I want this blog to be a dialog encouraging comments, discussion, argument, and critical thought. Therefore I am introducing a new segment called "Snap Judgement." In this recurring series I will present a news story, case study, or question for thought and discussion. Please participate by leaving your opinion and thoughts on the topic in the comments section. I will refrain from giving my opinion in the body of the text but participate in the discussion along with my readers.
Snap Judgement Episode 1: Anthony Stokes' Heart Transplant
This week an Atlanta, Georgia Children's Hospital made the news. 15 year old Anthony Stokes was diagnosed with an enlarged heart, the only cure is a heart transplant. Without transplant Anthony was given 6 months to live.
The hospital initially refused to place Anthony's name on the transplant list. The hospital listed "non-compliance" as the reason, feeling that Anthony was not likely to comply with the post-transplant medication or follow up schedule. Anthony has a history of low grades and has had trouble with the law.
Anthony's family began an all out media blitz, telling their story to all who will listen. The family claims that the hospital has no legitimate reason to believe the Anthony would be "non-compliant" as until his recent diagnosis he was in good health and has no history with the hospital. The Stokes Family's story has captured the media's attention and this week the hospital's decision was reversed.
This is of course a very quick summary of the situation. Other articles can be found here:
https://www.google.com/search?hl=en&gl=us&tbm=nws&authuser=0&q=Anthony+Stokes
A few questions for discussion:
1) How do you feel about the recent trend of media involvement in transplant decisions? Do you think the hospital reversal in this case, as well as the adult lung transplant in the 10yr old girl from earlier this summer, were directly related to the media taking up the fight of the families?
2) Do you think the hospital has a right to refuse transplant to patients with a history of non-compliance, or strong indicators that they will be non-compliant? And if so, what indication for non-compliance would be justified?
I look forward to a lively debate and discussion on this topic. Please remember to keep your comments, on topic, professional and edifying: no swearing, petty name calling, or personal attacks. This is an avenue for wholesome, fair minded debate, and this author reserves the right to remove any comments she feels stifle debate or contain inappropriate content. Thank you!
As you know, probability of success is an important factor in case-based ethics analysis involving distributive justice of, particularly scarce, therapies or treatments. And as you also well know, it is a well-established clinical ethics principle to consider patient compliance is an important medical indication in such cases.
ReplyDeleteI do not know all of the facts in this particular case. For one, I would be interested in if there was subterfuge prejudice by the transplantation team (I raise this because I have seen this); e.g. dislike for the patient and his past lifestyle choices, etc. I tend to look carefully for signs of judgmental regard, per Rosamond Rhodes, whenever a patient is denied therapy.
In addition, I would also be interested if the patient was a candidate for an LVAD as an intermediate or destination therapy -- at least for the time being, until the patient wins the confidence of the team that he would maximize his chances of a successful transplant.
There are a number of interesting ethical issues to explore, which I could not possible analyze without more information. What is immediately troubling to me about this case (and this is not the only time we have seen this in a pediatric transplant case this year) is what appears to be use of media and public relations to sway decisions.
As a lawyer and bioethicist, I have found that the court of public opinion, exacerbated by social media, is generally emotional, untutored, and prone to jumping to conclusions without sufficient evidence and deliberation. (Consider that you felt a need to caution those posting to your blog to behave themselves in their responses.)
In a perfect world, we would want everyone who could even remotely benefit from expensive or scarce resources to receive them. We do not live in a perfect world, and the best we can do is to attempt to comport with our notions of justice, which in the U.S. is as protective of individual rights as anywhere.
Barry, thanks for your comments. I always appreciate your legal-mind perspective, as I am not as strong in that area as I would like to be.
DeleteI agree that we need more information to make a conclusive judgement. I would hope that the hospital team is not being biased against this boy for his life choices, but at the same time having worked in transplant I understand the consequences of non-compliance and feel it is important to make every effort to ensure the patient understands the vital importance of taking post-transplant medications and coming to follow up appointments. If there is a legitimate concern that the patient would be non-compliant I understand the hesitation of the hospital, but would hope this issue could be resolved with communication and education sessions with the family. I have seen cases where education was not enough however and patient's developed fatal infections fairly quickly post transplant because of poor compliance, so I take non-compliance concerns very seriously.
I most definitely agree that the "court of public opinion" is no place to make these decisions. The decisions should be logical, rational, and well thought out...the media lately is none of those things.