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J Thorac Cardiovasc Surg 2003;125:23-24
© 2003 The American Association for Thoracic Surgery

Editorials

Nothing is fair or good alone

Niloo M. Edwards, MDa, Kenneth M. Prager, MDb

From the Departments of Surgerya and Medicine, Columbia College of Physicians and Surgeons, and the Departments of Cardiac Transplantationb and Clinical Ethics, Columbia-Presbyterian Medical Center, New York, NY.

Received for publication Sept 13, 2002. Accepted for publication Oct 1, 2002. Address for reprints: Niloo M. Edwards, MD, 7-435 MHB, 177 Fort Washington Ave, Columbia-Presbyterian Medical Center, New York, NY 10032 (E-mail: nme3@columbia.edu).

The first 20% of the full text of this article appears below.

See related article on page 49.

It is doubtful if many doctors who actually care for the sick and the infirm, plan their actions on the basis of the predicted effect upon society. Instead, the dominant tradition is for the physician to provide the best care of which he is capable for those who either seek his services or are assigned to his responsibility; by and large this is done without regard for the conceivably broader issue of whether treatment is justifiable on social grounds.

        —T. E. Starzl
Transplantation Proceedings, 1966

We are never more torn between our desire to do what is best for the patient and what is best for society as a whole than in the field of transplantation, where the shortage of organs has led to a policy of distributing this scarce resource on the basis of organ survival rather than strictly on patient need. In medical ethics terminology, it is a conflict between beneficence, doing what is best for our patients, and justice, the fair societal allocation of a scarce resource. The . . . [Full Text of this Article]


Related Article

Use of two recipient lists for adults requiring heart transplantation
Hillel Laks, Daniel Marelli, Gregg C. Fonarow, Michele A. Hamilton, Abbas Ardehali, Jaime D. Moriguchi, Jessica Bresson, David Gjertson, and Jon A. Kobashigawa
J. Thorac. Cardiovasc. Surg. 2003 125: 49-59. [Abstract] [Full Text] [PDF]





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