Sunday, January 02, 2011

The God Committee, Africa-style

Who knows when bioethics started? Like other annoying questions (When did philosophy start? When did romantic love start? When did rock and roll start?) there is probably no way to definitively answer it, but that does not stop people from trying. For some, bioethics started in the United States with the so-called 'Seattle God committee', the body of health care professionals and laypersons that was formed to decide who among patients with kidney failure should receive (then new, and very scarce) dialysis treatment. The situation in Seattle seemed to open a new field of inquiry: while the question 'who should get dialysis?' was partly a medical question, it went beyond that. It was not enough for doctors to invoke medical criteria alone, since many patients were medically needy -- the fundamental question was how to choose among them, if there are not enough machines for everyone. If not using medical criteria, what other criteria should be used, and how should we best come to reach such decisions? And so, the story goes, the idea was born of non-physicians assisting in resolving ethical problems within medicine.

This is an old tale. To read about it, you have to go back to a yellowed Life Magazine article from 1962. I was reminded of this piece of history when reading a recent article in BBC news about the rationing of dialysis machines in South Africa. It is striking that Tygerberg Hospital in Cape Town is wrestling with the same problems faced fifty years ago in Seattle, and from the reports, is not fairing much better. More specifically: just as the 'God committee' brought in controversial subjective criteria to decide who should gain access to dialysis, the committee in Tygerberg apparently cannot avoid doing the same. Part of the criteria are having 'good home circumstances' (i.e. running water, electricity, toilet, etc.), the motivation of the patient to adhere to the treatment plan and improve his/her health, and having a good social support network. It is fairly obvious that this criteria does not favor the poor. All other things being equal among needy dialysis patients, those who are better off socially and economically are more likely to gain access to dialysis. One could argue that these non-medical criteria have a medical justification: if a patient does not have good social circumstances, dialysis will not produce a favorable outcome for that patient. Probably. But the upshot is brutal. If you are really poor in Africa, and suffer from renal failure, you are seriously screwed.

In the United States, the federal government in 1972 made the unprecedented decision to extend Medicare provisions to enable the vast majority of patients with chronic renal failure to gain access to dialysis. Basically, faced with a very public rationing problem, they threw money at it. This is not an option in Africa. As chronic diseases become more and more prevalent in the region -- certainly more prevalent than new clinics, new technology and new medical professionals -- there are going to be a lot more stories like this.

Labels: , , ,

22 Comments:

Blogger Samual said...

Great Blog. Recognizing the vast potential of medical tourism, India has greatly increased its resource allocation to this thriving industry by engaging its more able citizens in learning the rudiments of medical practice and by providing infrastructure in order to facilitate medical tourism to India.

Orthopedic hospital India

3:04 AM  
Blogger BackpackUnion said...

I bow down humbly in the presecne of such greatness. It's good that they have thought about that. It was about time they did something. Thanks for sharing.
SwissGer Backpacks: Take 30%-50% off and enjoy FREE Shipping over $100, Ends 8/21/2011 @11PM PST

10:53 PM  
Blogger BackpackUnion said...

There is currently quite a lot of information around this subject on the net and some are most definitely better than others. You have caught the detail here just right which makes for a refreshing change! Replica Hermes Handbags | Cheap Louis Vuitton

10:11 PM  
Blogger Maffick said...

Arabic translation services Company Description: Los Angeles Translation and Interpretation, Inc. provides top quality certified translation services, translator and interpreter business

12:56 AM  
Blogger Maffick said...

Storage Melbourne To get the quality based service for storage services in Melbourne, Please contact Prestige Melbourne Removalist for a free and get the quality based service to meet out all your requirements for a perfect move

5:25 AM  
Blogger Wildnet Technologies said...

Actually you are going on the right track to make the sales high through the strategies and is will be much beneficial for boosting the sales. Implement it soon waiting for this one…SEO India

8:59 AM  
Blogger Wildnet Technologies said...

