Category: Bioethics

I forgot to link to this, didn’t I? It appears that organ sales are booming in China, and the organs are being harvested from prisoners. Not that this is some great surprise, but that people are being executed on an as-needed basis is… disconcerting.

Of course, in the comments for the article, someone tries to argue that Buddhist perspectives on organ donation limit the number of people who will consent to donation, thus China has to have a thriving organ sales market. Problem is, the prisoner is dead, so they’re not getting the money from the sale, and the prisoner’s family isn’t, either. In fact, it’s being presented as a “gift to society” – a gift with a hefty pricetag for the person skipping their country’s donation list to move to the head of the Chinese class.

Anyhow! I take exception to the idea that Buddhist perspectives on organ donation limit the number of donations, unless it’s from a purely practical, China censoring Buddhist leaders perspective. As I said in the comment thread, although there is the typical sitting for the bardo, which requires that the body remain where it is for three days past signs of cessation of life (in order for the essence to leave the body, and not remain in a lingering state, a sort of ghost of the word – a literal getting over attachment to the body, if you will), over the last 20 years most of the high ranking folk in Buddhism have come out strongly in favour of organ donation – it is, after all, a painless way of gaining merit.

If you really want to talk from a Buddhist perspective, you do have to question whether or not someone in jail is being pressured into doing something they might not want to do, or be comfortable doing. Jail, and knowing you’re going to be killed – that’s a pretty coercive environment. While donation of organs is a marvelous karmic boon, it’s only good if it’s done voluntarily and with no anxiety.

The concern becomes the taking of an organ of someone who was coerced into donating, or who did not consent or voluntarily give their organs – this could be viewed as karmically negative, of contributing to harm of another person. Your need/desire to overcome your body/shell’s imperfections to attain a longer/healthier life causing the death of another person would be a very bad thing. Given the report and the questions raised by the BBC, I’d think Buddhists in China would be wary about accepting organ donation, not about donating themselves.

To say I was lucky would be an understatement. To this day, I still can’t believe the series of events and how they happened at the same time I found the writing discipline and initiative that I’d so studiously avoided for three years. I have little advice for people wishing to break in to the business. No one else broke in the way I did, indeed, every writer I know has a unique tale to tell of how they got their break. The only lesson I draw from my experience is that I think everyone gets their break in this industry, but the question is whether you’re ready, willing and able to take advantage of that break when it happens. I was, and so I made it, but I’ve known many others who have had their break, only to watch it pass them by for one reason or another. It’s the kind of business that will discourage you if you can be discouraged, and you need to know that about yourself right from the beginning.
-Ron Moore

So last month, Stanford ix-nayed pharmaceutical freebies; the easist way to find any information about the ban is to simply search on David Magnus’s name; (Google likes to tell me every time some small paper picks up a larger syndicated article – you’d be amazed how often I’ve seen his name in the last three weeks). But basically, the idea is that even small gifts have been shown to influence physicians. The big pharma argument has been, for years, that they have allowances of no more than $100 per physician, and the cost is too small to really influence the course of decisions. It’s probably not a surprise to anyone familiar with some theories of gift economies that this isn’t actually the case, and something like pens, pads of branded paper, and/or a nice lunch will actually influence a physician’s prescribibg habit.

Anyhow, the commentary around this has really been run quite into the ground at this point, and I bring it up actually because of The Colbert Report and Demoicracy Now! guest Amy Goodman. Ms. Goodman drew some interesting parallels between gift economy/reciprocal altriusm (without using the language) and embedded journalists. An emdedded journalist relies on the troops they’re with to protect them, keep them safe, keep them informed. It runs very strongly counter to the best interests of the journalist (staying alive) to do anything to piss the troops off – like report negatively on them.

If something so simple as a less than $100 gift, a pen or pad, is enough to sway the opinion of someone who has, in theory, received enough education to make appropriate choices based on empiracal evidence and not gifts, how can it not be a force strong enogh to influence the reporting choices of someone whose life is potentially on the line? There is a sublte threat and coercion there which strongly tilts the reporting cards towards the military and away from factual reporting.

The internet is one of those fun things that can be used for good, or for serious procrastination (which some might argue is still good). Since I’m obviously not getting anything done that I need to, seeing as I’m buried under several blankets on the couch, watching Whose Line and trying not to form iciles on myself, I figured I’d use the procrastinating power of the internet to catch up on various email alerts and at least use my brain for something more strenuous than trying to figure out what animal Ryan Stiles is miming at the moment.

I’m still trying to figure out just how the paper affiliation is working, but this article in some Texas-area paper is talking about the growth of medical spas in our country. These are places doctors open to do mostly cosmetic surgeries in an aromatherapy-filled spa. It goes rather without saying that these places are not covered by insurance, but are out-of-pocket fixes for people with disposable money and the inclination towards cosmetic surgery. One of the more interesting things about them is that the doctors are not what you’d think: ob/gyn’s, neurosurgeons,… in other words, not people with cosmetic surgery backgrounds, and sometimes not even outside/extended training. That is, of course, if you manage to get a doctor at all – many people are simply technicians with little to no training, applying chemical peels and botox treatments.

In the article, David Magnus of Stanford’s Center for Biomedical Ethics says that this flocking of doctors to spa services “says something about medicine that we should be concerned about” and that it’s not necessarily about the traditional role of a doctor promoting patient well-being. As much as I admire Magnus, I’m more inclined to agree with Jonathan Moreno, who’s also quoted in this article. Dr. Moreno points out that society does have this notion of doctor’s acting for social good, a romanticized notion of the Time Life doctor walking down the dirt road, taking payment in the form of apple pie and gratitude as much as financially (well, Moreno starts that thought out, with my own embellishments for illustrative purpose). But that romanticized notion hasn’t caught up with the realities of managed care and the slim margins of profit now available for doctors. (Whenever I get depressed over the amount of debt I’m going to eventually graduate with, I just remind myself what my sister is going to end up with, once she’d got her M.D., and I stop grousing so much.)

In conjunction with our romanticized notion of the good doctor, we have the Porsche-driving, McMansion owning doctor who brings in fabulous amounts of money from their practice. What does it matter, we think, that insurance companies are in a position to negotiate lower payments while malpractice costs soar? They still have money! Our idea of who and what a doctor is has not caught up to the present, so we see articles about doctors opening spas for cosmetic purposes and roll our eyes; those greedy doctors, just wanting more money.

I just don’t think it’s that easy. Were it any other business, we’d be applauding the entrepreneurial spirit, finding a new way of making money! But since it’s attached to a medical degree, we become suspicious.

I do agree that we should look for some sort of guidelines for these spas, to guarantee some basic level of knowledge and care. But in some ways, this is also the responsibility of the client, to make certain the background of the person they’re seeing is up to parr. And given how many people who do have money opt to travel to other countries to have medical treatment, it’s obvious that credentialing services aren’t necessarily the most important thing for clients. Often, I think access, environment, and cost end up playing more to the greed and desires of the client.

It’s an issue that can’t simply be boiled down to “bad doctor, greedy”. I think these medical spas are symptomatic of several much larger social issues. Putting the emphasis on the doctor as greedy shifts the focus away from those larger social issues and lets them go unaddressed, while simply patching that which is immediately in front of us.