Ethical Dilemmas Part 1: Heart Transplant Patient

Background 

As I have mentioned in previous posts, I am a pre-medical student, currently working on my Bachelor of Health Science undergraduate degree. As such, I have taken a number of courses related to the inner workings of the body. However, my degree also requires I develop my knowledge in other areas such as psychology, healthcare reform, and the like. One of the courses I took last semester was an ethics course. As future healthcare professionals, my colleagues (classmates) and I took a look at some ethical dilemmas that we would be sure to face in the field. Our tutorial had us look at these types of dilemmas and reflect upon them. I found this to be quite interesting, and as such, have decided to post a mini-series on some of the situation’s we had examined. In my next four posts, I am going to share four of them with you- deciding between organ transplant recipients; the content of the Hippocratic Oath; decisions regarding course of treatment for geriatric patients with altered cognitive abilities; and finally, resources allocation in hospital settings from a Canadian perspective (or more specifically, Ontario).

Heart Transplant Recipients 

One situation we analyzed was taken from the standpoint of an individual on a transplant committee. There was 5 patients who needed a new heart, but only one heart available. e were also to go off the premise that whoever did not receive the transplant would definitely die.

The Patients

1. Mob Boss: The first patient was an elderly man who was the head of an organized crime group- he was the “Don Corleone” type of character. He was quite old, but he was wealthy and had promised to donate a large sum of money to the hospital if he was given the transplant.

2. The Widow/Mother: The second patient was a middle-aged woman who had recently lost her husband. She was also the mother of two children.

3. The Police Officer: We were then told about the third patient, a young police officer who had recently graduated from “the academy” and was about to start his career as a young, fit, law enforcer.

4. The Politician: Our fourth candidate was a politician. This man had promised that during his term in office, he would work towards putting into place a new healthcare reform.

5. The Celebrity: The last patient was a famous celebrity. At first, many of us would probably not have considered this character, but then we learned that he had planned on being the spokesperson for an ad campaign and organization that promoted things like blood donations, organ transplants, and charitable donations.

A short ethics lesson

Before I share how I responded to the situation, there are 4 concepts that healthcare providers must assign significance to and uphold in any ethical decision:

i.) Non-Maleficence- do no harm

ii.) Beneficence- going beyond simply non-maleficence and actually doing good (benefiting the patient)

iii.) Autonomy- allowing a patient to have the freedom to choose their own course of treatment

iv) Justice- in regards to fair allocation of resources

You will notice in my response below that I appear to take on a consequentialist view in this situation. I’m not saying that my decision is right, and I’m not saying that it is wrong. It was what I viewed as best at the time, and it comes down to what course of action could employ the ultimate use of beneficence, while still adhering to a fair allocation of resources.

The Decision

I believe that no one, single person is more entitled to life more than another. A bus driver deserves to live just as much as a lawyer; a waitress should be given the same standard of care as a famous musician. It is crucial, as a health care provider, to adhere to this standard ethical guideline when treating patients. However, this being said, it is my belief that as a health care provider, I will have an obligation to serve the greater good, especially in an instance, such as this, of choosing a recipient for an organ donation. For this reason, my choice would be to have the heart given to the police officer.

