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Reading Groups Reading Guides
Transplant ISBN 978-1-894689-10-6 TRADE PAPERBACK Technothriller. A top heart surgeon, kidnapped, seduced, threatened with an unspeakable loss -- all to make him perform a forbidden procedure. Cutting-edge technology. Fast read.
DISCUSSION GROUP QUESTIONS Ethical issues in Transplant--Author's discussion questions This novel makes us consider multiple conflicts regarding life patterns and decisions. Can one devastate one's family relationships--wife, children, marriage--in a quest for professional success? Is such a serious situation ever recoverable? Can people really grow, appreciate their shortcomings, and restore meaning to lost relationships? Is it right for a formerly hot but now aging actress to seduce a susceptible surgeon under false pretenses, in order to win a movie role for herself? Is this not truly a victimless crime? We ponder these heady non-medical issues as we watch Carras, Costas, and Beth, as well as Flynnt and Philip, and Hilary as well, struggle and grow. The heart of this novel, however, has to do with ethical issues in contemporary medicine. When is the right time to take an experimental procedure to clinical application in human beings? Is it right to expose the first patient or patients to an untried technique? Is not the entire history of medicine and surgery one of brave surgeons and patients navigating their way through uncharted waters. What alternative is there? How else can medicine advance? Beyond those issues, the single key ethical issue raised in this novel has to do with whether a father has the right to give his own heart to save his son. Magazines and newspapers are full of laudatory stories about mothers, fathers, brothers, sisters, and more distant relative selflessly giving their organs to a family member. There is no question that an organ from a related individual is a much better immunologic "match" than an organ from a stranger--leading to better long-term results. As in our novel, the situation often does arise in whichna needy recipient is unknowingly "immunized" (or, rendered allergic) in the course of daily life to organs from unrelated individuals. This acquired allergy to the tissues of strangers usually does not apply to tissues from family members. Donations from family members usually match very well, immunologically. We view organ donations from family members as a wonderful expression of human love. In many cases, even an unrelated individual donates an organ for a stranger. Again, magazines and newspapers are replete with tales of such totally selfless acts of kindness to one's fellow man. This is, after all, what the Bible preaches. Jesus says very clearly, in John 15, Greater love hath no man than this, that a man lay down his life for his friends. If one can lay down his life for a friend, then certainly even more so for one's child. The scenario in the present novel is different from any faced up to now in the real world. The difference resides in the fact that the heart is an unpaired organ. We have only one heart. We have two kidneys, two lungs, and liver that can be divided into multiple lobes. A kidney donor, a lung donor, or a partial liver donor has every expectation to live a normal life (although he does face a low, but real possibility of complication or even death from the donor operation). A heart donor--if there ever should be one-- is certain to die immediately upon donation. Herein arises the core ethical dilemma in this novel. The idea of giving one's life for another has a long and honored history. The ancient Greek playwright Euripides presented this scenario in Alcestis; the heroine for whom the play is named gave her life so that her husband could live (eternally). The Bible condones such ultimate sacrifice as an expression of love for one's fellow man. Yet, when we think of the father, Flynnt, forcing the surgeon, Carras, to take his heart out and place it in another human being, we cringe. Why? Please ponder the following specific ethical questions arising from the key conflict in this novel: 1. Just a few short months ago, the world was captivated by a news report about a marine in Iraq who saw a grenade come through the hatch and land on the floor of his armored vehicle. The marine deliberately threw himself onto the grenade, condemning himself to instantaneous death, but saving the lives of the four comrades riding in the tank with him. Society views this as an ultimate expression of heroism. The marine received a posthumous award for his bravery. Why is this marine a hero and Flynnt an ogre? Is it not inherent in the very concept of war that some will give their lives for others, whom they do not even know? 2. If Flynnt wants to give his life and his heart, why should Carras not be allowed or even encouraged to carry out the operation? Why should such a decision not be within the scope of human freedoms? How much responsibility falls on Flynnt and how much on Carras? 3. Would you get in the way of a bullet headed for your son or daughter? I would, without thinking. How is this different from Flynnt's giving his life for his son? Is there something different because Flynnt's actions are deliberate, calculated, and executed over months, as opposed to suddenly and reflexively stopping a flying bullet? 4. Flynnt threatens Carras's own son, Costas. Would Carras be justified in performing the forbidden transplant in order to spare his own son's life? Why should Carras even hesitate--thereby jeopardizing the life of an innocent young man, his own son, no less, when Flynnt willingly insists on donating his own heart? And, after all, Flynnt's desired donation is for Flynnt's very own son. 5. As far as your author is aware, no one in history has ever donated his own heart to a loved one for transplantation. The news media have made presentations about the black market in organs--mainly kidneys. But, these are unwilling donors whose organs are stolen. It has been documented, as well, that poor individuals have sold a kidney for money for their families (almost never producing any substantive sustained improvement in the family financial situation). We are not aware of a single heart ever being sold with similar intent. Nor are we aware--yet--of a single willing donation of one's own heart. Do you think that the mere publication of this novel will encourage this type of self-sacrifice? Will we really get calls from mothers and fathers wanting to donate for their children? 6. Say that this novel does open Pandora's box--as Carras and Vance find to be the case. Is your author ethically responsible for facilitating the opening of Pandora's box by virtue of the very act of writing this novel? Ethical issues in Transplant--Dr. Baillie's questions Dr. Harold Baillie, Provost and Professor of Philosophy at the University of Scranton, is a foremost authority on the ethics of medicine. He has written a respected textbook for college courses entitled Health Care Ethics, now in its Second Edition.
