HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Patrick M. McCarthy Robert M. Sade Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCarthy, P. M. Articles by Sade, R. M. Search for Related Content PubMed PubMed Citation Articles by McCarthy, P. M. Articles by Sade, R. M. Related Collections Professional affairs

Ann Thorac Surg 2005;80:793-798
© 2005 The Society of Thoracic Surgeons

---

Ethics in cardiothoracic surgery

Medical Ethics Collides With Public Policy: LVAD for a Patient With Leukemia

^a Division of Cardiothoracic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
^b Institute for Public Policy Studies, University of Denver, Denver, Colorado
^c Department of Surgery and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

^_* Address reprint requests to Dr Sade, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 409, PO Box 250612, Charleston, SC 29425 (Email: sader@musc.edu).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

The first 300 words of the full text of this article appear below.

	Introduction

 
Robert M. Sade, MD
There is a general perception that too much money is being spent on health care, and that costs are rising too rapidly. One source of the problem is believed by some to be the widespread use of expensive technologies, and this logically leads to a potential solution: get physicians to stop using such technologies. Obvious targets are cardiothoracic surgeons who have access to a substantial number of expensive technologies and a substantial number of patients to use them on.

To highlight some of the issues underlying the question of whether utilizing such technologies is justified, a case was constructed to illustrate the use of an expensive technology in a marginal clinical situation: a left ventricular assist device (LVAD) implanted in an older man with leukemia and an uncertain prognosis. To argue the question of whether or not the procedure was warranted, we recruited two outstanding proponents of differing views: Dr Patrick McCarthy, a cardiac surgeon who has broad experience with LVADs, and former Governor Richard Lamm of Colorado, one of the few public figures audacious enough to use the word "rationing" publicly. They presented their viewpoints at the Forty-first Annual Meeting of The Society of Thoracic Surgeons. The case that served as the focal point of their discussion is detailed as follows.

A 62-year-old male carpenter, Mr I. Sandy Wood, noticed that he was tiring much earlier in the day than he had just a few weeks before, and that the frequent small cuts he received at work bled much longer than in the past. His family doctor ordered a battery of laboratory tests that revealed acute myelogenous leukemia. Echocardiogram at that time was normal, with a left ventricular ejection fraction of 63%. He was told that the chance of ultimately curing his acute myelogenous leukemia with appropriate chemotherapy was . . . [Full Text of this Article]

This article has been cited by other articles:

				P. M. McCarthy, R. D. Lamm, and R. M. Sade Medical Ethics Collides With Public Policy: LVAD for a Patient With Leukemia Ann. Thorac. Surg., September 1, 2005; 80(3): 793 - 798. [Full Text] [PDF]