March 31, 2012

Bioethics- Determining One's Worth

I've been living in my head a lot today, so today is not a normal kind of a post, but more of a cerebral post, if you will. So if you're looking for funny or real life, this probably isn't the place today.

It's not so much politics as it is... bioethics.

We all know that Dick Cheney received a new heart. We've known for years that no matter what the guy did, his heart was no good. And I don't mean from a warm fuzzy, "The Grinch That Stole Christmas" kind of heart, although that didn't always appear so good either, but a mechanical/biological standpoint.

I've been rather amazed at how many people can't get past the fact he got a heart. It became a case of political clout, money, power, etc., all those things can evidently extend your life whereas if you're a poor sod, that nobody knows, you're destined to die.

Perhaps. Perhaps that really is it.

But I think there is more to this discussion than that. Let me state up front, if it had been any other 71 year old rich white guy, everyone would have looked away and this would not have been on anyone's radar. But the fact is, it was NOT some other rich 71 year old white guy, but Dick Cheney, who the average American views as evil. The fact he kind of comes across as Mr. Burns from the Simpsons, doesn't help. (For the record, I'm not a fan. But I don't deny him the right to a life.)

Our local paper did an article today on the bioethics of 71 year old Mr. Cheney having received his 'new to him' heart. (Look at that picture and tell me he doesn't look like a nicer gentler Mr. Burns...) The focus... his age.

And here is my take. Ethics on who receives a new organ is much more complicated than age. Do we REALLY base such decisions on a number? Really?

Seventy-one is such a varied number. I know people who have been as old as crap at 71 (paternal grandfather) and people who could run circles around someone 20 years younger (my Dad and Mom) and I find it stunning that someone who claims to be a 'bioethics' expert would use just ONE variable upon THEIR determination on who should die and who should live.

I find that fascinating. Can I be that judge and jury?

The article was interesting in the fact that another doctor explained that Mr. Cheney probably did not receive a perfect heart. He probably received one that had some issues, one not suitable for someone who should be living a much longer time. It appears they probably bought him 5-10 years. And who knows what we'll have in 5-10 years. Mr. Cheney could be a candidate for a better newer high tech fake heart by then.

But I still found it fascinating, that the one person they were quoting as a bioethicist were really hung up on this number. This theory amongst bioethicists of the 'fair innings' argument, that someone who had lived a longer life, step aside for those who had... not.

They must not hang out with many people over age 65, and what a disappointment to be them. I think most of my friends are over age 65. They are all mentors in my life, one way or another, whether it be how I want to continue to live my life or the complete opposite; what I don't want to be like. The people I hang with all contribute significantly to society.

So shouldn't that be a factor too? Not an age factor, but let's look at future contributions. Does someone who is 71, who is active, has family that they love and who loves them, who has a future of things left that they'd like to accomplish, really worth less than someone who is 31 overall unhealthy, has no great plans, and is inactive?

Shouldn't other factors come into play like acceptability, overall health, and the future? Shouldn't who they love and who loves them come into play too?

People would be horrified if we used another number as a yardstick... IQ. If one were to even dare to use that number, people would come unhinged. Talks of the Third Reich would emerge. Yet, it's OK to use this number of age.

I think most of you know the story of my mother in law. It's been 12 years now since she dropped dead on the altar of the local Catholic Church while leading the rosary. I've not made it a secret I still miss her. It's been 19 months since my father in law died. I rarely think about it. I've not been secretive of that either.

But when she had her massive stroke, there was still a faint pulse and so she was hooked up to life support in an effort to save her. She was brain dead. Her heart was kept pumping, O2 forced into her lungs. It was not something she wanted, having a DNR, but it was done anyway... and we won't go there with me.

When I walked in the room I knew she was dead. I could feel it. The monitor may have been giving a steady 'beep... beep... beep', but she was gone. I could feel it when I took her hand and it had that feeling of clay that humans get when their souls are gone.

When the family finally moved into acceptance, some of you know that the subject of organ donation came up. It didn't happen, something I won't go into, but there was some discussion as to whether a 74 year old woman's heart was actually considered a viable donation.