Respect for life is the foundation of medical ethics. It is the root of the Hippocratic Oath and the reason why that oath has retained its power for much longer than two millennia. While a concern with medical ethics is obviously quite ancient, there has been a recent resurgence of interest that began in the late nineteen-fifties with the development of kidney dialysis machines. Initially, the interest was forced by the limited availability of the dialysis machines; respect for life required an ethical basis for decisions regarding who would be treated by dialysis and who would not. This often meant deciding who would live and who would die. A simple solution to this problem involved more production of machines, and for a while the development of new medical technologies was closely enough matched by increases in production that it appeared that this type of medical ethics issue would disappear. In its place, the discussion of the ethics of practicing medicine shifted to concerns with patient autonomy and the right of the patient to provide informed consent. What began as a concern with the physician gaining the patient’s permission to touch the patient quickly became a complex discussion of the extent of patient autonomy and the responsibilities of the physician (or any other health care giver) to follow or to limit the patient’s decision-making, whether because of the physician’s medical knowledge or personal ethics. Along with the discussion of medical ethics, there has been a discussion of the ethics of scientific research. There are many different types of scientific research, but medical research, like medical practice, finds its ethical core in respect for human life. Scientific research typically looks for results that are confirmed by repetition and fit into the known system of science. To protect human life, medical research relies on ideas that may originate in a laboratory experiment, but then move on to extensive animal testing. Only after the research suggests strong positive results is the procedure carefully tested on humans, first in small numbers, and then in larger; each step of the way is characterized by intense analysis of the results. The goal is to identify and minimize any risk to human patients, yet also to confirm the medical benefit to a patient. Today, we are well aware of how complex discussions of the ethics of both medical practice and medical research have become, and it is this complexity that is so well presented in Dr. Elefteriades’ book. Early in the book, Carras’ willingness to operate on Dr. Goldenberg is the reason for the original attacks on Carras’ character. He appears to have violated the ethics of medical research by rushing from incomplete animal testing (and the lack of support from the research ethics committee) to human use of the procedure. There is a clear tension between Carras’ desire to save the life of his friend and the need to protect human life by patiently investigating the variety of potential consequences of the new and radical surgical procedure. Does Dr. Goldenberg’s imminent death relieve Carras of the ethical obligation to proceed cautiously? Can we experiment on those we are reasonably certain will die soon, or must we respect their humanity by remaining cautious? As another example, Terry’s nuclear powered heart pump produces clots, one of which eventually kills him. It does not matter how many of pumps we produce, there remains the unsolved research problem of those clots. Technology has limits beyond our capacity for production. In its own way, supply remains a problem. The heart transplant that Philip needs requires an available and compatible human organ, and the supply of a heart with the needed tissue type is virtually non-existent. Terry’s willingness to die in order to supply a heart for his son provides a practical solution to the supply problem, but it raises serious questions about the range of Terry’s autonomy. Can a patient arrange to die in order to provide an organ for transplant? Do we own our body in such a way that we can distribute its “parts” at our will? But Terry’s desire to provide his own heart to heal Philip requires the cooperation of Dr. Carras. Even if Terry has the right to dispose of his own heart, does he have the right to require Carras to perform the surgery? Carras’ personal ethics (as well as the laws of the United States and the strictures of even the Hippocratic Oath) loudly proclaim that this act of killing one in order to save the other cannot be done. Ordinarily, this would settle the question. But Terry tries first to bribe Carras and later to force him into submission through kidnapping and torture. Terry’s assumption that every man has his price fails in the face of Carras’ ethical convictions. One can follow Carras and conclude that Terry is unethical and coercive, deserving to be completely frustrated in his efforts to force the doctor to operate. The nagging problem permeating this book, however, is not so easily resolved. Is Terry’s desperate attempt to save his son, even to the extent of using his massive economic resources in ethically despicable ways, truly wrong? This is not simply a question of balancing a hierarchy of ethical principles, the task of weighing the good and the bad, or even simply recognizing the good and separating it from the bad. This is about the life of Terry’s son, literally a question of flesh and blood. Can one be said to truly respect life if one cannot save one’s own flesh and blood, given the opportunity? Would Terry be ethical if he (arguably, selfishly) refused to give up his heart while his son died from the lack of a transplant? Carras, of course, initially argues that the issue is suicide and murder, not self-sacrifice. From this perspective, Terry is trying to commit suicide, and in order to do so, is trying to force Carras to murder him. As a matter of principle, this interpretation of circumstances makes sense. However, Terry, and eventually Vance, argues that Carras is not addressing the true ethical issues. They suggest that Carras is simply “trying to win,” reacting to a deep seated, perhaps unconscious, desire to control all around him. In other words, they suggest that Carras’ ethics is nothing more than selfishness, an inability emotionally to open to other people hidden in an effort to dominate others. Carras’ own family problems, including his non-extistent relationship with his son, are cited as evidence of this selfishness. This final argument of the book raises deep questions about the nature and origin of ethics. Where do our ethics principles come from? Are they rational, expressing our ability to think in universal terms that transcend the personal? Much of ethical thought rests on this assumption, expressed by leading historical figures like Kant or a contemporary medical ethician such as Norman Daniels. Or are they, rather, expressions of what is most personal about us? Nietzsche argued that an individual’s ethics is simply the expression of her or his psychological make-up. What one thinks is right or wrong is the result of how one’s will is shaped by one’s personal history. For example, the commitment to one another that Terry and Isaac share seems rooted in their family history, while Maigrot seems to choose right or wrong out of a fear of physical harm that has roots in his childhood. The enjoyment to be found in this book is rooted in its ability to raise profound ethical questions in the very practical (if somewhat fantastical) situations of an action novel.
EXCERPT Kidnapped by a ruthless billionaire for whom he has refused to perform an unethical operation, Yale Medical School's senior heart surgeon Athan Carras has been forced to work like a field slave on a Haitian plantation. One night, he escapes and, dressed in rags, struggles across a dark pasture... He turned his head to look from the corner of one eye. Trees, he thought, and where there are trees and cattle there should be a farm. He went forward faster now and before too long he became aware of something that was definitely man-made stretching off to either side of him. Hands outstretched before him, he found a chain-link fence, and when he reached up it was taller than he was.
About The Author John A. Elefteriades, M.D. is Chief of Cardiac Surgery at Yale University. He is author of House Officer Guide to ICU Care , Your Heart: An Owner's Guide , Acute Aortic Disease , and The Women's Heart: An Owner's Guide Pulitzer Prize awarded to Wall Street Journal series highlighting Dr. Elefteriades' research.
Howard S. Smith’s List Price: $17.95
About This Book North Korea defiantly launches a nuclear-tipped missile over Japan, exploding it in a mushroom-cloud firestorm offshore. A nuclear Iran, through its allies in Lebanon, is mercilessly lobbing missiles into Israel. A powerful China launches a killer satellite and destroys half of America’s spy satellites. Will one man’s love for a woman save the world, or destroy it? Setting: Japan, Mariana Islands, Southern Lebanon war zone, Upper Galilee kibbutz Protagonist: Suzuki Haruto, rigidly by-the-rules Tokyo Police Inspector Opening: A dead ‘Westerner’ in a Tokyo hotel. Nuclear North Korea is extorting concessions from Japan. Israel can’t stop the never-ending rain of terror rockets. Originality: In Isaac Asimov’s stories, the robot-based plots develop interesting twists because the robots must follow their rigid rules known as the three laws of robotics. Some sixty years later, this book updates Asimov’s work with a realistic technology for the robots, as well as a realistic driving force – military need – for their emergence. This is one reason the title is used, but the other one is that the main character of this book, Haruto, is in fact almost a robot (jinzouningen) who must follow his own internal rigid rules. And by following these rules an interesting twist in the plot arises, and ultimately leads to the emergence of vast numbers of robots in our world, thereby bringing Asimov’s vision to fruition.
Discussion Questions • Why does Israel want the Mikiyasu military robots? Why do you think Japan developed these robots in the first place?
Excerpt “A few years later… Pacific Ocean 35˚N, 160˚E “Missile is launching south of Pyongyang!”
About The Author Dr. Howard S. Smith is an MIT-trained engineer with an interest in artificial intelligence – the supermarket self-checkout machines are all based on his work – and natural intelligence – evolution of the brain. The author welcomes your comments. Please write to him at: authorhowardssmith@robotpress.net Author Telephone Participation Author participation via telephone is possible for Reading Groups. Please e-mail us for further information info@robotpress.net |
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Disclaimer: The website link robotpress.net is a contraction of the legal corporate name and is not associated with any other tradenames related to robotpress or roboticspress.
Disclaimer: Howard S. Smith's I,robot is not associated with the 20th Century Fox Film I,Robot or the 1950 Asimov book I,Robot or many other products of similar name.