Week 22: Medical Economics and Ethics

Our lecturers said to us this week "So you though you were coming to medical school to help people?" it only took 22 weeks for someone to try to convince us otherwise as we were lectured to this week about some of the economics of medicine. Value, as we need to interpret it, is simply quality over cost. To increase value we either improve the quality and/or decrease the cost. The problem however is that their two processes aren't exactly mutually exclusive and we end up having to make decisions that doles out the most benefit for the whole -- even at the costs to some individuals. This reminded me of one of my interviews as a medical applicant when I was posed with the true vignette of a man who advertised that he was dying and needed a liver. Well, the man ended up getting a liver willed directly to him, got his much needed transplant, and the catch? He died about a year later. So the question here is whether or not this man Todd ethically obtained a liver? To Todd this was a life and death situation and he did whatever it took to get the liver he needed (many like him have resorted to going to foreign countries to get black market organ transplants or organs from prisoners), but to the medical community this was a blatant breach of medical economics.

UNOS, the United Network of Organ Sharing is the main sorting site in the United States for all patients waiting for organ donations. To get to the top of the list, politics aside, an individual must have a relatively good prognosis granted that they have a successful match and transplantation. In the case of Todd diagnosed with liver cancer, his prognosis was not good, and to the medical community his transplant was a waste of an organ - robbing someone else of a transplant who could use the same organ better and longer to prolong their life. Here's where the ethics comes in though, every time the medical community gets to play God and decides who lives and who dies someone is bound to be upset - and I can see why they would be upset too. In the interest of medical economics, medical ethics treads a very fine line too as we end up in these Catch-22 situations. Is Todd indeed not deserving of the organ because he will only survive a year with it when someone else could survive longer? Is Todd's unconventional way of obtaining an organ ethical and fair for everyone else who is waiting in line through UNOS? Would it be ethical to perform Todd's transplant even if you disagreed to the ethics of the situation? Tough case, and I think the interview question was meant to scratch this moral dilemma of helping with minimal hurting.

Well, I have my personal opinions about the situation and the problems that Todd has introduced but I'll let you ponder this one yourself, because no matter which way you rationalize your defense someone on either side of the balance is bound to get hurt and that I guess is the crux of the paradox of medicine. Economics and ethics to hurt and to heal.