The Societal Impact of the Artificial Heart

One of the obvious moral questions raised by research to develop an artificial heart is whether developing this device is the best way to spend limited research dollars in meeting the healthcare needs of Americans or of the world's population as a whole. Artificial heart research is expensive. The costs of doing the first TAH implants ran into the hundreds of thousands of dollars, and current research promises to be much more costly. Approximately 40,000 people die annually from heart disease so the life saving potential of the artificial heart appears significant, yet the development of expensive new medical technology raises ethical questions about where money should be allocated and what diseases should be the priority for research.

Many experts note that to develop, test, and manufacture a fully perfected artificial heart would probably cost billions of dollars. Those most likely to benefit from access to such a device would likely be those who could afford insurance to pay for mechanical hearts. The quest for a totally implantable artificial heart, as with many other new procedures, devices, and pharmaceuticals, brings to mind questions of equity and justice in asking all to bear the cost of research for a device that would only be available to some. Questions of fairness also exist in the decision to build a machine that may add years of life to those at the end of their life span, when tens of millions of persons around the globe die before reaching adolescence from diseases and injuries that can be prevented. Explicit debates about fairness have not been very much in evidence regarding how best to allocate resources to perfect new therapies in American healthcare policy. If the pursuit of a TAH is to continue, it would seem prudent to make considerations of fairness a more central part of the policy debate.

Finally, the development of the total artificial heart and the use of ventricular assist devices have gained popularity and are believed to be one solution to the problem of a limited number of donor hearts and an ever-increasing transplant waiting list. It is imperative as we seek new technology to replace organs that cease to function effectively that we continually ask, what are the acceptable limits of our drive for prolonging life through radical replacement technologies?

ARTHUR L. CAPLAN (1 995) REVISED BY ARTHUR L. CAPLAN SHELDON ZINK

SEE ALSO: Biomedical Engineering; Cybernetics; Healthcare Resources, Allocation of; Informed Consent; Justice; Research, Human: Historical Aspects; Transhumanism and Posthumanism

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