In new historical and technological era, new technological innovations permit new approaches to prolongation of life and saving people from incurable earlier diseases. Exotic lifesaving therapies is one of the effective approaches to treat patients and return them to life. The article discusses both strengths and weaknesses of "exotic (medical) lifesaving therapy," or ELT, and its ethical issues for medical staff.
ELT means medical tools which help a patient to prolong his life using “spare parts” such as somebody’s heart or mechanical devices able to replace an ill organ. Mainly, ELT means transplantation and mechanical prolongation of life with the help of technological solutions and devices such as haemodialysis. Rescher points out that ELT consultation and liaison require special skills. The first skill is knowledge of the biophysiologic components along with their associated psychosocial issues. The second skill is an understanding of the hospital culture along with a tolerance for professional ambiguity, and intrusions imposed by medical priorities. The third skill is learning to deliver psychological services both formally and informally, with an understanding those patients and their visiting families do not automatically want psychological services. The fourth skill is the ability to translate and communicate psychological principles and interventions that others can understand and even perform.
The main problem (and weakness of) with ELT is a selection criterion. Rescher underlines that: “in "spare-part" surgery there is always the problem of availability of the “spare parts” themselves (Rescher, 1969, p. 174). Possible roles associated with transplantation patients involve pre- and posttransplant assessment of the patient and family, assisting with coping during and after the procedure, support for the emotional needs of staff members, and sometimes grief work with the family, sibling donor, or staff if the patient dies. Each phase has its own set of stressors. Some pretransplant phase stressors are the family stress of possible sibling donors, which sibling donor is more appropriate, the patient being indebted to the sibling, the waiting period, and the misconception that the patient will acquire the personality characteristics of the donor.
Rescher proposes two main principles for doctors to select patients for ELT: the criteria of inclusion and the criteria of comparison. “(1) the selection from among all possible candidates (by a suitable screening process) of a group to be taken under serious consideration as candidates for ramified subtleties; and (2) the actual sintrination) that it is justified, insofar as any mode of procedure can be justified “ (Rescher, 1969, p. 175). Usually, patient-centered consultation involves bedside consultation and other forms of patient contact. Indirect psychological consultation relies just on the referral source without any patient contact. Collaborative team consultation involves interaction with the patient, referral source, and other team members. The referral sources are usually the primary clinical personnel, such as physicians and nurses. The psychologist should balance the needs of both the patient and clinical personnel. However, collaborative relationships with the referral sources are very important and the psychologist should not use a distant authoritarian manner. Satisfaction by the clinical personnel is strongly related to the diagnosis agreement between the referral source and the psychologist.
The main strengths of the proposed system and the criteria is that it allow at least some people to survive and be treated. New measures for determining quality of life have been developed. The study shows that informative support (advice or personal feedback) and emotional support (caring, sympathy, love) are negatively related to adherence to the immunosuppressant medications. A possible solution is for multiple investigators in different hospitals to collaborate in their research. This will offer more concrete and valid information on the effects of ELT. Rescher underlines that the contribution of cognitive-behavioral approaches to comprehensive care in patients is increasingly well recognized by various professional groups. A survey of health care providers revealed that ELT interventions are among the most widely offered psychosocial services. This widespread use of such intervention strategies can be attributed to several factors. First, and perhaps most important, cognitive-behavioral interventions have been shown to be effective in reducing emotional distress and controlling physical symptoms. Second, the interventions can usually be administered in a brief period of time and thus are well suited for use in oncology where rapid control of aversive symptoms may be necessary. Third, the ELT can be easily tailored to deal with the unique symptom control problems and quality of life issues that cancer patients experience. Fourth, the ELT are readily accepted by patients because of the emphasis that is placed on increasing the patient's sense of personal control and self-efficacy. ELT intervention strategies place great importance on the normalization of patient adjustment. Additional analyses indicated that patients who received group therapy and hypnosis experienced less pain than patients who received group therapy alone. Although these findings support the use of hypnosis for relief of pain related to metastatic disease, they require replication for at least two reasons. First, the assignment to self- hypnosis in this study was not based on random assignment. Second, since many subjects died before the one year follow- up, the outcome analyses required extensive use of statistical corrections for missing data. Future studies could best deal with this issue by examining the efficacy of hypnosis over shorter time intervals. ELT studies have demonstrated a number of phenomena that may be important in understanding the determinants of ELT selection and the effects ethics. Studies dealing with issues of illness hopefully illuminate issues in self-management across a wide range of chronic illnesses.
A model of stress in ELT suggests that initially there is an adjustment phase to the news of the required perception of this approach. It is viewed as a stiessor that interacts with the existing resources and the perceptions of this stressor. This leads to the adaptation phase where initially they treat everything as a crisis. This leads to a “pile-up.” Strategies to deal with this pile-up involve coping methods of perception of this pile-up and use of existing and new resources. During each of the three phases of OT, appropriate play techniques can ameliorate some patient stress. Rescher explains that: “ELT should be recognized that this injection of man-made chance supplements the element of natural chance that is present inevitably” (Rescher p. 184). The parents may feel guilt over issues such as the death of the donor, competition for limited organs, and the burden of the informed consent decision for the child. One study showed that BMT survivors had good quality of life (physical and psychosocial dimensions of functioning). The wait at home has concrete issues such as a financial burden with subsequent concerns about the need to get public involvement to raise funds.
The issue of organ transplantation has become a serious consideration and will continue to be prevalent in the 21st century. Therefore, it is used as a prototype to discuss issues of decision-making and treatment compliance issues that raise the ethical and practical concerns involved in having this choice. Finally, the issues of prevention of accident, injury, and recognition of the precursors of ELT are discussed. The author attempts to set forth a functional analysis for use by health care professionals to help them see where to focus their efforts, whether it be on prevention, remediation, or teaching self-care behaviors. Future directions for research are specified. ELT proposes great chance for terminally ill patients; still it should be carefully applied by medical professionals to meet ethical criteria of their profession and patients’ rights.