Adriana
بواسطة Adriana KirkpatrickLet’s walk through what’s in my Ethics PowerPoint, which discusses Prompt #11: Should organs be allocated based on a patient's past actions, or should everyone have equal access regardless of their past actions?
This topic has been living rent free in my head ever since I had the honor of being the first person my sister-in-law, Jennifer, called when she received the long-awaited news to head to Methodist Hospital in Houston for a new kidney and pancreas. Yes! I know it sounds crazy, but she is a successful double transplant that includes a pancreas. She no longer has diabetes and is blessed with a normal life. This project is dedicated to her!
Moving on! In this PowerPoint, I discuss how we decide who gets an organ when there are not enough to go around. That is the whole game. The scarcity of transplantable organs forces us to face decisions regarding ethics whether we like it or not.
Some people argue that past actions should matter when being considered for an organ transplant. For example, if someone’s liver failed after years of heavy drinking, they say that person should go lower on the list than someone with a genetic disease. It sounds tidy until you realize how messy it gets in real life. Others say once you are a patient, your history is not the point. The policy should look at medical need and how likely the transplant is to work well, not whether you were a paragon of virtue in the past. That is the big fork in the road. Merit or equality?
Okay! I chose to consider the ethical opinions of two philosophers: Kant and Mill. They will serve as our guides as we explore the topic of allocating organs to hopeful patients that are currently waiting on transplant lists who keep you from fooling yourself.
Kant first. His view is deontology which is duty-based ethics. The simple version is this: People must be treated as ends, not as means. You make rules you could live with if everyone followed them all the time. So, would you want to live in a world where the hospital denies lifesaving care because you made mistakes ten years ago? Kant would likely say no. He would say the job of a medical system is to respect the dignity of each and every human and try to preserve life regardless of their decision-making history. When you start allocating organs in a way that rewards good behavior, patients end up being used as a tool to teach society a lesson. Whether that is intentional or not, that is the message that is sent. This is what Kant refers to as treating a person as a means. Kant refers to a concept that he has coined as a “categorical imperative”. This concept does not support a system that denies treatment based on past choices, and the conclusion under the Kant section is equal access. Once a person is on that hospital bed and in desperate need of lifesaving treatment, you treat them based on that current need.
Now on to Mill. He is a utilitarian. He asks which action will bring the most benefit and the least suffering for the most people. Now at first glance, it’s easy to see how people try to twist Mill into a moral scoreboard. However, Mill can support prioritizing patients who have a better medical prognosis. Longer survival. Better graft longevity. Though, this is not to assign any sort of blame. It is simply outcome forecasting. Mill would most certainly support prioritizing those who are likely to have more years of good life after an organ transplant. He also warns that if you start factoring in character judgments, then you begin to invite bureaucracy, bias, and distrust into the mix, which actually lowers total societal well-being. So even from a utilitarian angle, moralizing the list backfires.
So, the slide summary brings both philosophical points together. Kant pushes hard against judging people for their past at the bedside, and Mill shifts the focus from worthiness to prognosis and overall benefit. The upshot is that both lean away from moral judgments regarding a patient’s past. They share more sentiments than you would expect! That is… respect all persons. To use evidence on outcomes. That is the handshake.
My presentation also addresses a few blunt facts. Demand is higher than supply. People die waiting every day. A huge share of those waiting are kidney patients. My sister-in-law was given just a few months to live with the function that she had at the time. When you realize that a list is not just a bunch of random names but souls racing against a clock, you feel why this matters. You cannot hide behind superficial ideology when someone’s time is short.
With that being said, what do we do? I chose to end this with a plan that tries to be both just and practical. It says a just system must be impartial, consistent, and medically rational. It challenges us to adopt the principle that looks at present and future potential instead of digging around in personal history. This means three things: One, check current health status and clinical readiness. Is the person able to safely receive the organ right now? Two, look at medical prognosis. What does the risk model say about survival and longevity? Three, confirm that the person being considered actually meets criteria. Then, of course, there are three “rules” that must be enforced to keep it fair. Impartiality. Same rules for everyone. Prognosis over past. Focus on how sick they are now and how likely the transplant is to succeed. That last one is not a moral purity test. It is a way to honor the donor by making sure the organ has a real shot. Things like taking meds, showing up to follow up care, and leading a lifestyle that respects the life that was lost that gifted them that organ in the first place. This should be paired with actual support. Transport, education, case management. The slide literally phrases it as justice with open doors, which I really like.
If I had to explain the heart of this policy to a friend of mine in one breath, I would say to let everyone in with equal dignity. Then we can proceed to use medicine rather than morality to decide which match is most urgent and most likely to work. That does not mean we ignore reality. It means we pick criteria we can defend without turning doctors into moral judges.
Uhm, there is one more thing that I think is crucial and that is the social trust aspect of things. People worry that if we do not reduce the priority of those who made unhealthy choices, then we are encouraging bad behavior. Again, the Mill section of this PowerPoint presentation addresses this pretty straight-forward. Turning the list into a punishment tool creates complexity that invites subjective treatment, which only makes the public trust the system less. That trust really matters. Organ donation depends on the public to believe the system is fair. If families think organs go to the morally favored rather than to those who are medically best served, donation registry numbers can drop. Then we only exacerbate the shortage of organs.
Since I am nearly thirty-five and not nineteen, I will say this part plainly. Addiction is not simply solved by lectures. Neither is poverty the same as negligence. A transplant system that tries to “calibrate” a person’s moral worthiness is not wise. It is naïve…and it is selfish. It will predominantly punish the poor and the stigmatized most. Equal access at the door is simply a guardrail against our personal biases.
Do I have personal feelings about this? Yes. Uhm, although my sister-in-law’s condition was genetic, this is something that I encountered face-to-face. There is something about seeing the fear of death in someone’s eyes that sort of sends you into a new perspective. We could benefit from rules that a nurse can apply at 2 a.m. without guessing what a patient deserves. We need criteria that a family can read without needing a lawyer. Maybe even audits for bias and a real way to appeal. If a rule does harm when we measure its outcomes, then we change the rule. That is humility and it is part of justice.
That is the whole thing. There you go!
