Video about heart transplants. Comment on the appropriate constraints on experimental medicine (which should also relate to our discussions about genetics) .http://www.nytimes.com/video/us/100000004281389/a-change-of-heart.html?emc=edit_th_20160321&nl=todaysheadlines&nlid=25414714
Here's the related print story, with hyperlinks for more information:
http://www.nytimes.com/2016/03/21/us/artificial-hearts-ticking-along-decades-after-jarvik-7-debate.html?emc=edit_th_20160321&nl=todaysheadlines&nlid=25414714&_r=0
After reading the print version of this story I found some interesting points. In a quote towards the beginning of the article after the author spoke of the failed heart transplants it was said "the question boiled down to whether the operations enhanced life or prolonged the painful journey toward death." This is a question that we in society should be forced to face in not just situations that involve artificial hearts but all artificial life support. Are these things truly helping those who are dying or prolonging their pain? The goal of research and finding new knowledge does not outweigh the importance of quality end of life care.
ReplyDeleteOn the research side of things we must look at these complete artificial hearts in order to determine how they will affect a person's quality of life. The ending of the article states that the heart is a very simple organ. Indeed it is yet there are many seemingly 'simple' processes in our body but most of them interact with one another in a way we do not understand fully. If the heart is such a simple organ why haven't scientists been able to make and successfully sustain someone for a longer period of time? Our bodies were made in a perfectly abstract way, we can understand bits and pieces but we may never know exactly how everything works. When the question of making these mechanical organs arises it is important to remember our discussion of genetics and gene therapy. We must take a step back and be sure to not enter a slippery slope in which we are 'playing God'.
Okay I agree with what you are saying Abby and you wrote a little book it looks like here. I agree with you on the research side of things that we should have an understanding on how these will help someone's quality of life. Even though I am not a fan of the quote asking if this procedure will prolonge someone that is dying their pain. If they need a heart then this will not ceate pain what so ever when looking at what this artificial heart has done to help people today.
DeleteI do believe that the first artificial heart was ahead of its time. I think people should have done more research on them and ultimately understood how they worked much better. Surely this heart worked, but it did not 'lessen the blow.' If I had a choice to die a painful death or to be prolonged and sustain a painful life (and obviously eventually die), I would choose to get my misery over with. Is it really sustaining life if it is full of complications and misery? On the other hand, I can understand wanting to do this transplant for research's sake. I am all for research and experimenting, but it gets very risky when you are messing with people's lives.
ReplyDeleteGenetics can relate to this transplant in many ways. One, people definitely look at gene therapy and think it is against human nature. The fact that we can change someone's genes in a way to help society is not seen as natural (I agree). Neither is a heart transplant. Even though these things could help society, it is a subject that needs to be taken very lightly. But if they are going to help society should this lighten our view? Or should we still look at this and think it is wrong in that it is synthetic. The second similarity I found is the media's attention. Is the media surrounding this because they want to further progress in genetics or are they doing this just to get views? Is it seen as unethical in today's society? Well of course some people see this as unethical. Also, some institutions see this as unethical, especially religious ones. It sucks that in today's society, people with good intentions of enhancing our knowledge of us and the world are blamed for being unethical in their work. Clearly the scientific community must lightly tread on waters that may not seem ethical in the public's perspective.
I would argue that the appropriate constraints on medical research would revolve around understanding the effects the research could have on the subject before performing them. This, of course, requires much experimentation in animal phase of trials in order to better understand how the treatment will interact with living things. If, during this phase, a variety of or even a very serious issue arises that the experimenters did not predict or have no solution for, they should have work in that phase until such a time that they can solve the issue. If the issue continues into the human phase of the experiment, they experimenters should have to do the same thing once more.
ReplyDeleteIn the instance of these artificial hearts, once it was understood what the general issues were, namely the clots and infections, the experimenters should have gone back to the drawing board and considered the best way to continue with the transplants after figuring out how to solve those issues.
I think that this article/video brings to light some of the biggest and most controversial questions that we’ll have all semester and, honestly speaking, all our lives. Should we sacrifice our lives and our pain for the benefit of research and others? At what point should we withdraw or refuse treatment?
ReplyDeleteAt the very end when they say that few alterations to the artificial heart have been made since the first transplant, I was a little concerned. It has been a good 20-30 years and a piece of machinery/electronics has not advanced? Then of course, they say that they have simply studied it more, which begs the question: how much did they study it before testing on humans? Did they put the first couple gentlemen through tortuous testing without significant proof or research?
They can now control infections and blood clots. They say it was reapproved and meant as a bridge to a transplant; however, they are beginning a trial where it is a permanent replacement. Will similar problems occur? I know that from the earliest cases, the patients were not living more than 2 years post-surgery plus they were living a low quality of life in the hospital. The patients would suffer through infections, blood clots, and strokes. The first couple uses of the artificial heart were also intended as permanent fixes whereas now it is more so as a bridge.
What should the requirements been for such transplants?
Based off the print article I felt that one major thing stood out about the artificial heart used in the 1980s. In every occasion it led to complications that one might feel is worse than death. Each patient that the article mentioned that received the Jarvik ended up suffering horrible complications and eventual death. We need to be careful that we are giving people something we think will save their lives rather than something that will lead to a device that saves lives. If one does "medical" procedures that most likely will only benefit future patients and have a reasonable chance of hurting the current recipient, then the person doing that procedure is morally wrong. They are using people exclusively as means.
ReplyDeleteI too believe that the article/video brings questions, but also answers to many questions revolving certain things brought up in this semester. We've discussed the questions about pain, and the benefit it may have to research but the pain we must sacrifice in order to achieve that research is what is in question.