First, I would like to address my concerns with the other candidates. As I have previously mentioned, I feel that every life is sacred and every patient deserves the same standard of care. All candidates in this scenario are deserving of the transplant, and all have the potential to affect the community in a positive manner, if given the opportunity. With that being said, I think that the police officer has the best chance of doing the greatest amount of good for the community at large. It is true, the “mob boss” has a large family and has offered a large sum of funding for the hospital. However, he is the oldest (presumably) and so has the least amount of viable years to live. In addition to this, although I am not an expert on tax auditing, it would seem logical that the government would intervene and investigate the origin of the funding, which could end up meaning no funding at all. This is why I would not choose the “mob boss”. It is sad for a child to lose a parent, and even worse to lose two, but the reality of the situation is that the widow would be bed ridden for an extended period of time, unable to care for her children. I feel most guilty about not awarding the healthy heart to this case, but it is likely that this woman’s children would end up in foster care either way and it is better to inflict heart break on two people than to inflict it on thousands. The actor and the politician are very similar cases in my opinion. Both of these patients are public figures who claim to do incredibly wonderful things for the community. Considering the nature of politicians, I am quite sceptical as to whether or not she will live up to her word. But to play the devil’s advocate, I am going to assume that there are plans for health care reform. Based on this optimistic assumption, let us consider that a politician is always the face of a political party, but not the entire brain. If there are, indeed, plans in the works, an entire team will have been working on the proposed political agenda. Because of this, if this patient dies, then her prodigy will continue the projects which she has already started- if such plans existed, that is. In the same way, the actor is simply the face of a campaign and not the entirety of it. The masterminds are often those behind the scenes, and so, the organization will continue to function- they will simply need to find another spokes person. This actor’s death will most likely also be good for the organization’s publicity as well. As always, we must consider the greater good. I would also like to mention that it is my opinion that this candidate is the least deserving of the transplant. The brutal reality is that humans are creatures of habit. If this gentleman lives a lifestyle of wild partying and drug use, then it is likely that he will return to that same life and waste the new heart.

It is possible to find fault in all people, and it is possible to find reasons to deny the new heart to the police officer just as easily. He is in a dangerous field of work and could be killed on the job at any moment. Although this is true, we must acknowledge that it is also possible for anyone to die at any time. I could be walking to class one morning and the roof could cave in and crush me; someone else could be taking their dog for a walk and have a rabid squirrel randomly attack them. The point is, we never know what is going to happen until it does. There are 3 main reason why I chose the police officer to receive the new heart. First, he is the youngest, and so the heart will probably be put to use the greatest amount of years if he were to receive it. With a longer lifespan, he will be able to do more good for the community than the rest of the candidates. Secondly, because of his occupation, it is likely that he will stay healthy and fit. Because of this, it is less likely that he would need another organ transplant and has the greatest chance of keeping the organs viable if he did die and somebody needed him to donate. Lastly, the police officer seems to me to be the candidate who will serve the community the best. With the other patients, it is questionable, but his job is to keep the streets clean and the citizens safe. He may not be able to positively influence as many people as the “mob boss’s” money or the politicians proposed plan, but both of these candidates affect on society is a gamble. In closing, I chose the police officer simply because I believe he do the largest amount of good for the community.

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The Word of the Lord- A Chronicle of Faith

The Word of the Lord- A Chronicle of Faith

Alright, so I know that I haven’t really fulfilled my duties as a blogger, but it’s the end of the semester so things have been a bit craaaaazy lately. However, seeing as how it is Easter weekend and I have a bit of time, I would post a little something. I’m not quite sure if writing about the topic of religion would be taboo or not, but I feel that it is slightly appropriate for this occasion. I won’t profess to be the biggest church-goer around, or try to convince anyone to be “reborn into the family of God”, but rather, I thought I would give a little history lesson on my experience with the church and my altered view of God and the afterlife and all that jazz. For today, I won’t go too deep into my beliefs, but we’ll have a little crash course in the basics.

So, to start, my old man is Anglican. He was raised that way and his mother was very involved in their church. However, when he was younger, he used their church for a different purpose. Now, one thing you have to know is that my dad, while being a pretty decent guy, is a bit odd and isn’t like most other people. I’ll give you an example: I have two sisters, and after my grandfather died, the three of us went through boxes of some of his stuff. We found old war medals and pictures, but we also found some report cards from when my dad was in elementary school. There was one in particular from when he was in the first grade. The marks were pretty good, but under the comments, his first grade teacher had said “Jamie is obsessed with cleanliness”. Most little boys like to play in the mud and whatnot, but here he is, just a little kid, and he was obsessed with cleanliness- so let that set the stage for his many idiosyncrasies. Back to his experience with the church though, instead of becoming working with the minister, he convinced those who ran the place to let him practice playing trumpet there.

My mother on the other hand grew up as a Roman Catholic. Her father (my opa) was an alter boy when he was young, but got fired because he liked to sleep in on Sundays and was late every week. So, although it was unorthodox, I was baptized as both an Anglican and Catholic. I also was sent to Catholic school, but it was very rare that my family attended church. Of course, we DID go on special occasions such as Christmas and Easter, and I received my first communion and first confession.