Great stuff from you, man. I have read your stuff before and you are just too awesome. I love what you have got here, love what you are saying and the way you say it. You make it entertaining and you still manage to keep it smart. I cant wait to read more from you. This is really a great blog.SEO India

9:16 AM  
Blogger danial11 said...

Welldone,I got useful information from your Blog.I will share this on facebook.Online Pharmacy

11:41 AM  
Blogger Maffick said...

Therapist NaturalTherapyForAll is the best resource to find a therapist, counsellor, psychotherapist, acupuncturist, hypnotherapist or therapy course information

2:42 AM  
Blogger adamstarc said...

Your post is truly informative for me and i am so grateful to you for sharing this informative post here. really great job done by you.

Brazil Butt Lift

10:58 PM  
Blogger Ricky jordan said...

Thanks for the update.There is a scope to reach out for the best with the power of information in our hands that i got from your blog.
astrological signs

4:59 AM  
Blogger john smith said...

I am agree with your Blog.Thanks for the useful information.I have been reading a lot of stuff about it. but the way in it is presented is nice.Here is the information about Production Services.

7:35 AM  
Blogger Allen soly said...

Such a inspirable and good blog . I got new knowledge able while reading this . Keep sharing this type of informative blogs.
Jewelry Stores

12:23 AM  
Blogger bridal stores in phoenix said...

Protect yourself from the sun with the high UV protection of our awnings sail shades Melbourne locals need Yarra Shade Co is worried about your safety when it comes to Sun damage awnings melbourne

12:54 AM  
Blogger martinsuji said...

There are firms who are in these services and offers storage facility to their clients. If you post more than please inform me by clicking this link Self Storage Melbourne.

5:53 AM  
Blogger martinsuji said...

The companies are well into the business and have everything f their own including blankets to plastic covers and boxes to cartoons. If you post more than please inform me by clicking this link Storage in Melbourne,Storage Victoria.

5:54 AM  
Blogger martinsuji said...

However my only concern is that these service providers only provides space at the end of the day you only need to load and unload goods to these spaces. If you post more than please inform me by clicking this link Storage Melbourne.

5:55 AM  
Blogger sana said...

Brand revitalize is on demand due to tough completion in the market. Thus lot of companies are available in the market for improve your search result in different search engine.

2:59 AM  
Blogger Hannah bolton said...

It’s a great site to see. That will help for improvisation of me. Will definitely marked as Bookmark.

business phone broadband

7:30 AM  
Blogger Ethan Harry said...

great work has done thanks for sharing and keep it up

Accredited GED Online

1:23 AM  
Blogger komal jain said...

I like your blog and say thanks for that a wonderful blog,
_________________
Vashikaran mantra for love Success

9:08 AM  
Blogger Zheng junxai5 said...

2015-10-13 zhengjx
Abercrombie And Fitch Clothing Outlet at New York
Louis Vuitton Handbags UK For Sale
uggs australia
Jordan 6 Retro Discount Sale
burberry outlet
Michael Kors Outlet Factory Online Store
celine handbags
michael kors bag
michael kors outlet
hollister uk
Louis Vuitton Handbags Official USA Website
Michael Kors Outlet Online 70% Off Handbags
michael kors bags
Michael Kors Outlet Online Store Clearance
coach factory outlet
Coach Outlet Online Coach Factory Outlet
Oakley Sunglasses Official Website Cheap Off
canada goose outlet
Coach Factory Outlet Official Website
Louis Vuitton Outlet Purses and Handbags For Sale
louis vuitton handbags
canada goose jackets
Louis Vuitton Outlet Store Locations
Michael Kors Outlet Factory Handbags For Sale
michael kors handbags
michael kors outlet
Abercrombie And Fitch New York Clothing Warehouse
hollister clothing
Up to 70% Off Louis Vuitton Outlet
true religion outlet

9:11 PM  

Post a Comment

<< Home