Artificial Heart Devices
In its never ending pursuit of advancement, science has reached a crucial
biotechnological plateau, the creation of artificial organs. Such a concept may seem
easy to comprehend until one considers the vast knowledge required to provide a
functional substitute for one of nature's creations. One then realizes the true
immensity of this breakthrough. Since ancient times, humans have viewed the heart as
more than just a physical part of the body. It has been thought the seat of the soul,
the source of emotion, and the center of each individual's existence. For many years,
doctors and researchers left the heart untouched because they thought it was too
delicate, too crucial to withstand the rigors of surgery. However, the innate human
desire to achieve brought about the invention of the artificial heart. The potential for
such inventions are enormous. According to the American Heart Association, there are
between 16,000 and 40,000 possible recipients of artificial heart devices under the age
of sixty-five. If perfected, it would enable us to save thousands of human lives.
In considering the full impact of artificial heart devices on society, we must not
narrow our thinking to include only the beneficial possibilities. There exist moral,
ethical, and economic factors that accompany these new innovations to humanity. Who will
receive these brilliant inventions? Obviously not all of the patients will get
transplants, so selection criteria must be established. The high price of artificial
heart devices and their implantation will eliminate some candidates. Unfortunately, this
is not fair. The rich, in essence, can buy life, whereas the poor are abandoned to die
in a diseased state. A thorough analysis of the implications of the implantation of such
devices reveals not only selection and economic consideration, but mortality and ethics
as well. Many contest that it is simply wrong to tamper with the ways and creations of
nature. By prolonging life through unnatural means were are defeating natures foremost
tenet of the "survival of the fittest." We are preserving the weaker gene pools and
contributing to the deterioration of the human species. These and other considerations
play a vital role in determining the artificial transplants actual benefit to the
contemporary world and the world of tomorrow. A full-scale incorporation of the
artificial heart devices technology into the medical world could have serious
consequences, all of which must be considered before such a rash step is taken.
Artificial heart devices are indeed a biotechnical wonder. Although they are not yet
perfected for permanent implantation, they are the most reliable substitutes for bad
heart parts until other functional, transplantables can be located. The Jarvik-7 was the
first artificial device heart which was created by Symbion Incorporated. This system was
used to replace the heart of Dr. Barney Clark, the first artificial heart patient. The
device lasted for one-hundred and twelve days before Mr. Clark sank into an agony of
complications and died. The Jarvik-7 was implanted four more times to replace failing
hearts, with similar results, before the federal authorities halted the procedure.
Other devices have made progress since the Jarvik-7. One of the more successful
inventions is the left ventricle assist device (LAVD). This device incorporates a host
of hard won technological advances. Perhaps the most important is its "bio-compatible"
materials, which have allowed the LAVD to function without problems for well over a year
in a patient's body. The LAVD has been implanted in more than seven hundred people for
up to seventeen months, as they have awaited human heart transplants(Stipp 38).
It is difficult to fathom the great scientific ingenuity that was required to develop
these devices. However, we must not be blinded from seeing the whole picture. In
assuming its role as a boost to humanity, these inventions bring many concerns. The
issue of selecting patients for implantation is an important one. There are three
alternatives for selecting patients who should have priority to receive artificial heart
devices. The first decision- based medical criteria, which seems to make the most sense.
This method is meant to choose the ideal patient; the patient who can reap the most
benefits not only for himself, but for researchers. Therefore, researchers look for a
subject who will yield the information sought and thus produce the gains of new knowledge
and therapies. In choosing a subject in this manner, researchers are governed by a
principle of nonmaleficence, which means they can do no harm solely in order to further
the experimental aspect of the operation. This rule prevents the "mad scientist"
mentality from taking hold in experimental research. As Claude Bernard, the father of
experimental research stated: "The principle of medical mortality consists in never
performing on a man an experiment which might be harmful to him in any extent, though the
result might be highly advantageous to science and to the health of others"(Holland 14).
It would also seem logical that the decision be based on medical need, but practicality
rules these out since many candidates have roughly equal needs for artificial heart
devices.
A second method of selecting patients is ranking them based on their "social worth."