When we moved for the first time to a new town, I entered the 3rd grade in a public school because it was more convenient than the Catholic one, which was on the other side of town. Eventually, I became friends with a few kids who were students at the Catholic school and so I switched.  The church and the school were strategically placed beside each other, and so, before school every Tuesday morning, I would go to mass. One morning, I had “spelling” homework due, but I has not finished it. When I was praying in during the mass, I had prayed that something would happen, and I wouldn’t have to turn it in. I think that was the first time I experienced what I thought was God (sorry if that offends anyone). I say this, because it just so happened that my teacher ended up going home sick at lunch and the homework was put off until the next day. Shortly after, I followed in the footsteps of my opa (grandfather), and was trained as an alter boy. Before you ask yourself, let me answer you- No, I was not molested by the priest. To be quite honest, I don’t think that the old man would have had it in him, even if he wanted to. I often questioned if he could see, and thinking back now, the poor old guy most likely had some degree of dementia.

Traditionally, in Catholic school, students receive the sacrament of “confirmation”, which is when you are recognized as an adult in the church, during the eight grade. When it came time for my confirmation, I was no longer serving in the church and had become quite a smartass. Now, with this sacrament, you are supposed to take the name of a saint and your catholic name. I didn’t really take the whole process too seriously, and chose St. Lucifer (the devil). I’m not quite sure how, but my teacher never quite caught on, which may call into question her level of cognitive abilities. So, I am now the devil in the eyes of the Catholic Church.

To say that I strayed from the church in my youth would be an understatement. I went to a Catholic high school, wore the uniforms, took religion classes and went to mass when the whole school went a few times a year, but apart from that, I had no connection to faith or religion (which are actually two totally separate things in my opinion). The type of people I spent time with would most likely spontaneously burst into flames if they ever stepped foot in any religious institution, and the types of mischief we got into would give a priest a heart attack if I were to go to a confessional. When I began university, I met the girl I am currently with during the first week. Now this girl was nothing like me at all. She had grown up in a Christian Reform household, gone to a private Christian Reform high school and was very innocent. Her family was very involved in their church, and she was a Sunday school teacher. The first year or so we were together, we often had discussions and debates over different issues regarding faith and everything that went along with that. When we moved in together, her family was not happy, as this went against what they had taught her and believed that we were living in sin. At this point I had only met her parents once (I spent a little bit more time with her sister), and so things were rocky. After almost a year, I had to man up. I decided that if we were to have a future together, it was important to get to know them. When we first got together, she had stopped going to church for the most part, so in an attempt to rectify the situation, I gave her church a chance and went to a service.

 Now, I had some experience with a Christian Reform family in the past. In my younger days, I had worked for a farmer who was a deacon at a Christian Reform church and on occasion, we had discussion about his religious views. Although he was a good man for the most part, I did not like what he had to say in some matters. He tried to convince me that it is wrong to be gay and that women should be subservient to men. Now, I may not be a homosexual, but I DO think that what people do in the privacy of their own bedrooms is their business. Needless to say, I did not have a very good impression of this religion. I was very surprised to find that not all Christian Reforms are like that. The first time I went to her church, the pastor wrote his sermon around “Cats in the Cradle” by Harry Chapin. The next week, he played some David Bowie in church. The man himself is very young- about 28 years old- and extremely lively and charismatic. He had hair past his shoulders and wear glasses which are reminiscent of Buddy Holly. When I tell people of him, I call him the hipster Jesus. Every Sunday, it is as if I am going to the theatre because his sermons are more like a one man play. His wife, who is also in school to become a pastor, reminds me of a modern hippy. The first time I attended service at this church, she was wearing blue jeans and a flannel shirt.

