10 replies to this topic

[Luna]

http://www.rcseng.ac...plant-treatment

I am not sure what kind of "ethical principle" is to be considered here.. :X

[kismet]

Most questions are rather sane to me, but some are typical ethic-committee drivel:

Since this is not a life-saving procedure, do the benefits of the procedure outweigh the significant risks of harm?

Who cares? It's not your choice to decide about someone else's life. The people who need the procedure will decide for themselves.

How can we obtain valid consent for an experimental procedure that has only been performed once?

Not at all. Perfectly informed consent does not exist. Do what you always do, explain the chances of success and remind people that they can die from the procedure...

emphasis mine:

Dr Daniel Sokol, a medical ethicist at St George’s, University of London, and a member of the Taskforce:
“Laryngeal transplantation is an exciting prospect, but in our enthusiasm we should not forget a key ethical principle in medicine: above all, do no harm. We must be satisfied that the benefits of this experimental procedure will outweigh the inevitable harms that will result.”

Dr. Sokol you are on my official "I hate you" list for using that despicable and empty phrase. Above all do what your (mentally sane and consenting) patients want you to do. You are not allowed to decide the lives of others based on a 2000 year old principle! (or any principle for that matter)

Edited by kismet, 03 May 2009 - 07:37 PM.

[eternaltraveler]

ethicists are just another kind of bureaucrat. Like all bureaucrats they like making and following rules for their own sake.

[kismet]

And they're not even to blame, I mean they need to do some "work" to seem useful as they're being paid by someone. If they told the truth, i.e. that most answers (disregarding religious dogma and other pseudo-fascism) are painfully obvious from the Universal Declaration of Human Rights, the consitution and common sense, they'd become redundant and jobless. Other than that ethics (and interpretation of ethical guidelines) is probably more of religious and political power play than anything remotely useful these days.

I didn't even know that larnyx transplantations a. haven't been done on a regular basis, b. are that dangerous and c. there needs to be actual debate whether doctors are allowed to try to improve the life of their patients.
Anyone in the know care to elaborate on the difficulties with the procedure?

Edited by kismet, 03 May 2009 - 09:43 PM.

[eternaltraveler]

It's not your choice to decide about someone else's life. The people who need the procedure will decide for themselves.

I assume you are only speaking in terms of his role as an ethicist for making rules other physicians have to follow. Any individual physician should be able to refuse to do whatever procedure they want. Actually I don't even know if this guy is a medical doctor or a phd.

[kismet]

I assume you are only speaking in terms of his role as an ethicist for making rules other physicians have to follow.Any individual physician should be able to refuse to do whatever procedure they want.

Yes, it's their right. Obviously, all other rules apply as defined in laws (when I'm saying "no one should dictate someone else's life based on any principle"). If the risks are known to both the doctors involved and the patients (who should understand them well enough if they're communicated correctly), the free market should decide: if there are patients and doctors who want to pioneer any form of procedure, then let them pioneer that procedure.
Ironically the ethics committee laments their limited knowledge about the procedure. I'm wondering how they want to increase their knowledge without actual work in humans?

I'm wondering if we might have seen pioneering work on head transplants in humans if our society was more tolerant of personal freedoms. I'm sure some doctors and patients would have loved to pioneer that procedure (I can only think of one real moral issue but I don't want to turn this thread in a debate on head [full body] transplants).

Edited by kismet, 03 May 2009 - 09:56 PM.

[DJS]

Ethicists? Ehh. Yeah, I agree that they're generally useless, and sometimes a little bit encumbering.

Usually all they're really doing is formalizing the conflicting sentiments of society or providing cover for a particular political agenda.

In this case, Dr. Sokol can hold any opinion he wants, but if there is a strong (ie, profitable) market force for larynx transplantation only a decidedly negative response by society would make his objections relevant.

When the technological environment changes it is society as a whole which decides, not ivory tower bioethicists.

[kismet]

http://tracheotomy.i...d...r=0&thold=0

"...“truly a special occasion,” said Marshall Strome, M.D., chairman of the Clinic’s Department of Otolaryngology and Communicative Disorders and leader of a team of eight surgeons, anesthesiologists and nurses who performed the 12-hour operation.
During Mr. Heidler’s procedure, the Clinic team transplanted the larynx, the thyroid and 70 percent of the throat of the donor. The only other attempt at a human laryngeal transplant was 25 years ago in Belgium. However, the individual, a cancer patient, died from the disease a short time following the surgery."
I'm sure it's probably not the easiest operation.

"Some say that we shouldn’t perform this type of transplant because the larynx is a non-vital organ."
Sometimes I'm wondering why we live in such a cruel world were people apparently wish others to suffer and take away their right to decide over their own lives. I always thought being pro-choice is the only choice.
Why are the same people (or are they?) not protesting against cosmetic surgeries?

It'd be very cruel not to try. NEJM article: http://content.nejm....ull/344/22/1676
"This patient underwent transplantation of the larynx, trachea, pharynx, and thyroid and parathyroid glands, and the transplant has remained viable for 40 months. He has a human-sounding voice with inflection, range, and qualities unique to him, and he can swallow normally. Transplanting 75 percent of the donor pharynx did not compromise swallowing. Thus, when transplantation is a reconstructive procedure, a constricted pharynx can be widened without impairing swallowing, as long as sensation is restored."
The article also shows our crude approach to managing rejection. Perfect HLA match and there were still episodes of rejection and the patient has to take immuno-suppresive drugs until the end of his life. The solution to that problem is even more of a bioethical problem...

Edited by kismet, 03 May 2009 - 10:20 PM.

[kismet]

I recommend reading the transplantation literature. It's really fascinating on the one hand, but on the other hand also quite bizarre. The "ethical" ponderings turn my stomach.

from: The Spectrum of Complications of Immunosuppression: Is the Time Right for Hand Transplantation? http://www.ejbjs.org...full/84/10/1861
"Although an experimental treatment may provide benefit from the patient's perspective, it is the surgeon's responsibility to make sure that such benefit does not exact an unacceptable cost. Before undertaking experimental surgery, it behooves us to reflect on the tenet "primum non nocere" ("first, do no harm")."

This begs yet again the question, who gave you, the doctor, the right to play god? To decide other's fate based on an age-old, subjective criterion?

"Llull suggested that a moratorium be placed on transplantation of the hand"
"...opposition from the majority of the hand surgery community"

"evaluating how innovative surgical techniques might be applied to hand transplantation. The criteria include [everything but the patient's opinion it seems] (1) the scientific background of the innovation, (2) the skill and experience of the team (so-called field strength), (3) the ethical climate of the institution, (4) open display, (5) public evaluation, and (6) public and professional discussion."

On a more scientific note, our ability to sustain grafts is indeed abysmal:
"Chronic rejection with loss of the allograft is seen in 52% of patients (thirteen of twenty-five) by five years after cardiac and lung transplants"
Personally, I'd probably not take the risk of an unnecessary graft (e.g. hand) & strong immuno-suppression, but I'm aghast at those people who think they're allowed to make that decision for me.

Edited by kismet, 03 May 2009 - 11:12 PM.

[Luna]

hands transplant! of course they should practice that..

Edit: I didn't read the page yet so I don't know the risks.. but it would be amazing once it can be done regularly!

Edited by Winterbreeze, 04 May 2009 - 02:22 AM.

[Luna]

I am curious.. it says he has his own quality (resonance) of voice.. wouldn't it be more of the donor's?
the pitch should be.. and that pharynx is the main resonance chamber in the body isn't it?