Transplant coordinators want to work with physicians to increase donations
Regarding "Defining physicians' roles in increasing organ donations" (Article, July 10/17): The members of the North American Transplant Coordinators Organization share the concerns brought to light by
your article. In fact, the lead statistic -- 60,000 people on the national waiting list -- is more than 10,000 less than on today's list! Alarming news, but true. And every day patients die waiting because a suitable organ was not available.
In the article, Michael Williams, MD, aptly points out that the physician "sets the stage" for donation. In this country, where families designate donors, the grieving process is an unavoidable forum for donation discussions. Multiple studies have high
lighted the importance of timing and compassion when introducing donation to grieving families.
NATCO's members are procurement and clinical coordinators and other transplant professionals who work tirelessly to improve donation rates and to care for patients before, during and after transplantation. Our 1,850 members are knowledgeable and experi
enced in virtually every aspect of transplantation. We share the physicians' concerns that it is often up to the physician to help the family understand the finality of brain death.
We strongly agree that physicians can help donation immensely by taking time to explain death to families, and the absolute nature of brain death. Transplant procurement coordinators recount numerous incidents showing the lack of understanding of brain
death among family members.
Timing is critical in the donation process, so it is paramount that physicians understand that bringing up donation in the same discussion in which the death is announced is not an effective approach. Organ procurement organizations, like physicians, a
re looking for the optimal way to provide sound information to decision-makers at a very difficult time. Neither OPOs nor the Dept. of Health and Human Services intends to remove physicians from the request process; rather, collaboration is sought so that
families have all the information they need before they make a decision.
We are grateful the AMA is examining this issue. More patients are added to the list every day, while countless organs are buried because families either did not get the option to donate, or the option was not considered positive. Let us work together
to find the best way to let grieving families know donation is their choice!
--Bruce Nicely
President,
North American Transplant Coordinators Organization
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Article should have pointed out ethical concerns on physician-run day spas
Regarding "Club med" (Article, July 3): It is important that entrepreneurialism not override ethics. This article overlooks the guidelines developed by the AMA Council on Ethical and Judicial Affairs o
n the sale of health-related products (Opinion 8.063) and appears to condone practices that may in fact violate AMA ethics policy.
The article is silent on the possibility that spas in a professional office may create a conflict of interest. Physicians who establish spas should be mindful not only of business pitfalls but also of ethical concerns.
Are patients being offered scientifically valid treatments? Are physicians disclosing their financial interests to patients? Do patients feel any pressure, however subtle, to utilize the supplementary services? Even a perception of such pressure erodes
the trust of the patient.
Finding new sources of income should never come at the expense of patients or the integrity of the doctor-patient relationship.
--Herbert Rakatansky, MD,
Chair, AMA Council on Ethical and Judicial Affairs
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Participation in executions is collusion with "judicial murder"
Regarding "Physicians do have proper role in capital punishment" (Letters, Aug. 7):
I take strong exception to the assertion by Olgard Dabbert, MD, that capital punishment, if "democratically approved," should be supported.
The oaths that medical practitioners take do not permit us to collude with judicial murder. Medicalizing murder by having it happen by lethal injection on a gurney makes it no less a murder. Physicians who are involved should be charged with unprofessi
onal conduct, and should be subject to malpractice or wrongful death actions. Let the state hang, shoot, gas and electrocute those whom it would murder, and leave medical professionals out of its grisly business.
--Alan A. Wartenberg, MD
Norwood, Mass.
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"Feeding tube" creates false image
Regarding "Court to ponder rights on medical decisions" (Article, July 31): One part of this issue is our framing of the options, and the language we use. Our biomedical technology has outpaced our voc
abulary to discuss it.
For instance, it is not a "feeding tube" unless you think you can get an enchilada down it. It is not "food" and it does not "feed." Artificial nutrition and hydration come not from the kitchen but from the pharmacy.
When health care professionals say "food" or "feeding tube," they call to mind decades of memories around "nurture," thus giving misleading information on which they expect families and courts to make good decisions. What we "say" is what they "see." B
etter metaphors will result in better decisions for patients.
--The Rev. Chuck Meyer
Vice President Operations,
St. David's Medical Center,
Austin, Texas
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