Sunday 20 July 2014

A Futuristic Solution to a Medical Need

In recent years I have contributed book reviews to the EMWA journal. Most of these have been reviews of books related to medical writing but a few have been for works of fiction with medical or scientific relevance.

The book Never Let Me Go, by Kazuo Ishiguro made a big impression on me and a review I wrote was published in 2011 (TWS, volume 20, issue 4). The review is reproduced in full (spoiler alert if you read on...)

Some may be familiar with another book by this author ‘The Remains of the Day’ but the setting for this tale is very different from previous books by Kazuo Ishiguro. Set in England in the late 1990s, it is a country we know but don’t quite recognise as normal. The story is told by Kathy H, a carer reminiscing about her own life and those of friends from her much loved school Hailsham and we follow their exploits through school and beyond.

Initially we find out how the children coped with life at the school. Familiar scenes are depicted with undercurrents and a certain degree of strangeness. The children are boarders with assigned guardians and vie to have their art work selected to be viewed in the gallery. Earning tokens from the sales and exchanges that take place several times a year allows the children to make small purchases for themselves. When they become older and leave the school they move into “the Cottages” and come into contact with “veterans”. At this stage they are encouraged to attend seminars in preparation for the next part of their lives and rumours abound about what this will be.

At first, the story has the feel of an ordinary tale about young people growing up, however, as it progresses there is an undertone of things not being quite as they seem. It appears that the children know nothing about life outside and have no family or memories of life before the school. The words used in the book to describe roles the young adults are expected to undertake are words we would recognise from society today: carer, donor, completing, guardian, donations. However what becomes clear is that their meaning in the society depicted in this fictional world is entirely different from what we might expect in our own
lives.

One rumour the young people really believe is the ability to have a “deferral” if you can show you are in love; Kathy and her two close friends search desperately for a deferral. In doing so, they discover the truth about themselves. What emerges is that the children are clones designed to be used as living donors with their beloved Hailsham described as a failed experiment. They are told by one of the school founders:

“...How uncomfortable people were about your existence, their overwhelming concern was that their own children, their spouses, their parents, their friends, did not die from cancer, motor neurone disease, heart disease. So for a long time you were kept in the shadows, and people did their best not to think about you. And if they did they tried to convince themselves you weren’t really like us...”

“…we demonstrated to the world that if students were reared in humane, cultivated environments, it was possible for them to grow to be as sensitive and intelligent as any ordinary human being. Before that, all clones—or students, as we preferred to call you—existed only to supply medical science….”

In calm and pseudo-scientific terms an explanation is given as to how they came about “….when the great breakthroughs in science followed one after the other so rapidly, there wasn’t time to ask sensible questions. Suddenly there were all these new possibilities laid before us, all these new ways to cure so many incurable conditions…..people preferred to believe these organs appeared from nowhere, or at most in a kind of vacuum…”

Beyond the donation processes, where the living donor obtains “completion,” still more possibilities for harvesting useful parts are described. This is one scenario of how technology might advance to make organs and treatments for incurable disease more available to all who need it. I hope reality never imitates this fictional account.

I read this book when it was first released and I often find myself thinking back to the premise of the book and wondering if we will ever go that far. Some of the more disturbing stories that emerge about the trade in human organs can be regarded as urban myths but not all. One recent report that had wide coverage involved a teenager from China who was reported to have sold a kidney because he wanted to buy a new iPAD [1]. One thing is sure, that organ was sold on for a lot more than the cost of an iPAD.

Ask yourself: if necessary, how much would I be willing to pay for a kidney, a heart, or a liver and would I question where it had come from?

1. see http://www.bbc.co.uk/news/world-asia-pacific-13647438

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