Transplantation Ethics

As a medical anthropologist, I study the culture of medicine as it affects patients, healthcare providers, and society at large. I am interested broadly in the problem of clinical uncertainty, and the complex social dynamics and moral problems that arise from it.  Medical practice often must balance precariously on the knife’s edge between offering healing and doing harm, because many of our most powerful therapeutic tools contain the potential for both.  Deciding what can be risked in the hope of helping cannot rely on scientific data alone, but is powerfully guided by social norms and moral values as well.  My research looks to understand how such difficult decisions are made and experienced by the patients, clinicians, and policy-makers faced with them. 

I have explored these issues in two areas of medicine where the balance between saving life and risking it can be uncertain: organ transplantation and pain management.  As an anthropologist, I am interested in comparing how different cultures respond to the problem of clinical uncertainty, and so have studied these issues in the U.S., Mexico, and Spain.

Organ Transplantation

My research on organ transplantation focuses primarily on the social and ethical questions raised by living organ donation.  I have conducted in-depth interviews with living kidney and liver donors in the U.S. to explore how they came to donate and what their post-donation experiences have been.  I have also carried out extensive fieldwork in Mexico to study the development of living donor kidney transplantation there, and its impact on families, the healthcare system, and national politics.  My work on transplantation appears in numerous journal articles and is published in my recent book Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico.

Pain

Pain is the most common reason for seeking medical care in the U.S.  Yet the subjectivity of pain and the risks that accompany many pain medications often leave clinicians uncertain about how best to assess and treat it.  This uncertainty can produce frustration and even conflict with patients, making pain management a highly contentious area of both clinical practice and public policy.  Using shadow observations and in-depth interviews, I have been studying how clinicians and patients interact and make decisions around pain.  This ongoing research seeks to shed light on these difficult dynamics, and forms the basis of my second book project.

For more information, please see my faculty profile.

Publications

See publications in PubMed.

Contact

Contact Megan Crowley-Matoka, PhD, at 312-503-7962.

Ethical issue in Pediatric Cardiology

I am interested in issues that affect decision-making, informed consent, and implications of policy recommendations in pediatric cardiology. To this end, I have pursued research relating to:  

• Implications of universal lipid screening and statin therapy in children
• Pediatrician attitudes towards universal electrocardiogram screening and its implications
• Variations in practices for heart transplant listing among pediatric transplant cardiologist
• Presence of concomitant genetic abnormalities in neonates undergoing surgery for congenital heart disease and its potential impact on parental decision making
• Parental refusal of surgery for congenital heart disease

Bioethics Certificate Program

I am involved in creating a bioethics certificate program for graduate medical trainees.  Clinical medical ethics or bioethics has long been recognized as an important component of residency education and requires that residents are provided educational experiences to demonstrate competency in professionalism and interpersonal and communication skills. Specifically, understanding ethical principles, identifying ethical issues encountered in medicine, and demonstrating the ability to perform ethical analysis is critical in clinical decision-making when it involves consideration of patient and family values.   Training physicians to do this well and be leaders in the future in biomedical ethics education can be challenging.  My goals for this program are to: 

• Evaluate the current landscape of trainee education with a rigorous needs assessment
• Explore methodologies to develop a curriculum that will not only effectively teach ethics to medical trainees but will also identify tools that will translate to trainees’ future careers

For more information, please see my faculty profile.  

Publications

See publications in PubMed.

Contact

Contact Angira Patel, MD/MPH, at 312-227-4100.