However, my experience with this church has solidified what I had already thought about religion and faith. Although I ceased to be involved with the church by the time I was in high school, I did believe in Jesus Christ. Some believe that he was the Son of God, other say he was merely a man, and there are also people who do not believe that he existed at all. Whatever your belief, if you read the Holy Bible, you will notice that there is a theme in the Gospel of love and peace. I am not saying that I agree with everything in this book, but the messages that Jesus taught were ones that can be carried out, even for atheists or other religions. Turn the other cheek, do not harm others, love your neighbour. There it is, the one thing that binds all religions together, the golden rule- treat others as you wish to be treated. This is what brings me to the foundation of my faith (which has always been quite strong). When I was in the 11th grade, I took a compulsory world religions course. The teacher was quite awful, but there was one class where she was talking about Mother Theresa, and she recited a quote that basically said that to a starving child in [Africa], the only way that they could experience God was through a loaf of bread. This is what I base my view of a higher power on. I think that essentially, all religions are the same. There are semantics that cause religions to differ from each other, but they all have the same God, but are simply experiencing and seeing this higher power slightly differently. In the end, no matter what you call “Him”, how you see “Him”, or what you believe about “Him”, it is going to be the same entity who simply wants you to spread love and care for one another. Personally, I don’t believe in all of the 10 Commandments that were given to Moses. Many of them don’t quite make sense to be rules of the Lord. In the words of the late (but great) grandfather of comedy, George Carlin, “About 5,000 years ago a bunch of religious and political hustlers got together to try to figure out how to control people and keep them in line. They knew people were basically stupid and would believe anything they were told, so they announced that God had given them some commandments, up on a mountain, when no one was around.”

As long as you have the ones about harming others, you don’t need the rest. It can be broken down to about 4:

  1. Thou shalt not kill (or harm anyone physically or emotionally)
  2. Thou shalt not steal
  3. Thou shalt not bear false witness (lie)
  4. Thou shalt not commit adultery

These four prohibit you from committing acts against others. All of the rest are bullshit. Perhaps I will dissect the commandments at a later date, but for now, I will just state that as long as you don’t harm others, anything else should be alright. What really gets me is this business about premarital sex and homosexuality. Why is the church so concerned about what people are doing in their bedrooms? If you get an STI, wear a darn condom. If someone doesn’t WANT to have sex with you, then don’t do it. It’s very simple. Sex is healthy, it’s an excellent cardio workout and let’s face it, it’s pretty damn fun.

I will stop there and continue on that train of thought some other time, but my main point is, all religions are the same, they simply experience their higher power in slightly different manners. This thought of my was solidified the first time I attended this Christian Reform church I spoke of. Now Roman Catholic churches are very traditional and formal. The priests wear robes, the music is often solemn, and the service typically follows a strict regimen. Now this church was a bit more laid back. Not everyone was dressed in suits and dresses, the pastor was dressed very casually, the music was performed by a rock band, and they do not have communion (or Lord’s Supper as they call it), every week. These are very little differences, but in essences, they are the same at the foundational level. I’m aware of how Christianity was split off into the different sects after the work of Martin Luther’s theses, but I think that all of the holy wars and fight for power among all religions is futile. I am a strong believer in peace; John Lennon and Mahatma Ghandi are among the people whose lead I choose to follow; I am a Christian by nature, but I do not ascribe to any specific religion. When people realize that there should be a separation between faith and religion, the world will be one step further to knowing peace.

Until next time, keep your eyes and ears peeled for some more Paradigm Ramblings (still haven’t come up with a better sign off)

–          A.P. 

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The Alternate Degenerate (1)

The Alternate Degenerate

By Acer Peeves

 

-1-

 

It wasn’t a bright day, nor was it a particularly eventful one. In actuality, not many of Cod’s days were bright or eventful. Most were filled with the monotony of sleeping until noon, only to wake up and reach for the television remote and a cold coke from the beer fridge he called a nightstand. Without a job (or even a prospect of one), a girlfriend or any such venture to occupy his time, Cod looked forward to the delivery of the mail (the majority of which consisted of bills he had no means of paying for) and perhaps the lucky chance of a door-to-door salesman to provide him with a small amount of human contact that he desperately needed.

 The current state of affairs that constituted Cod’s life were not always so dim. In his youth, he had been full of enterprise and motivation. However, somewhere amidst all of the bad breakups and late-night partying; frivolous spending and two unfortunate arrests, Cod had lost both his family and full university scholarship, not to mention any drive he once possessed to make a difference in the world.

