‘Bloodless’ Lung Transplants Offer Hint at Surgery’s Future
nytimes.com
nytimes.com
> He said his focus was intensified by the knowledge that if a patient died for lack of blood, a second life might hang in the balance — the wait-listed patient who would otherwise have received the organ.
Doctors should not be adrenaline junkies playing with other peoples' lives, especially those who aren't even their patient. This looks like a pretty clear breach of the ethics I expect from doctors.
If your proposed standard of ethics were strongly enforced, such progress would stop.
The 'right-thinking' mainstream can easily become inbred and inflexible – especially so in medicine. The occasional surprise successes of nuts and daredevils are a necessary corrective, so their deviations from the norm should be respected (and perhaps even celebrated), not disciplined.
This isn't to say that a doctor's decisions can't be colored. Evidence-backed, community accepted guidelines are very desirable, as are second opinions. But once the decision is made that someone needs surgery, I would want a guy who's excited to operate.
And what does he suppose the odds would be if he applied the same cherry-picking whilst operating with the option of a blood transfusion?
I'm not necessarily advocating for reliance on blood transfusions here, but the logic (and ethics) of this seem highly questionable.
Among those who would prefer not to receive blood, should the doctor be experimenting with this novel approach on all patients, without regard to a risk of complications? How would that be more ethical?
Also, when you start a new technology you always do the low hanging fruit first, so cherry picking is pretty normal and reasonable.
Full disclosure: I'm a Jehovah's Witness.
I feel I read that somewhere recently...
In this case, JWs are presenting themselves as the control group for experimenting with blood transfusions... in a "study" that would be utterly unethical.
Imagine a doctor that refused a blood transfusion that would normally be called for in a serious surgery, because the patient was part of a study and fell into the "no transfusions even in dire need" group.
A randomized study like that is (still) impossible and unethical, but because we have this group of people who place themselves onto the higher-risk path, doctors can test out the actual boundaries of where transfusions are needed -- and indeed, seriously advance the science.
The Jehovah's Witnesses are at higher risk, and more of them will die because of this decision, but we're getting quite useful data in the meantime.
You mentioned the Army -- medicine is also advanced by the normally-unethical medical approaches to medicine that are required by battlefield medicine. There's some overlap with the real requirements there, and the self-imposed requirement of JWs refusing transfusions that actually are available -- so certainly they'd be interested.
Now we just need a new L Ron Hubbard to invent a religion that requires adherents to go all the way -- and always take the most-data-rich path through medical treatment -- then we'll be making progress in leaps & bounds (though of course more guinea pigs will die along the way).
The article mentions that there's some evidence that transfusions carry their own risk. How closely has this been studied, and what are the risks? Without accurate knowledge of that, how can we make definitive statements as to the negative repercussions to people that opt out of transfusions?
Additionally, I fail to see how more Jehovah's Witnesses die because of this decision, which allows the operation to continue, when the alternative is that they don't get the procedure at all, which I believe results in death?
The grey area, where getting a transfusion might actually be riskier than not getting one, is what they're finding out more about. That's useful to know.
There are also cases that are not at all grey areas, where refusing transfusions means they will die. They're still refusing them (and unfortunately, that death doesn't provide any useful data, beyond "yes, what we were sure would happen, happened").
It should be noted that there's a lot of hospitals / medical centers that have bloodless surgery programs.
http://en.wikipedia.org/wiki/Bloodless_surgery#Hospitals_and...
If this many are doing, it can't just be crazy person talk, there must be some real benefit.
It might be somewhat helpful to have doctors who are less trigger happy when it comes to giving blood transfusion but I don't see how that is particularly innovative or hinting in any way at the future. This only helps a couple of not too ill people who want to keep their imaginary friend happy.
One such commandment is in acts 15:28-29:
For it seemed good to the Holy Ghost, and to us, to lay
upon you no greater burden than these necessary things;
That ye abstain from meats offered to idols, and from
blood, and from things strangled, and from fornication:
from which if ye keep yourselves, ye shall do well.
Fare ye well.
as it mentions in the article, there is " a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases".