Borrowed Time

"Miracles of modern medicine," such as organ transplants and artificial organs, are acclaimed as the American medical communityas progress against death. But is progress equivalent to success? What is the quality of life for those chosen to receive such "miracles"? What criteria select the recipients? Who pays and how does this affect the ethical choices that must be made by doctor and patient? Using dialysisthe artificial kidney machine that "solves" renal failureas his framework for evaluation, Alonzo Plough examines the medical, economic, political, cultural, and ethical questions that remain unanswered amidst the technological triumphs. The procedures used to treat kidney failure (dialysis, the artificial kidney, and kidney transplants) are the only extreme medical technologies that are government subsidized for anyone, requiring them to live. Although once just as controversial as the use of the artificial heart is today, these procedures are now accepted as routine. Through extensive research and interviews, Plough shows how federal entitlements force the rationing of services in subtle but important ways. He states: "Survival and rehabilitation depend as much on the social class of the patient as on the miracle of the technology. The cure is not a cure but a prolongation of life, and the quality of those prolonged months or years ranges from pure agony to remarkable adjustment." This controversial study, which was recently supported by the New England Journal of Medicine, asks: How do we differentiate between the miracle and the mirage in modern medicine? Borrowed Time confronts the varieties of hope invested in new machines, the nature of medical rhetoric, and the power of medical mythology, and examines their effects on our experience of health and illness. Author note: Alonzo L. Plough is Associate Professor of Health Policy in the Department of Urban and Environmental Policy at Tufts University.