Innovation and risk

The more novel a treatment, whether in the medical community at large or in a particular treatment center, the higher the risks for a patient considering a treatment, as the discussion by the physicians in this case reveals. Not only does the technology associated with a novel procedure improve, the statistics improve for a given center as the associated surgeons gain experience, so the risk for the first patient in a procedure or in a center is much higher than for later candidates. The last three decades of organ transplantation offer a case study in the costs and benefits of innovation in surgical techniques, and have been extensively commented upon by scholars in many disciplines. Our authors raise questions not only about the feasibility of this particular procedure for this particular disease, but also about the justice of the distribution of the healthcare dollar between expensive procedures that benefit a few and less expensive treatments for other diseases that may benefit more – much discussed questions of utilitarian ethics and public health. The open and decentralized US system of health care and reimbursement renders many such considerations moot, since there is no designated “healthcare dollar” in that society that cannot be allocated in other ways.

Adolescence and decision making

Both this case and the next represent difficult healthcare decisions about high-risk medical treatments involving adolescents.