I was kind of horrified, my argument being, isn't there someone close to her age that would benefit from her donation? Certainly it wouldn't be right to put her 74 year old heart in an 18 year old kid's body, but there wasn't someone in their 60's or above? And if I were on a list and I was 21 and my choice was dying or taking the heart of a 74 year old woman... guess what I'd choose? The heart that had been reliable for all those years in hopes I might get another 10 or 20.

There was NOTHING wrong with her heart. She'd taken care of herself, exercised, and had good genetics.

Yet it was not to be. I found it puzzling and still do.

So I find this whole conversation about Dick Cheney surely not about the Bioethics of giving a 71 year old man a heart, because if it were so, and the conversation were held with truly intelligent people, the argument would have far more factors than just a number.

I suspect it's because people don't like Mr. Burns Dick Cheney, and therefore feel he is... unworthy.

Posted by Boudicca at March 31, 2012 04:20 PM

I feel very proud that someone I know* and consider a friend would boldly point out the fallacy of why age should not be the sole determination of whether a life is deemed "worthy" of living. Who are we to think that any one life is more precious than the next? High five, sis.

*Know = See once per year, but really think the world of...

Posted by: Erica at March 31, 2012 05:45 PM

Well, my friend, it's not so hard to be bold when it's a small little blog! Bwhahahaha! But thank you. :)

The age thing bugs me, whether it's young or old. It irritates the stew out of me that someone's self worth is wrapped up in a number, that people are marginalized, either way, by age.

I joke at work when the young engineers start, "Kindergarten starts!" or "Do they shave?" but in reality? Once they're hired by us, they are fair game when it comes to work. Someone has already ferreted out whether or not they are capable of doing what we do, so I'm all about, "Pull up a chair, here's half my work, go for it."

And I was just talking to my boss the other day, telling him I think we're approaching the age where we are no longer marketable. He said, "I think I'm there." Age will keep us from getting hired soon. Who wants an engineer over 50? Youth is where it is in this society and it irritates the crap out of me...

I could do posts on what we're doing to our aerospace industry, but I'll stop. :)

Posted by: Bou at March 31, 2012 07:08 PM

What a well written and thoughtful piece about a difficult subject. It has caused me to rethink the organ donor thing. I think I will add an addendum to my Advance Health Directive (sometimes misidentified as a "living will") to give the power to make this decision to my Advance Care Representative.

Posted by: Jim - PRS at March 31, 2012 08:24 PM

What I find interesting is that our news was reporting that Dick Cheney waited twice as long as other people his age before he got the transplant.

Posted by: The Thomas at March 31, 2012 08:41 PM

Jim- Just make sure it's someone you really trust. I've already negated a couple members of my family for ever having any end of life say for me. Fortunately, they're in-laws. I told my husband after my father in law died, "You passed the test. You're allowed to make end of life decisions for me..."

Thomas- He not only waited TWICE as long, they had put him on one of those fake heart pumper things. I can't remember the name now, but it circulates your blood for you when your heart is so damaged it can no longer do it for you. It's a crazy invention. I did some research on it a year ago for my boss whose fil was about to have to get one. They have a couple different kinds and it's amazing technology. But it's not fully life sustaining. Dick Cheney couldn't be on it forever. (They have issues like clotting etc.) You need to look it up. They have some where you have to carry a battery pack with you and some that are battery operated without the pack. I think DeBakey had something to do with it all.

Posted by: Bou at March 31, 2012 08:56 PM

It was the one that "pumps", not like the newest one that jets the blood and has no clotting issues. As Glenn says, Faster Please.

Posted by: The Thomas at April 1, 2012 12:04 PM

Yeah, I wasn't sure what he had. I remember when I was doing the research my first thought was, "Holy crap. I can't believe we can do this..." My second thought was, "Wow, you have to be in really bad shape.." and my last thought was, "How odd not to have a pulse..."

