One Miracle, Many Doubts

A feat of heart surgery sharpens the debate over benefits and costs

  • Share
  • Read Later

(2 of 8)

On a narrow technical level, this is partly a continuing debate about the comparative merits of transplanted human hearts vs. mechanical hearts (not to mention animal hearts like the one that kept Baby Fae alive for three dramatic weeks). When Dr. Christiaan Barnard began performing some of the world's first heart transplants in 1967, such efforts usually ended in failure and death because the patient's immune system rejected the implanted heart. But the development in 1980 of the antirejection drug cyclosporin has brought a drastic change. More than 200 heart transplants a year are now being performed in the U.S. alone, and the survival rate is about 80% for one year, 50% for five years. "I love life," says Dr. Barnard, now 62, retired, and contemplating a third marriage (to a 21-year-old Cape Town model), "but I certainly wouldn't go for an artificial heart. A transplant, yes, but I don't fancy being attached to a machine for whatever life I have left." On a more philosophical level, some experts challenge the very idea of artificial and transplanted organs. Dr. Lewis Thomas, president emeritus of the Memorial Sloan-Kettering Cancer Center and the thoughtful author of The Lives of a Cell, warns that such procedures represent an "insupportably expensive, ethically puzzling, halfway technology." Says Kenneth Vaux, professor of ethics in medicine at the University of Illinois: "We are going to have to decide as a society what we want from our bio-medical projects. What kind of a person are we seeking to create? A collection of interchangeable parts you can continually change when those parts fail? An artificial person? We are going to have to temper our ambitions and learn to accept the inevitability of disease, the inevitability of death itself."

Colorado Democratic Governor Richard Lamm, 49, who created a furor last spring by declaring that "we've got a duty to die and get out of the way with all of our machines and artificial hearts, so that our kids can build a reasonable life," reasserted" that view last week. Said he: "High-tech medicine is really the Faustian bargain, where for a few extra days of life, we have to pay the price that could bankrupt the country."

Pay the price—the argument keeps coming back to that. When people are sick, they and their families hardly question the price; somebody will have to pay—the insurance company, the Government, the hospital. Humana, for one, is waiving all heart implant fees for Schroeder and other pioneering patients, though this may serve primarily to give the institution a commanding leadership in the field of artificial hearts. But somebody does eventually have to pay.

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
  6. 6
  7. 7
  8. 8