ReplyDeleteI believe the artificial heart may of began as an answer, but the answer also came with consequences that some were not aware of. I this is the case, the experimenters should have gone back to the drawing board to fix the issues that were occurring, because the initial concern is how much testing and studying was truly done before humans were the ones being tested on.
This is the same with transplants. I would not allow doctors or anyone to use me as an experiment, where they think this organ may work or they are some what sure that I will not suffer through infections or a stroke, to only live one or two years tops.
I did not know that doctors in the 1980's were working on an artificial heart. I do not agree with the video where they plan to give patients an artificial heart for the rest of their lives. But I do think it is beneficial to patients who are waiting for a heart donor to be given an artificial heart in the mean time. In the 1980's the medical technology was not as advanced as it it now. It was hard to see the patients with the artificial hearts diminish after a few months to two years after the transplant due to blood clots and strokes. It did not seem like they were given the quality of life that was expected from the transplant. This medical "experiment" should have been tested on a different type of subject like a cow or chimpanzee rather than on humans.
ReplyDeleteI personally have a direct attachment to this video. I have a heart condition that is very rare which effects the electrical signals going from the AV Node to the Bundle of His. My diagnosis is called a left bundle branch block with hypotropic cardiomyopathy. I will need to get a pacemaker within the next 5 years and I could eventually need a heart transplant in the future.
ReplyDeleteI feel like this video really shows how far medicine has come and without the people in the beginning we wouldn't be where we are at today with the type of medical advancements we have made. I feel like the ethical principles in the 1980s were good because the patients knew the consequences and even the Clark wanted to do something with his life for future generations. I feel like there is always trial and error, thats how we discover new things every day.
In the printed article, there was a question of was the intention of the artificial heart implants to “save a life or to serve the experimental interests of the surgeon?” This is something that we also have to think about when talking about genetics. When doing genetic testing, are we trying to use it to save a life or are the researchers using it for experimental reasons. This questions allows for the discussion of heart surgery and genetic testing in the sense of either being ethical or morally acceptable.
ReplyDeleteIntersting, I see where you're coming from. But without the people wanting experimental surgery and surgeons using experiments on humans with consent, how would we advance society into the future?
DeleteAfter watching the video on the artificial heart I was amazed to say the least. I have heard of artificial hearts but I did not fully understand what the concept of it was and did not know how it worked. It is a great idea and a innovative chunk of technology. I say that because in the 1980's it was way ahead of its time and the world may not have been ready for it. Now that there are restrictions on the process, being that it is used only temporarily until a donor heart is available, I think that it has become a great success. This relates to the discussion of genetics because it was a technology that was ahead of its time and was not perfected. Genetics is a complicated subject just like when the artificial heart was invented. The artificial heart was said to be unnatural and some people probably considered it to be "playing God" just like the current debate about our advanced experimentation through genetics.
ReplyDeleteThe Jarvik-7 was a success in that it prolonged patients' lives. However, the state of living was painful with patients suffering from convulsions, kidney failure, memory lapses, blood clots and strokes before succumbing to the inevitable. Many medical ethicists asked the question of whether the operations enhanced life or prolonged the painful journey toward death. One specific question in the article was asking if the intention was to “save a life or to serve the experimental interests of the surgeon?” The surgeon said that whenever these statements discouraged him he would ask his patients if they wanted him to stop and they would always say no, they wanted to fight. But in the end all that gave them was a more painful death. Years later, a new device came out that was just a temporary heart. Less complications came from this and less controversy because it was actually giving patients a "good" life. Without people in the beginning like Clark, who wanted to do something with his life to help future generations, this temporary heart may not have been here today saving all the lives that it does.
ReplyDeleteI really not surprised by this story, especially after some of the other stories/cases we have discussed in this class. To me, this relates to the treatment of cancer (from the beginning to now). Was it ethical? Most likely not, but without the information that we learned, we most likely wouldn’t have a treatment for most cancers today. Just like without the testing of the artificial hearts, we wouldn’t have the devices we do today, to help people with bad or falling hearts.
ReplyDeleteThe adequate research may have not been done correctly when creating the first artificial heart and is the reason why it failed. But I have had two grandparents get this artificial heart and one out of the two is still breathing. Even the one that has passed away I believe that this transplant really benefitted them and is the reason why I was able to be alive during there time of life. So I am with out a doubt for this procedure. It always takes time when first starting something and looking at this shows the evolution of the artificial heart. I believe that it is a risk but these artificial organs have really become a game changer.
ReplyDeleteI agree that while adequate research was not done in the beginning and the replacement was risky, I think it was a start. We would not be where we are today if people like Dr. Clark had not agreed to undergo the early procedures. I believe it was immoral that they put an artificial heart in Dr. Clark without knowing the full effect especially looking back on the quality of life he had after the replacement which was not very good.
DeleteThis video is absolutely amazing. It shows, that when given the opportunity, man-kind can create when given the opportunity. The artificial heart was said to be ahead of it's time. Today, we still use it in some areas as a last minute option and we're seeing major results in lifelong span of life. However, I didn't like that the video didn't mention any other options between what's available now. The LVAD system is used for failing hearts that pumps through the left or right vena cava of the heart controlling the left or right side. This lets the side that's hurt heal itself. I've seen this used as a last minute option as well. The state of living within the artificial heart was harsh. The LVAD, gives people the opportunity to live a life uninterrupted.
ReplyDeleteWith experimental medicine the constraints is that it must be able to improve the patients life status not worsen it. The patients that received the artificial hearts lives were able to be extended, but for the first patient the quality of life was not improved. The quality of life must also be taken into account when using experimental medicine on patients. In regards of genetics when using experimental medicine on patients the same concepts should apply. When trying to treat a disease through gene therapy the quality of life of the patient must be taken into account before treating the patient.
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