On March 23, 1983, Barney Clark, the world's first recipient of a permanent artificial heart, died only 112 days after his surgery. In Case Studies in Biomedical Research Ethics, Timothy Murphy examines this controversial case and raises questions about the ethics surrounding new medical interventions.
Barney Clark was born in 1921 and, after a lifetime of smoking, was diagnosed in 1978 with emphysema, congestive heart failure, and cardiomyopathy (degeneration of heart tissue). Heart transplantation was relatively new at that time, and Clark at 57 was considered too old to be eligible for the surgery.
A medical committee at the University of Utah was interested in finding a candidate to be the first person to receive an artificial heart, the Jarvik-7 (named after its designer). This committee thought that the candidate should be so ill that death was imminent and the prognosis offered no more than a year of life. Clark met these conditions.
Clark signed an eleven-page consent form, he was interviewed by members of the IRB about his choice, and a team of physicians tried to test his determination by urging him to change his mind. He did not.
Dr. William DeVries led the medical team that supervised the implantation of the artificial heart in a complicated surgery that began at 11 P.M. December 1, 1982. The Jarvik-7 was a mechanical device that was hooked by tubes to an external air compressor to move blood. The external compressor weighed 375 pounds, and Clark could never be without it. After the operation, Clark was in poor state and experienced considerable confusion, delirium, memory loss, periods of semiconsciousness, and seizures. He required surgical intervention to replace one of the heart valves which broke two weeks after the initial operation.
Clark’s health was never especially good, but he did appear before videocameras, and selectively edited videos were released to the media. This public visibility gave the impression that he was glad to be alive. In fact, Clark’s overall condition could only be called burdensome, and he died on March 23, 1983, of multiple organ failure. It was not long before scientists were split in their opinion about the value of the artificial heart. Some called it one of the boldest experiments ever attempted. Others said it more than failed. Still others called in unacceptably expensive. DeVries defended the artificial heart noting that, without it, Clark would have been dead by midnight on December 1, 1982.
The FDA, which oversees medical devices, allowed DeVries three more tries with the Jarvik-7. The first of these patients died after surviving for twenty-one months; the second survived for ten months and two days; the third survived ten days. In the last case, DeVries admitted that the surgery had probably shortened the patient’s life. In 1990 the FDA withdrew approval for use of the Jarvik-7 as a permanent device, or even as a bridge for a patient awaiting a human heart transplant. Patient referrals to DeVries dropped, because other physicians were concerned that he had too many conflicts of interest rooted in his desire for success and financial gain. They worried that he was putting technical success ahead of patient care.
Murphy closes this examination by leaving readers with the following three questions:
- To what extent is it ethical for a health care team to offer a patient an intervention that might possibly extend his life and then try and persuade him to not accept it?
- What information do you think would be crucial in explaining the risks and benefits of an artificial heart transplant?
- It is reasonable to expect some failure with new medical interventions. In your view, do the survival times of the patients in this case amount to a reason to shut down the use of a mechanical heart, or should more attempts be allowed?