Playing the God Game

[AthenaAwakened]

Teen heart transplant recipient killed in police chase

In the politics forum there is a thread about this. I am posting this here to discuss the morality of choosing who does and does not get a transplant. Where do we draw the line? Should a smoker get a new lung? Should an alcoholic get a new liver? Should a drug addict get the surgeon's time and a hospital resources?

What do we do this broken people when they get sick?

 

[Tom Sawyer]

Organs are a limited resource and there's a much greater demand than supply. This means that when doctors decide who gets one, they are going to be playing god and deciding who lives and who dies regardless of how much they may or may not want to do so and there are always going to be harsh choices where some lose out who do not deserve to lose out.

They need to decide who has the best chance of the longest survival. If there's a choice between giving a smoker a lung or a non-smoker a lung, the non-smoker should win out and it sucks to be the smoker, but one of them needs to lose because there's not enough lungs to go around. If there's a choice between giving a liver to an alcoholic or a non-drinker, the non-drinker should win out and it sucks to be the alcoholic, but one of them needs to lose out because there's not enough livers to go around. If there's a choice between giving a heart to an obese man or an athletic man, the athletic man should win out and it sucks to be the obese man, but one of them needs to lose out because there's not enough hearts to go around.

In this case, the doctors' initial decision was wrong and their reversal was correct. They didn't reject him because there was a greater chance of him getting himself killed, they rejected him because they felt that his history of juvenile delinquecy meant that he wouldn't comply with taking all the medication and follow-up treatments. There's no evidence I've seen that this was the case at all. Even if he continues his criminal activities, there's a far greater chance that he'd end up in prison instead of dead and prisoners should be entitled to the same medical treatment as everyone else. Sure, they less valuable lives and contribute less to society but unless we want to start bumping brain surgeons to the front of the line over janitors that shouldn't be a factor in the consideration and I don't want to start doing that.

 

[dystopian]

Doctor's shouldn't and aren't legally allowed to just make decisions like that. Deciding that a non-smoker gets the lung instead of the smoker who'se higher on the waiting list would violate about a dozen laws in just about every country; and rightly so. Who gets the organ and who doesn't is and should be down entirely to just two things: who is higher on the list, and who is at greater risk of dying in the short term if they don't get that organ. Average these two criteria out and you arrive at a name who gets the organ. Whether or not someone smokes has nothing to do with either of these things, and it is neither the doctor's job nor their right to withhold medical treatment to people based on their lifestyle. The fact that this is even in question is deeply disturbing.

 

[CJW]

but how do you get on the list?

 

[AthenaAwakened]

What if the non smoker is a child molester?

What if the non-drinker is a professional daredevil and jumps things with a motorcycle for a living?

What if the prisoner in need of a heart is a confessed serial killer who was convicted in a state which at the time had no death penalty?

What criteria are proper and correct to consider and what are not? What are the moral judgments that we should and should not be making?

 

[Bomb#20]

Well, since organs are a limited resource and there's a much greater demand than supply, somebody is going to decide who gets one, somebody is going to be playing god, and somebody is going to be deciding who lives and who dies. In the absence of an actual god, logically, it follows that the next best thing to a god is a government. As citizens we all have equal standing to make policy. Therefore nobody has the right to set himself up above the rest of us, make a moral decision for himself, and in doing so override the considered judgment of our democratically elected representatives.

 

[Tom Sawyer]

What if the non smoker is a child molester?

What if the non-drinker is a professional daredevil and jumps things with a motorcycle for a living?

What if the prisoner in need of a heart is a confessed serial killer who was convicted in a state which at the time had no death penalty?

What criteria are proper and correct to consider and what are not? What are the moral judgments that we should and should not be making?

Child molster and serial killer should be on the list the same as everyone else. If they're not capital crimes then doctors shouldn't be making determinations about the value of their lives. A quick google search didn't find me any data on the life expectancy of daredevils vs other dangerous jobs like fishermen or loggers, so I'd ignore it.

Taking things like criminal activity and job dangers into account is simply another way to try and funnel limited organs away from the poor, who are more likely to have those factors, and towards the rich, who more often do not. The only criteria that they should be considering are medical ones.

