Medical ethicist Art Caplan joins Boston Public Radio on Wednesdays to tackle tough ethical quandaries in the field of medicine. Caplan is head of the division of medical ethics at New York University's Langone Medical Center. Wednesday on BPR Caplan talked about organ donation, Frank Underwood's "America Works" plan in House of Cards, marriage dynamics when a spouse gets sick, and doctors' bedside manners.
Questions below are paraphrased. Caplan's responses are edited where indicated [...].
So being an organ donor isn't as simple as checking the box on your drivers license?
Polls show that most people want to be donors. [...] The default is you opt in, you have to say, I wanna do this. [Support is] probably 70, 80 percent for organ donation.
That's huge support. So why are there organ shortages?
The problem is this: to be an organ donor [...] you have to die on life support. You have to have a head injury, and everything else has to be in good shape.
You have to be on life support — with a head injury for instance — for your organs to be useful?
You can donate tissues like cornea without going on life support.
And family can also intervene.
[Yes.] It's no just some guy coming in there and yanking out the organs.
In the new season of Netflix's House of Cards, President Underwood proposes a work project called America Works. He says unemployment is a public health hazard. Do you think it's persuasive?
It's novel, I agree. Unemployment is linked up to poor health. You know years ago when doctors went down to those Freedom Rides to Missisippi, one of the things they prescribed was food.
Do you think Underwood's proposal would work out here in the real world?
I appreciate the sentiment, [...] but it's not an emergency. It's chronic. [...] I'm not saying it's bad as a publicity stunt. [...] I don't want to make everything into a public health problem that doesn't require any medical expertise.
Is Netflix influential enough to have a policy impact, and have lawmakers contemplate pushing something like this?
A tiny bit. I mean, sadly, in the heavily stratified world of TV viewing and media viewing, I don't know if House of Cards hits that many eyeballs.
A new Iowa State University study found that a marriage was more likely to end in divorce when the wife got sick. Does this surprise you?
Who paid for that study? That is a ridiculously unnecessary study. Everybody knows that men are wusses, everybody knows that men are jerks. [...] I'm not here to argue it.
A recent piece in The New York Times talked about doctors improving care by listening better. This makes a lot of sense as a simple fix, right?
Learning to listen — you don't necessarily interrupt the patient every two seconds. You're going to listen to them explain what it is they're feeling. You don't have to solve every problem, but you have to listen to it and be supportive.
And patients aren't stupid, either.
They kinda know if they have certain kinds of cancer [that] they don't have a lot of time. So what works better is, 'Hey, I hope you make it to see the Super Bowl.' [...] Giving them a little hope. It's more [like,] get empathetic to where their situation is. Don't ignore them, but don't over-promise.
Distraction plays a part in this, right?
It's great that we have all the electronic health records, [...] but when I go to the doctor my doctor's not looking at me. He's looking at a screen! [...] Technology has started to overwhelm the time of people. For a lot of folks they just want that attentive ear.
