distrust and criticism for UNOS. d.
What are some of the concerns with retransplanting the same patient?
Tahmina Shima Section 002
Is it fair to give a particular patient a second or third organ when others haven’t even gotten their first one. e.
Why do utilitarians reject UNOS' rule of "sickest first”?
The ‘sickest first” rule of UNOS is rejected by utilitarians who believe that the person with the best chance should receive the organs. 8.
How has the system changed from getting organs from cadavers to getting them from living donors? What new ethical problems has that created?
It was thought that a live organ transplant was feasible and a better option than cadaveric transplantation. This was first noticed when twins, age 23, underwent kidney transplants by Dr. Joseph Murray. Having children in order to supply organ resources for their already-living siblings
became the new ethical conundrum. a.
What is a savior sibling and what ethical problems do they create?
A savior sibling is born to provide organ resources for their dying sibling. This is an ethical issue. b.
Explain how transplant teams have asymmetrical relationships to donors and to recipients. The only people with whom transplant teams interact are the recipients. They are not compensated financially for treating the donor medically. c.
Describe the non-heart-beating-cadaver donor protocol and the ethical problems that it creates.
The NHBCD "declares death after ventricular fibrillation, asystole, or electromechanical dissociation occurs and after a period of two minutes in which no pulse is observed." It permits the administration of medications, the purpose of which is to enhance the viability of organs destined for transplantation. It states that an irreversible loss of heart function results in death." The distinction between controlled and uncontrolled NHBCDs raises ethical questions. The protocol must also have consent from all parties.
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