 

[Keith&Co.]

Taking things like criminal activity and job dangers into account is simply another way to try and funnel limited organs away from the poor,

Scrooge's 'surplus population,' as it were.

Was it Tales from the Crypt where a guy got a super-whammodyne life-saving device? They developed a cocoon that would deploy if a person was in danger of dying. Oxygen supply, pacemaker, a full suite of drugs, armor, it would keep you alive even if a building fell on you, until rescuers could reach you.
Saved his life several times, and where someone without the device would have at least had to slow down, he remained a productive executive of the corporation, working the same number of hours that would have killed him without the device. The Life-Pod or something.

The evil revelation at the end was that he remained productive and corporate long after he just wanted to die. But his life insurance was so expensive, the insurance company couldn't afford to let him die. It was financially better to keep him alive.

 

[AthenaAwakened]

What if the non smoker is a child molester?

What if the non-drinker is a professional daredevil and jumps things with a motorcycle for a living?

What if the prisoner in need of a heart is a confessed serial killer who was convicted in a state which at the time had no death penalty?

What criteria are proper and correct to consider and what are not? What are the moral judgments that we should and should not be making?

Child molster and serial killer should be on the list the same as everyone else. If they're not capital crimes then doctors shouldn't be making determinations about the value of their lives. A quick google search didn't find me any data on the life expectancy of daredevils vs other dangerous jobs like fishermen or loggers, so I'd ignore it.

Taking things like criminal activity and job dangers into account is simply another way to try and funnel limited organs away from the poor, who are more likely to have those factors, and towards the rich, who more often do not. The only criteria that they should be considering are medical ones.

So placement on the list should be the single determining factors in who does and does not receive a transplant?

 

[Tom Sawyer]

So placement on the list should be the single determining factors in who does and does not receive a transplant?

Yes. Since one's placement on the list is the end result of all the determining factors put together, that is the only logical conclusion.

Is it somehow unclear what "placement on the list" means? If one person gets the transplant instead of another person is there any situation in which that would not be an exact synonym for "he was placed higher on the list"?

 

[AthenaAwakened]

So placement on the list should be the single determining factors in who does and does not receive a transplant?

Yes. Since one's placement on the list is the end result of all the determining factors put together, that is the only logical conclusion.

I agree.

Is it somehow unclear what "placement on the list" means? If one person gets the transplant instead of another person is there any situation in which that would not be an exact synonym for "he was placed higher on the list"?

 

[Juma]

Doctor's shouldn't and aren't legally allowed to just make decisions like that. Deciding that a non-smoker gets the lung instead of the smoker who'se higher on the waiting list would violate about a dozen laws in just about every country; and rightly so. Who gets the organ and who doesn't is and should be down entirely to just two things: who is higher on the list, and who is at greater risk of dying in the short term if they don't get that organ. Average these two criteria out and you arrive at a name who gets the organ. Whether or not someone smokes has nothing to do with either of these things, and it is neither the doctor's job nor their right to withhold medical treatment to people based on their lifestyle. The fact that this is even in question is deeply disturbing.

You base this on... what exactly?
Lifestyle is definitely a matter in the case.
And how should that be disturbing?
Priorities are made constantly, organs is just one example.


And I despise the use of the phrase "playing god".

 

[Angry Floof]

The United Network for Organ Sharing (UNOS) was established in 1984 for the purpose of coordinating donors and recipients.

Sometimes people will their organs to a specific person, and there are other instances where the UNOS won't make the decision, but when UNOS is involved, they have a set of criteria for choosing recipients, including Culpability.

Culpability and worth: The potential recipient may be partially to blame for their predicament, for example, through substance abuse – lifestyle choices of excess drinking, of smoking, or of illegal drug addiction. Furthermore, one potential recipient may contribute more to society than another, either before or after the transplant. Currently neither of these factors are considered in allocating organs, but one might argue that they should be. One could argue that people somewhat responsible for their need for an organ should be lower on the list than others not so responsible, or that someone worth more to society should be higher than someone not worth as much.

