1948: Life Magazine

Technological Advance1963 -1st Lung Transplant1967 - 1st Heart Transplant1968 - 1st Pancreas Transplant1981 - 1st Heart/Lung TransplantMechanical Ventilators1960 - Dialysis

Technological AdvanceEarly 1950sexperimental kidney transplants from cadavers to patients close to death.All failedDecember 23, 1954Joseph Murray, John MerrillExcised healthy kidney from 24 year old donorRecipient lived 8 years

Ethical DilemmasKentucky, 1967Jerry Strunk potential donorResident of mental hospitalBrother required organCourt approved reasoning that Jerry would be benefited by the continued life of his brother

DialysisMarch 9, 1960: Seattle, WashingtonClyde Shields, 39, renal failureDr. Scribner connects to his invention First time patients can be treated for chronic kidney diseaseVery Expensive$10,000-$20,000 per yearNecessary to allocate the resource

Committee DevelopmentMedical Advisory Committeecomposed of physiciansselected patients based on medical and psychological suitabilityAdmissions and Policy Committeecomposed of anonymous membersminister, lawyer, homemaker, businessman, labor leader, two physiciansdecided who would receive treatment

The God Committee: Life 1962

Federal FundingOctober 30, 1972Nixon signs legislationHR1 with Renal Disease AmendmentFirst phase: 11,000 patients @ 280 million1990s: 50,000 patients @ over one billion

Principles in Professional PracticeAutonomyself rule/self determinationNonmaleficencedo no harmBeneficencebenefit/do goodJusticeequal/fair treatment

Autonomy(autos, self; nomos, rule)

an action is autonomous when an agent acts:intentionallywith understandingwithout controlling influences that determine their action.

Respect for AutonomyTo 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 JustificationKantTreat others and ends not means only

MillMaximizes good for the individual and communityFeministAutonomy must be moderated with other obligations

NonmaleficenceAbove all: DO NO HARM

What can constitute a harm?Withholding information from a patientProviding false informationProfessional incompetence

Nonmaleficence ContinuedPatient request for harmful procedures

amputate a leg with a basal cell carcinomakeep elderly patient aliveMother requests antibiotics for viral infection.

Conflicts with patient autonomyOther types of harms

BeneficenceTo benefit or do good for the patientBenevolence (character trait, virtue)

In what ways can you benefit your patients?Education/preventioncompetent careclean safe environmentother?

PaternalismActing in what one believes to be the patients best interest without his or her consent.

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

Limits of BeneficenceWhat are the limits to your obligation to do good?

The good vs. the minimally decent semaritan.

JusticeThe 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 JusticeUtilitarian Theoriesgreatest good for greatest numberEgalitarian Theoriesequitable distributionsLibertarian Theoriesentitlements

Contemporary Justice TheoryJohn Rawls

Robert Nozick