Meet medical professionals who discuss the shifts in doctors' decision making process today. Part 4/4.
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The Ethical Responsibilities of Doctors Part 4/4 Mark P. Aulisio: So one of and some of the controversial areas include donation after cardiac death which has somewhat been sensationalized but it really but it always raised questions about well, after cardiac death are people really dead? It used to be called 900 meeting donation. Host: Questions about what constitutes death is at the heart of the controversy of an organ transplants. According to Doctor Aulisio, there has been a fear that if someone offers to donate their organs, they may not really be dead when the organs are removed. There has been a lack of confidence and understanding about these issues. For instance, what does it mean to brain dead? Mark P. Aulisio: There is a 60 minutes episode back in the late 90s that focused on non-heart beating donations. Host: In the area of organ transplants other major concerns are centered around questions like, “Under what circumstances can organs be taken? And how can the medical community insure that all of the criteria are met”? Mark P. Aulisio: And there was a protocol under discussion at the Cleveland clinic and there are all kinds of controversies to whether the protocol was in place or not place, you know there were examples given the examples given in the 60 minutes episode. From what I could tell weren’t actually examples from the Cleveland clinic, there were from a hospital in Toledo. You know, so there were issues with that episode as I saw it. Host: He says that for many people there is skepticism and a lack of confidence in the health care system. Mark P. Aulisio: But my father when after that episode played called me and he said, “Mark, do you have anything to do with this non-heart-beating’s whatever it is stuff”? And I said, well, yeah, I know a little bit about it and we do it at the University of Pittsburgh. I was at the University of Pittsburgh at that time. UPMC Medical Center did non-heart beating as one of the pioneers. And you know he said, “Well, am I going to go into the emergency room and they’re going to take my organs? Basically, we’ll he’s pretty healthy and we could get five of his organs, let’s go right now”. You know, I said, “No, that’s not what’s going on. That’s not even what’s viewed in this 60 minutes episode”. I try to explain about DNR and about cardiac death. I’ve been assistile in and two minutes from assistile in all the stuff but then that affect on my father was, “Oh, my gosh, they might take my organs”. Host: Another topic related to the organ transplantation is the medical definition of death. It is becoming increasingly difficult to define what Death is at this point in medical history. Since the medical community now has the ability to keep people technically alive almost indefinitely through various technologies. Stuart Youngner: But I believe that we all die, there is such a thing as death but that in high technology environments where we can keep some vital functions going while others have stopped with machines and fancy drugs that determining the exact moment of death becomes somewhat arbitrary and is not a scientific decision. It’s a social decision, it’s a religious decision. It’s moral decision and it’s very unlikely that there’ll be widespread agreement. So that if you look at that issue up course and under the microscope about when does the exact moment of death in an intensive care unit, I believe it’s indescribable, we can have conventions, we can lost but they’re not absolute in terms either science or philosophy. Host: So how to do it? We determine what death is and when it occurs. This is at the heart of the controversy about organ transplants. While the exact time of death may not always be a critical issue it becomes critical when the decision to remove organs for transplantation has to be made. Stuart Youngner: If you can take the organs out, it matters because we don’t take organs out of the living people and kill them by the taking their organs out. They have to
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