Psychological Dilemmas of Medical Progress

The psychological dilemmas created by medical progress are ambiguous and complex. In the selection of patients for chronic hemodialysis there is little evidence that psychiatric screening prevents behavioral disturbances associated with the rigors of dialysis; and in view of the ethical objections to selecting one patient over another for life-saving procedures, psychiatric contraindications are limited and should not be confused with value judgments to rationalize rejection of some patients. With living unrelated and related donors for organ transplants the basic psychological issue relates to whether the donation is based on altruism or neuroticism. The increased use of artificial and transplanted organs also raises questions related to quest for immortality and the role of the psychiatrist in working with the patient caught in the bind of the “too long” life.

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