1948: Life Magazine

Technological Advance





1963 -1st Lung Transplant
1967 - 1st Heart Transplant
1968 - 1st Pancreas Transplant
1981 - 1st Heart/Lung Transplant
Mechanical Ventilators
1960 - Dialysis

Technological Advance

Early 1950s
experimental kidney transplants from

cadavers to patients close to death.
All failed

December 23, 1954
Joseph Murray, John Merrill
Excised healthy kidney from 24 year old

donor
Recipient lived 8 years

Ethical Dilemmas




Kentucky, 1967
Jerry Strunk potential donor
Resident of mental hospital
Brother required organ
Court approved reasoning that Jerry
would be benefited by the continued life
of his brother

Dialysis





March 9, 1960: Seattle, Washington
Clyde Shields, 39, renal failure
Dr. Scribner connects to his invention
First time patients can be treated for chronic
kidney disease
Very Expensive
$10,000-$20,000 per year
Necessary to allocate the resource

Committee Development

Medical Advisory Committee
composed of physicians
selected patients based on medical and

psychological suitability

Admissions and Policy Committee
composed of anonymous members
minister, lawyer, homemaker, businessman,

labor leader, two physicians
decided who would receive treatment

The God Committee: Life
1962

Federal Funding




October 30, 1972
Nixon signs legislation
HR1 with Renal Disease Amendment
First phase: 11,000 patients @ 280
million
1990s: 50,000 patients @ over one
billion

Principles in Professional
Practice

Autonomy
self rule/self determination

Nonmaleficence
do no harm

Beneficence
benefit/do good

Justice
equal/fair treatment

Autonomy

(autos, self; nomos, rule)

an action is autonomous when an agent
acts:
intentionally
with understanding
without controlling influences that determine

their action.

Respect for Autonomy

To respect autonomy, you must:
acknowledge a persons right to hold views,

to make choices, and to take action based
on personal values and beliefs.

Ethical Justification

Kant
Treat others and ends not means only

Mill
Maximizes good for the individual and

community

Feminist
Autonomy must be moderated with other

obligations

Nonmaleficence

Above all: DO NO HARM

What can constitute a harm?
Withholding information from a patient
Providing false information
Professional incompetence

Nonmaleficence
Continued

Patient request for harmful procedures
amputate a leg with a basal cell carcinoma
keep elderly patient alive
Mother requests antibiotics for viral infection.


Conflicts with patient autonomy
Other types of harms

Beneficence


To benefit or do good for the patient
Benevolence (character trait, virtue)
In what ways can you benefit your
patients?
Education/prevention
competent care
clean safe environment
other?

Paternalism

Acting in what one believes to be the
patient’s best interest without his or her
consent.

What if a patient is reluctant to accept a
procedure that would be beneficial.

Limits of Beneficence

What are the limits to your obligation to
“do good?”

The good vs. the minimally decent
semaritan.

Justice

The basic idea is that of fair, equitable,
and appropriate treatment in light of
what is due or owed to persons.

Treating other fairly and equally

non-discrimination

Theories of Justice

Utilitarian Theories
greatest good for greatest number

Egalitarian Theories
equitable distributions

Libertarian Theories
entitlements

Contemporary Justice
Theory

John Rawls

Robert Nozick