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Features Departments Information |
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Thoughts of wonder and apprehension aFall 1997 A VERY IMPORTANT development for our hospital is just starting. This is the implementation of a program of liver transplantation and eventually other organs. Joined to those already in existence (heart, kidney, stem cell transplants), the new program confirms our high standing among pediatric institutions and expands our capabilities in a major way. Trivial modifications may pass unnoticed. Insignificant changes are complacently tolerated, even when disliked. But major changes, those which deeply affect our lives, never fail to cause a stir. Indeed, the ability to replace diseased organs through transplantation is an achievement that understandably causes both wonder and apprehension. Critics say that access to this extraordinary technology is not equitable but favors patients who manage to attract media attention or can somehow wield emotional, political or economic resources. They also point out that organ transplants divert enormous amounts of human energy, skills, and money away from more pressing and more widespread concerns. Further, they say, the ever-bolder attempts at organ replacement, like multiple organs transplanted into the same patient, express an insensitive medical and surgical arrogance — the kind of bellicose triumphalism that refuses to accept limits to the human condition. These criticisms are disturbing, because they are not entirely unfounded. There is some truth in them. Many physicians were bred in the "heroic," overly optimistic culture that exalts the determined pioneer's attitude that recognizes no bounds to human achievement and gives no thought to the cultural or spiritual harm that overzealous excess can bring in its wake. These are hard philosophical, not medical, questions. They have no straightforward answers. On the other hand, transplants improve the health of patients, relieve suffering and offer hope — the only hope — in desperate conditions. They yield precious information that otherwise may fail to accrue. Knowledge often derives from unexpected sources, and insights gained in one field redound to the benefit of other seemingly unconnected areas. In a world that often seems enraged and bent upon destruction, we, at Children's Memorial Hospital, have cause to feel proud that all our efforts and concerns, whatever critics might say, aim primarily to help children in pain, to alleviate their suffering and promote their well-being. But we should pause and take thought. The criticisms are helpful if they make us realize that the astounding medical progress of recent times has much wider implications than we, as physicians, are used to. The ultimate significance of these therapies is non-medical; it has to do with equity and justice, how we think about our bodies, what it means to be human, and ultimately, with how we cope with the awesome fact of our own mortality. |
