In its never ending pursuit of advancement, science has reached acrucial biotechnological plateau, the creation of artificial organs. Such aconcept may seem easy to comprehend until one considers the vast knowledgerequired to provide a functional substitute for one of nature’s creations. Onethen 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. Ithas been thought the seat of the soul, the source of emotion, and the center ofeach individual’s existence. For many years, doctors and researchers left theheart untouched because they thought it was too delicate, too crucial towithstand the rigors of surgery. However, the innate human desire to achievebrought about the invention of the artificial heart. The potential for suchinventions are enormous.
According to the American Heart Association, there arebetween 16,000 and 40,000 possible recipients of artificial heart devices underthe age of sixty-five. If perfected, it would enable us to save thousands ofhuman 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 newinnovations to humanity. Who will receive these brilliant inventions?Obviously not all of the patients will get transplants, so selection criteriamust be established. The high price of artificial heart devices and theirimplantation will eliminate some candidates. Unfortunately, this is not fair.
The rich, in essence, can buy life, whereas the poor are abandoned to die in adiseased state. A thorough analysis of the implications of the implantation ofsuch devices reveals not only selection and economic consideration, butmortality and ethics as well. Many contest that it is simply wrong to tamperwith the ways and creations of nature. By prolonging life through unnaturalmeans were are defeating natures foremost tenet of the “survival of thefittest.” We are preserving the weaker gene pools and contributing to thedeterioration of the human species. These and other considerations play a vitalrole in determining the artificial transplants actual benefit to thecontemporary world and the world of tomorrow. A full-scale incorporation of theartificial heart devices technology into the medical world could have seriousconsequences, all of which must be considered before such a rash step is taken.
Artificial heart devices are indeed a biotechnical wonder. Although they arenot yet perfected for permanent implantation, they are the most reliablesubstitutes for bad heart parts until other functional, transplantables can belocated. The Jarvik-7 was the first artificial device heart which was createdby 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 anddied. 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 successfulinventions is the left ventricle assist device (LAVD). This device incorporatesa host of hard won technological advances. Perhaps the most important is its”bio-compatible” materials, which have allowed the LAVD to function withoutproblems for well over a year in a patient’s body. The LAVD has been implantedin more than seven hundred people for up to seventeen months, as they haveawaited human heart transplants(Stipp 38). It is difficult to fathom the greatscientific ingenuity that was required to develop these devices. However, wemust not be blinded from seeing the whole picture. In assuming its role as aboost to humanity, these inventions bring many concerns.The issue ofselecting patients for implantation is an important one. There are threealternatives for selecting patients who should have priority to receiveartificial heart devices. The first decision- based medical criteria, whichseems 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 forresearchers. Therefore, researchers look for a subject who will yield theinformation sought and thus produce the gains of new knowledge and therapies.
In choosing a subject in this manner, researchers are governed by a principle ofnonmaleficence, which means they can do no harm solely in order to further theexperimental aspect of the operation. This rule prevents the “mad scientist”mentality from taking hold in experimental research. As Claude Bernard, thefather of experimental research stated: “The principle of medical mortalityconsists in never performing on a man an experiment which might be harmful tohim in any extent, though the result might be highly advantageous to science andto the health of others”(Holland 14). It would also seem logical that thedecision be based on medical need, but practicality rules these out since manycandidates 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 communityand demonstrated dedicated social productivity. After all, if someone hashelped society, he or she is entitled to their fair return. Although thisalternative 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 oneis to receive priority. This also contradicts the American principle of theequality of all human beings, regardless of social contributions. The thirdmethod, random selection, may be used to select candidates with equivalent needsfor artificial heart devices. Random selection may be accomplished either bylottery or by queuing, which is exemplified by the adage “first come firstserved.”This method seems fair until one considers that one has led criminallives or have done poorly by society may come out on top. This is definitelynot justice. So how should we select patients for implantation’s ofartificial heart devices? Perhaps the selection process cannot be simplynarrowed down to a single criterion, but combinations of several could be usedto determine who deserves these transplants the most.
As depicted above, the selection of patients is a serious issue in therealm of artificial heart devices. Once a candidate has finally been chosen,however, how is he or she to finance such an elaborate surgical operation? Theprice for an implant of such complexity is extremely high. The estimated pricefor an LAVD is about fifty- thousand dollars(Stipp 41). This figure does notinclude hospital bills for the care and the board of the patient. This is anextravagant amount which most people simply cannot pay. Perfection ofartificial heart devices will naturally lead to a widespread demand for theinventions, but still many will be unable to afford it. A total incorporationof heart transplants into the field of medicine would force insurance companiesto expand their coverage. The population would benefit from this expansion, aswould the insurance companies, since they would surely sell more healthinsurance plans because of the increased demand. Some believe that theimplantation of artificial heart devices will strengthen the case for thenational health insurance.
Another question to be considered is whether or not it is worth the highcost to have the operation. The common response is to say that a price cannotbe put on life, but can we honestly say it is worth thousands of dollars toprolong someone’s life for an indefinite length of time? The price may beindeed be too high to postpone what might be a destined fatality. One couldspend fifty thousand dollars to have an implant placed in his eighty year-oldfather’s chest, only to witness the death a month later. After all, it isnatural 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 moneyto prolong his life, but to have his quality of health diminish greatly. Withtoday’s technology, an artificial heart recipient’s mental state may become verydistraught. Thoughts of death hover over his head, as he can never predict whenthe device may fail.
The use of artificial heart devices as a viable technique willundoubtedly 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 thenature of the operation and its dangers, and still be willing to go through withthe procedure. However, a real life scenario may occur which does not allow forthe patients consent. For example, suppose a patient is on the operating tableundergoing bypass surgery and sudden complications occur involving heart failure.
The doctor uses his best judgment to find the only way to save the patient’slife; he inserts an artificial heart device. The physician may be endangering the patient’s life by removing the natural heart and inserting an artificialdevice. However, the transplant without informed consent should be consideredas an emergency medical operation. Possibly the patient’s family should be theconsenting party. This sounds like a suitable solution, but factors such asgreed may interfere with the family’s decision. If the patient has a large lifeinsurance plan, his beneficiaries may consent to the artificial implant since itwould greatly improve the risk to the patient’s life.
The perfection of artificial devices for the heart will definitely havea great impact on society. This can be classified in two major ways: financialproblems and population problems. Of course, increased use of artificial heartdevices in medicine is going to increase the financial burden on society. Thepotential gains will be substantial when the lives of many productiveindividuals can be saved. The extent of the financial burden depends largelyupon the number of patients who benefit from the artificial valve, theavailability of the device, and improvements in its efficiency and dependability.
In the long run, worldwide utility of the artificial valve technology wouldincrease the world population. Overpopulation is already the root of many ofthe world’s crises. The many debates concerning artificial heart implantation as a medicaltechnique each have their own significance, and each deserves thoroughconsideration. Before we rush headlong into complete employment of the devicesin medicine, we must evaluate the moral, social, ethical, arguments. Hopefullywe can reach a decision that blends all of the aforementioned considerationsinto a harmonious existence, working to the maximum benefit of society.