 Cod’s actions had led him to a dismal existence of microwave dinners and inadequate welfare cheques. By three in the afternoon, the only thing on television was British soap operas and staged courtroom cases. As Cod went to flip his pillow to the cold side, the broken doorbell went off in it’s skewed chime. Rushing to throw some pants on for the first time that day, Cod knocked over the tower of empty pop cans and stack of dirty plates that had amassed upon the coffee table in front of his futon mattress. However, opening the front door, the only thing to be seen was an eviction notice nailed over the brass number 23, an eyesore which Cod noted had been there for the past three days. Disgruntled, he returned to the bed to find something better than Coronation Street on the television, chalking the disturbance up to merely some mischievous kids in his apartment building playing a practical joke.

 After flipping through the insipid content on his television screen, Cod settled on a cooking program, which reminded him that he had yet to eat that day. With an empty, yet noisy stomach, he got up to boil water for his favourite boxed cuisine- macaroni and cheese. While jumping up and down on his tiptoes from the pain of burning his finger on the burner, Cod heard the doorbell again. Not wanting to bother walking the ten steps to the door for a couple of kids with nothing better to do than bother him, he blasted cold water from the tap and stuck his hand under it. “Ahhhhhhhh” he sighed to himself in relief, “That’s much better”.

 But then he heard it again. And again, and again. Trying to ignore the doorbell, not to mention the kids attached to the fingers pressing it, he went to tear apart the freezer in hopes of finding a couple forgotten hotdogs in the back to throw into his pasta. But the ringing continued. Over and over again it went off, with the sound increasing in frequency, and Cod’s patience decreasing with each passing moment. Finally, after what seemed to be the hundredth ring, he lost it. Grabbing a baseball bat in one hand and the cold knob in the other, he yanked open the door, only to find nobody there once again. Looking up and down the empty hallway, Cod hastily stuck his feet in an old pair of worn-out flip-flops and trudged down to the superintendent’s office without bothering to put on a shirt.

 

***

“As I have already told you a dozen or so times” explained Mr. Roscoe, the old, burly landlord of Cod’s mid-century Brooklyn apartment building, “I cannot kick somebody out simply because of their boisterous children. Besides, there have to be a good twenty families with youngsters living here Mr. Wallop.” Cod hated when people called him by his last name. Truthfully, he hated his entire name in general- Cod Wallop. Although his parents had thought themselves quite clever in coming up with such a title, Cod’s name had been a source of grief ever since he was a young child. In school, whenever the attendance was called, snickers were heard being stifled from both students and teachers alike. He was never taken seriously when going for a job interview, and when introducing himself, Cod would find people to react in the most awkward of manners. But such was Cod’s life, and like most things, he had come to accept it.

 “Whatever happened to children doing as they are told?” retorted Cod. “When I was a boy, you did not speak until you were spoken to. You sat quietly listening, and you most certainly did not run rampant, disrupting your neighbors. I’ve been living in this building for twenty-five years, I demand some respect. Unless you do something soon, I might have to look into finding a real estate agent.”

 “Don’t be ridiculous, Wallop. You’re only thirty-two, you have not been living here for twenty-five years, you’ve been here for six years and have only paid for four of them. Besides, this is the only place in town that you can afford. Relax buddy, crack a beer and settle yourself down.” said Mr. Roscoe in an attempt to get Cod out of his office and more importantly, out of his hair.

 “The fact remains, I pay good money to live here and…”

 “You don’t pay anything to live here.” Mr. Roscoe interrupted, “You haven’t paid rent in close to four months.”

 “Regardless, I have important things to do and I do not want to be disturbed.”

 “I’ll tell you what- when you start paying your bills and stop leaving your garbage in the hall, we’ll talk. Until then, you’ll just have to deal with the ‘disturbances to your important work’ yourself.”

 “This isn’t the last you’ll hear from me, Roscoe. I’ll have these people out one way or another.” And with that, Cod slammed the door and furiously stormed back to his apartment with such haste that to see him, one might believe that the young man really did have important things to attend to.