Sometimes the transplant team will choose not to transplant an organ into a patient whose organs were damaged by heavy smoking or drinking, not because the person is responsible for their own plight, but because there is indication that the person will be repeating the same damaging behaviors that will likely make the new organ fail too.

Though on a gut-level using worth as a criterion may make sense to some people and offend others, such a suggestion might be difficult to implement. Some objective hierarchy of value would have to be worked out by which to judge a person’s worth, whether past or future, and the future is uncertain.

That cannot be an easy decision for anyone involved. Doctors and patients' families and attorneys, etc., are often part of the process. I can't imagine being the one to decide that an otherwise qualified recipient should not get an organ because they have demonstrated that it will most likely be wasted (drug addicts, etc.). Sometimes this decision is made because the recipient is so old that they will likely die in a short time anyway. It sounds so callous, but with limited organs and a list of people including children, young moms and dads, soldiers... All I can say about that is that I'm grateful these choices are not left to me. I don't know if I'd have the courage to even try taking that responsibility.

Yes, there's a disproportionate percentage of minorities who don't receive organs or have to wait longer for one, but that is at least partly because "Blood type B
is more common among minority populations, but only about 12 percent of deceased donors have this
blood type."

List of criteria (you can find the details here):

• Blood and tissue type
• Medical urgency
• Length of wait
• Local primacy (This policy of “local primacy” occurs partly due to the fact that organs spoil quickly as they travel, and also because of some kind of “geographic favoritism” that local donors should help local needs first.)
• Age, Expected benefit
• Culpability and worth
• Ability to pay

 

[AthenaAwakened]

The United Network for Organ Sharing (UNOS) was established in 1984 for the purpose of coordinating donors and recipients.

Sometimes people will their organs to a specific person, and there are other instances where the UNOS won't make the decision, but when UNOS is involved, they have a set of criteria for choosing recipients, including Expected Benefit.

That cannot be an easy decision for anyone involved. Doctors and patients' families and attorneys, etc., are often part of the process. I can't imagine being the one to decide that an otherwise qualified recipient should not get an organ because they have demonstrated that it will most likely be wasted (drug addicts, etc.). Sometimes this decision is made because the recipient is so old that they will likely die in a short time anyway. It sounds so callous, but with limited organs and a list of people including children, young moms and dads, soldiers... All I can say about that is that I'm grateful these choices are not left to me. I don't know if I'd have the courage to even try taking that responsibility.

Yes, there's a disproportionate percentage of minorities who don't receive organs or have to wait longer for one, but that is at least partly because "Blood type B
is more common among minority populations, but only about 12 percent of deceased donors have this
blood type."

but is the expected benefit based on other physical aspects or future prediction of behavior?

 

[Angry Floof]

The United Network for Organ Sharing (UNOS) was established in 1984 for the purpose of coordinating donors and recipients.

Sometimes people will their organs to a specific person, and there are other instances where the UNOS won't make the decision, but when UNOS is involved, they have a set of criteria for choosing recipients, including Expected Benefit.

That cannot be an easy decision for anyone involved. Doctors and patients' families and attorneys, etc., are often part of the process. I can't imagine being the one to decide that an otherwise qualified recipient should not get an organ because they have demonstrated that it will most likely be wasted (drug addicts, etc.). Sometimes this decision is made because the recipient is so old that they will likely die in a short time anyway. It sounds so callous, but with limited organs and a list of people including children, young moms and dads, soldiers... All I can say about that is that I'm grateful these choices are not left to me. I don't know if I'd have the courage to even try taking that responsibility.

Yes, there's a disproportionate percentage of minorities who don't receive organs or have to wait longer for one, but that is at least partly because "Blood type B
is more common among minority populations, but only about 12 percent of deceased donors have this
blood type."

but is the expected benefit based on other physical aspects or future prediction of behavior?

The criterion "Culpability" is what I should have focused on. I updated my post.

 

[OLDMAN]

Not to derail, but at car accidents they usually help the people that ( if obvious) were not at fault, first. The negligent party should be thankful because if the innocent party dies he or she might be charged with manslaughter. But this is probably a derail.....

 

[AthenaAwakened]

Not to derail, but at car accidents they usually help the people that ( if obvious) were not at fault, first. The negligent party should be thankful because if the innocent party dies he or she might be charged with manslaughter. But this is probably a derail.....