I think I'd have to be on some sort of sedative. I'd spend too much time thinking about some sort of mechanical failure. I'd definitely have to be right with the end of my life knowing it could happen at any moment.

Posted by: Bou at April 1, 2012 12:17 PM

You are so right about the age thing: it's just a number. My parents are of the same generation as the Rolling Stones, Aerosmith, etc....but they would never be able to get up on stage, prance around, and go on tour. Going on tour for my folks is going out to bingo or dinner at The Outback.

One of the things I question most in life is how does that happen? What makes two people of the same age end up so completely different: one elderly, one a rock star. I know there are a lot of obvious factors, but that never totally explains it. I want to know the *un~obvious* factors.

Posted by: DogsDontPurr at April 1, 2012 05:28 PM

DDP- Well that's a good question. Between my grandparents and my own parents, I know what it is. My parents really take care of themselves. They eat well, keep their weight down, drinking is a glass of red wine or a glass of scotch (Dad), a day, and they both exercise and don't smoke.

My paternal grandfather ate a high fat diet, smoked, drank a lot in his youth, became a diabetic, and never exercised although he was a REALLY hard worker. But he burned that candle at both ends. He'd eat all the crap he had no business eating and then get out in the yard and do hours of yardwork. One doesn't negate the other... cooking your eggs in bacon grease every day and then cutting the grass doesn't cut it.

But for the crazy rock stars we're seeing? What is crazy is that you know they all did some serious 'carry the baggage' drugs. They had to have done permanent damage. But they evidently aren't living that life style now. The one's you see on stage... with big energy... aren't they all really thin? I'm thinking they're doing that healthy stuff now. I would be surprised if they weren't.

Then again, maybe it's just genetics...

Posted by: Bou at April 1, 2012 05:51 PM

I read that article too and I thought it was a fair one, trying to focus less on if you like Cheney or not and more on if you think someone younger should have received the donor heart. You're right about how age is just a number, especially with medicine. So how do a bunch of surgeons who have never met any of the people involved decide who gets a donated heart? The article noted that it has less to do with personality or age than with things like "can you be available and are close enough to the donor's location to be able to physically receive the heart in time."

Posted by: George P at April 1, 2012 11:39 PM

George, It really didn't focus on Cheney at all. My focus was that I think that people in general, THEIR issue is whether they like him or not.

What I liked were the two docs they picked. I know of both. Most of my friends go to one of the two of them. My question was... the bioethicist. This whole talk that she had with this fair innings theory. Are the bioethicists really being so narrow minded? Thankfully the two docs interviewed were not...

Posted by: Bou at April 2, 2012 05:52 AM

Speaking of people taking care of themselves: Kathy Martin of NY is known as the Running Realtor. Breaking masters running records at age 60.

It looks like she has more money to throw at her body to keep it going (Team Martin involves a chiropractor, a massage therapist, a strength coach and a physical therapist).

Her picture looks kind-of like you.

Posted by: The Thomas at April 2, 2012 04:15 PM

The pump is called a LVAD or Left ventricular assist device. It is a temporary fix to a heart that can't pump well mecahnically. He had a pacemaker to help control the electrical beat but in end stage heart failure, electricity can't work if the heart can't pump mechanically. It IS very cool. It used to be this huge machine at the end of your ICU bed the nurses had to monitor 24/7. Now as you can see or actually can't see, its under your clothes and you take care of it yourself! Its strictly used in end stage heart failure as a 'bridge' to transplantation.

Posted by: jd at April 3, 2012 10:01 AM

Great writeup Bou.

I am on the opposite side of the fence than you on Cheney but I totally agree that our personal opinion of him has nothing to do with the discussion.

My parents, for example, are both in their mid seventies, and have barely slowed down. They walk miles every day, they eat well, they go on long trips to visit friends (mostly by car), they recently got back from a month long cruise to New Zealand and Australia and showed no ill effects. I also have friends who are fifteen years younger and if you had to guess who was older, you'd probably pick the friends.

Posted by: Calvin A. at April 4, 2012 10:10 AM