The Dead

How many resources should be used on the deceased? Although at first glance, this may seem like an odd question in the health care field, it's actually quite relevant. For example, should we be paying for autopsies? Currently, the expense of most autopsies are covered by the academic institution performing them; weird as it sounds, it's a "free service" that the hospital provides. Autopsies historically were incredible sources of academic knowledge; they allowed physicians to confirm or deny that they had the right diagnosis, and to learn so much more intimately about disease states. Autopsies aren't cheap to do, however; pathology training is longer than that for internal medicine physicians, and they have a set of skills that no other doctor has.

Or what about keeping someone alive until their family arrives? It is such a common ICU theme that someone will be brain dead, or close, and we will maintain their organ functions artificially until the whole family can arrive. While this seems completely reasonable, a night in the ICU can cost thousands of dollars.

What if in order to keep an organ donor alive for the evaluation and procurement of organs, dialysis would be required? Would it be ethical - in a resource conscious way - to dialyze someone who was deceased in order to keep their organs healthy?

I don't think these questions are completely clean cut. We all have our feelings about those who have passed and also an idealized notion of what medicine is about. But in the resource-strapped environment we face today, we have to negotiate what seems reasonable and what doesn't.