Six years ago, I met a man who had survived a tragic automobile accident. He also had survived a gruesome attack by the Australian medical establishment.
After his SUV crashed, he was hospitalized in a coma. After a short period of time, his parents were informed that he was brain dead and that they should sign the organ-donor papers so that their son's organs could be transplanted to other people who needed them.
Despite relentless pursuit by the medicos, his parents steadfastly refused to permit the harvesting of organs from their son. I have no idea why his parents had this reaction, but it turned out they were correct. Their son recovered and eventually finished his education to become a metallurgist. He even carried the Olympic torch during a portion of its journey through Adelaide in 2000.
I was reminded of this meeting when I read this in Slate, summarized from the LATimes.
A man whose family agreed to donate his organs for transplant upon his death was wrongly declared brain-dead by two doctors at a Fresno hospital, records and interviews show.I am concerned about such incidents. They tend to make others very cautious, perhaps even reluctant to agree to organ donation from a brain-dead relative. They also raise very dicey questions about costs and benefits in the health care system:
Only after the man's 26-year-old daughter and a nurse became suspicious was a third doctor, a neurosurgeon, brought in. He determined that John Foster, 47, was not brain-dead, a condition that would have cleared the way for his organs to be removed, records of the Feb. 21 incident show.
What if Foster's daughter had had to pay, out of her pocket or expected inheritance or insurance benefits, the full costs of keeping her father alive? What if, at the same time, she had been offered, say, $50,000 for her father's organs? She might not have responded to these incentives, but you can bet that some people would.
It turned out that Foster, unlike the man I met in Australia, died 11 days later, and after the delay his organs no longer useful for transplant. Some people will say that ex post fact justified the physicians' attempts to get legal permission to harvest the organs when they did. Others will balk at both this justification and at the thought that people in this situation might respond to financial incentives in the future.
Me? I am really torn. It is easy to take a moral position, as I have most of my life, favouring keeping people alive on life-support systems, when it involves spending other people's money; if, for example, it were one of my children or grandchildren here in Canada, I would fight tooth and nail to have all the taxpayers' support used to keep them alive.
But when the opportunity costs of using medical resources are considered (not even thinking about the opportunity costs of how specific organs are used), I have much more difficulty maintaining this position, from both a moral perspective and as an economist considering opportunity costs. In low probability of survival situations, a strong argument can be made for redeploying scarce medical resources to other patients -- that's what triage choice is all about, and it must persist in all aspects of health care, whether we like it or not.