 Arriving back at his door even more vexed than when he left, Cod noticed a small white envelope that appeared to be floating beneath his doorknob. Upon closer examination, he noticed that it had been tied ever so carefully to a short strand of clear fishing line and attached to his door.

With confusion and curiosity temporarily over-shadowing his current ire, Cod ripped the envelope off the fragile line. Turning it over, he saw in long, thin script:

Mr. Cod Wallop

Do not open until 7:43 pm

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Losing My Blogging Virginity

                I have thought long and hard about this, and I think I’m ready to take the big step- today, folks, I am going to lose my blogging virginity. I may not be young, but I am innocent (at least when it comes to the world of blogging), so for all you veterans out there, be gentle, for it is my first time. I think this is going to be interesting, so let’s take this ride together and delve into the thoughts of someone who might not have a traditional way of seeing the world.

                Just so nobody wastes their time here, let me explain a bit about myself so that you know what you are getting into. I’m not sure my mind works the same as most people. The perspective of the sane does not always coincide with that of the masses, and my own seems to lie somewhere in between. I cannot guarantee that what you will find in this blog will always be logical, but I do believe that it will be unique, and at times, quite interesting.

                So, what does that mean? Well, I may be new to blogging, but I am no stranger to the literary arts. In another life, many moons ago, writing was a passion of mine. Though I simply detest essays, especially those which require extensive research, short stories and poetry were my opiate of choice. As with most passions of the young, life took over and creative outlets were left on the sidelines. In this blog, you will be introduced to some older works, as well as new endeavours. I leave you to be the judges of their merit, and criticism (as well as praise), is not only welcome and appreciated, but also encouraged. You can use that as support for any foreseeable backlash. After this first post, I will post the first instalment of a small project I started a year ago but never finished. My hope is that this blog will serve to cure me of my procrastination and motivate me to finish it.

                Now, enough of this rambling, and let me tell you who I am. I mentioned before that I was not young, but I will leave it to your imaginations to determine just how far from a youthful glimmer I have strayed. My heart is in the world of literature, and to be quite honest, as a child, while the rest of my peers would be playing sports in the school yard, I was the boy in the corner of the yard with my nose buried in a book. I’m also a musician and enjoy all types of music. Although I drift towards certain genres at times, my theory is that as long as the artist has talent, it shouldn’t matter what type of music he or she plays. Some may say that I’m a “hippy” who was born a few decades too late, but I don’t particularly like that label. I do believe in peace though, and it is my opinion that there is never a cause for violence- those who are truly intellectual are capable of finding solutions without it. To that end, I think that in regards to war, if these political “leaders” must lean on fighting to solve the problems of the world, then we should let them go into the field and fight each other. I am also a very strict vegetarian and have many reasons to be so. I say these things because it is likely that many blog posts will be of a personal nature. I was born into a Christian household (Roman Catholic), but I will not preach religion. However, that is not to say that I will not speak of faith. I think that people do not have to be religious to have faith, and I don’t think that those who are religious are necessarily the ones with the strongest faith- I will devote a separate post to elaborate on this one day. Beyond that, I’m working on my bachelors degree in Health Science currently and hope to attend medical school afterwards. I am not interested in the title, glory, prestige, or pay check (though, they are nice little bonuses). My goal is to graduate from medical school and eventually join Doctors Without Borders. I think that it would be a very fulfilling position and I have a strong desire to travel the world.

                From me, you can expect fiction, poetry, and opinion pieces. I have very strong opinions so be warned, I may offend at some times, but there will almost always be an edge of comic relief in there. When I feel inclined, I will share narratives from my life, both past and present, and these will many times include stories from the small farm town I grew up in. To be honest, I don’t know what will come out along the course of this blog, but I am excited to see what happens. So take a journey into the a skyward paradigm and let’s see what happens.

Buckle up folks. It’s going to be a bumpy ride.

Until I figure out a gnarly signoff, keep your eyes and ears open for some more paradigm ramblings

–          A.P.

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Hello world!

Welcome to WordPress.com. After you read this, you should delete and write your own post, with a new title above. Or hit Add New on the left (of the admin dashboard) to start a fresh post.

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