David Shactman is the author of the new novel Mortal Choice. A health policy expert, he lives in Massachusetts and in Florida.
Q: What inspired you to write Mortal Choice, and how did you create your character Cassandra Crawford?
A: When I was a health policy researcher at Brandeis University, I found out that over a million Americans travel out of the country every year for surgery. This seemed surprising because we have the most sophisticated and high-tech health system in the world.
Of course, the reason for what is called “medical tourism” is money. Many surgical procedures cost 40-80 percent less in other countries and there are millions of Americans who lack health insurance and cannot afford our health care.
I started to research this phenomenon and came across something that piqued my interest. A lot of Americans were traveling abroad to get illegal organ transplants. There is a worldwide shortage of kidneys for transplant and thousands of Americans die every year on a daunting waiting list.
Since life expectancy on dialysis is only 5-10 years, and since the potential success of a transplant diminishes every year, many people have a stark choice: Die or buy a kidney.
However, buying a kidney is illegal in every country except Iran. And the black-market is illegal, dangerous, and exploitive. Rich people don’t sell their kidneys, so there are serious moral questions about the rich bribing the poor for their organs.
Some question whether there should be a legal, regulated market. After all, we could save thousands of lives every year. Since outlawing the sale of kidneys has done nothing to curtail the trade, some say that it is not illegitimate to ask if we are willing to let people die to preserve our moral purity.
On the other hand, treating human beings as a commodity is debasing. Not everything should have a price.
All of these issues are controversial and morally difficult, and that inspired me to write this book. It might inspire others to seek better solutions than our currently flawed system of distributing organs.
I thought the best way to elicit readers’ emotions was to create a sympathetic character; in this case, a mother with a young child who needed a kidney. Making her an FBI agent was just a possible plot that began to play out in my mind.
Q: Did you know how the novel would end before you started writing it, or did you make many changes along the way?
A: The plot changed continually as I first wrote it. Sometimes characters kind of surprise their creators. As you think about them you see new possibilities that you did not envision previously.
After the first draft of the manuscript, I saw areas where the plot could improve. It wasn’t until the third or fourth draft that I changed the ending substantially, bringing the moral questions more sharply into focus.
Q: What do you think the novel says about the kidney transplant system?
A: The transplant system in the U.S. is well-meaning and run by dedicated professionals. However, it has many serious flaws. I do not pretend to have any answers and do not advocate for any particular solution. If my novel gets readers to think about the current problems and, perhaps, involve themselves in better solutions, I would be very pleased.
Q: What do you hope readers take away from the book?
A: I hope people grapple with the moral questions. In part, the book is about the tension between morality and mortality. Does the fact of an imminent death ever change the moral equation? In addition, I hope the book increases the awareness of the shortcomings in our current system.
Q: What are you working on now?
A: I am working on another Cassandra Crawford – Martin Goldberg mystery. The plot includes counterfeit drugs and terrorism.
--Interview with Deborah Kalb
No comments:
Post a Comment