At accident scenes I have witnessed, people tend to help the most seriously wounded first. In first aid class, they taught us that too.

But maybe that's just me.

 

[AthenaAwakened]

Here's the thing.

Once you start deciding who is deserving and who isn't, people who don't deserve to die, do. People get blamed for things cause by circumstance and root problems go unsolved.

how far do we take the criteria for who deserves to live? if we can deny organs to people because they are bad people, why not operations? medicine? police protection? employment? food? shelter?

 

[EricK]

If there is a limited supply of some item (eg organs) and a larger number of people who need them; and if you don't believe that any person is more deserving than any other, then it is hard to see why you should care how those items are distributed (as long as the maximum number of people get them). So you shouldn't really care if the person doing the distribution believes that some people are more deserving than others.

The only reason you should care (assuming the maximum number of people are being helped) is if you, too, believe that some people are more deserving than others but you disagree with the person who is making the decision as to who those most deserving people are.

 

[Bomb#20]

The United Network for Organ Sharing (UNOS) was established in 1984 for the purpose of coordinating donors and recipients.

Sometimes people will their organs to a specific person, and there are other instances where the UNOS won't make the decision, but when UNOS is involved, they have a set of criteria for choosing recipients, including Culpability.

Culpability and worth: The potential recipient may be partially to blame for their predicament, for example, through substance abuse – lifestyle choices of excess drinking, of smoking, or of illegal drug addiction. Furthermore, one potential recipient may contribute more to society than another, either before or after the transplant. Currently neither of these factors are considered in allocating organs, but one might argue that they should be. One could argue that people somewhat responsible for their need for an organ should be lower on the list than others not so responsible, or that someone worth more to society should be higher than someone not worth as much.

Sometimes the transplant team will choose not to transplant an organ into a patient whose organs were damaged by heavy smoking or drinking, not because the person is responsible for their own plight, but because there is indication that the person will be repeating the same damaging behaviors that will likely make the new organ fail too.

Though on a gut-level using worth as a criterion may make sense to some people and offend others, such a suggestion might be difficult to implement. Some objective hierarchy of value would have to be worked out by which to judge a person’s worth, whether past or future, and the future is uncertain.

That cannot be an easy decision for anyone involved. Doctors and patients' families and attorneys, etc., are often part of the process. I can't imagine being the one to decide that an otherwise qualified recipient should not get an organ because they have demonstrated that it will most likely be wasted (drug addicts, etc.). Sometimes this decision is made because the recipient is so old that they will likely die in a short time anyway. It sounds so callous, but with limited organs and a list of people including children, young moms and dads, soldiers... All I can say about that is that I'm grateful these choices are not left to me. I don't know if I'd have the courage to even try taking that responsibility.

A lot of people who feel conflicted about taking culpability into account are evidently trying to resolve the dilemma in their own minds by reframing it as taking into account whether the organ is likely to be wasted by a recipient who can reasonably be expected not to take good care of it. But that's not a good stand-in for culpability. For all the people who would shrink from denying a liver to an alcoholic because he brought it on himself, but are okay with denying him a liver because he's probably going to keep drinking, how many of them would also be okay with denying a kidney to somebody because she's probably going to destroy it in three years by going off her anti-rejection drugs, because she can't afford them, and although Medicare will pay for dialysis for life, and Medicare will also pay for an unlimited sequence of destroyed kidneys, Medicare will not pay for more than three years of anti-rejection drugs?

If people applied the same logic to the kidney that they apply to the liver then they'd callously tell the kidney patient she's not a good risk and the kidney will buy more years of health for a wealthier candidate, the same way they're willing to callously tell the liver patient he's not a good risk and the liver will buy more years of health for a candidate without addiction issues. But they don't. Why don't they? What's the difference? Culpability. It's not the kidney patient's fault she's being screwed by Congress's* insane Medicare regulations.

So since we're evidently going to take culpability into account, let's face it squarely and not try to sneak it past our conscious selves through the back door.

(* And yes, bills to fix this legal monstrosity are introduced every year and never get passed.)