This method would reward those who have benefited the community and demonstrated
dedicated social productivity. After all, if someone has helped society, he or she is
entitled to their fair return. Although this alternative is based on fair morals, it may
meet the problem of social value. Two people might be valuable to society completely
different ways, and which one is to receive priority. This also contradicts the American
principle of the equality of all human beings, regardless of social contributions. The
third method, random selection, may be used to select candidates with equivalent needs
for artificial heart devices. Random selection may be accomplished either by lottery or
by queuing, which is exemplified by the adage "first come first served." This method
seems fair until one considers that one has led criminal lives or have done poorly by
society may come out on top. This is definitely not justice. So how should we select
patients for implantation's of artificial heart devices? Perhaps the selection process
cannot be simply narrowed down to a single criterion, but combinations of several could
be used to determine who deserves these transplants the most.
As depicted above, the selection of patients is a serious issue in the realm of
artificial heart devices. Once a candidate has finally been chosen, however, how is he
or she to finance such an elaborate surgical operation? The price for an implant of such
complexity is extremely high. The estimated price for an LAVD is about fifty- thousand
dollars(Stipp 41). This figure does not include hospital bills for the care and the
board of the patient. This is an extravagant amount which most people simply cannot pay.
Perfection of artificial heart devices will naturally lead to a widespread demand for
the inventions, but still many will be unable to afford it. A total incorporation of
heart transplants into the field of medicine would force insurance companies to expand
their coverage. The population would benefit from this expansion, as would the insurance
companies, since they would surely sell more health insurance plans because of the
increased demand. Some believe that the implantation of artificial heart devices will
strengthen the case for the national health insurance.
Another question to be considered is whether or not it is worth the high cost to have
the operation. The common response is to say that a price cannot be put on life, but can
we honestly say it is worth thousands of dollars to prolong someone's life for an
indefinite length of time? The price may be indeed be too high to postpone what might be
a destined fatality. One could spend fifty thousand dollars to have an implant placed in
his eighty year-old father's chest, only to witness the death a month later. After all,
it is natural for people to die. We all have a destiny which looms over us, over which
we have no control. The patient himself must ask if it is worth the money to prolong his
life, but to have his quality of health diminish greatly. With today's technology, an
artificial heart recipient's mental state may become very distraught. Thoughts of death
hover over his head, as he can never predict when the device may fail.
The use of artificial heart devices as a viable technique will undoubtedly raise many
legal and ethical questions. Before completing the discussion of artificial heart
technology, these questions must be addressed. An important requirement for the surgical
operation is that the surgeon must receive the informed consent of the patient. The
patient must be aware of the nature of the operation and its dangers, and still be
willing to go through with the procedure. However, a real life scenario may occur which
does not allow for the patients consent. For example, suppose a patient is on the
operating table undergoing bypass surgery and sudden complications occur involving heart
failure. The doctor uses his best judgment to find the only way to save the patient's
life; he inserts an artificial heart device. The physician may be endangering the
patient's life by removing the natural heart and inserting an artificial device.
However, the transplant without informed consent should be considered as an emergency
medical operation. Possibly the patient's family should be the consenting party. This
sounds like a suitable solution, but factors such as greed may interfere with the
family's decision. If the patient has a large life insurance plan, his beneficiaries may
consent to the artificial implant since it would greatly improve the risk to the
patient's life.
The perfection of artificial devices for the heart will definitely have a great impact
on society. This can be classified in two major ways: financial problems and population
problems. Of course, increased use of artificial heart devices in medicine is going to
increase the financial burden on society. The potential gains will be substantial when
the lives of many productive individuals can be saved. The extent of the financial
burden depends largely upon the number of patients who benefit from the artificial valve,
the availability of the device, and improvements in its efficiency and dependability. In
the long run, worldwide utility of the artificial valve technology would increase the
world population. Overpopulation is already the root of many of the world's crises.
The many debates concerning artificial heart implantation as a medical technique
each have their own significance, and each deserves thorough consideration. Before we
rush headlong into complete employment of the devices in medicine, we must evaluate the
moral, social, ethical, arguments. Hopefully we can reach a decision that blends all of
the aforementioned considerations into a harmonious existence, working to the maximum
benefit of society.
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