As I have mentioned in previous posts, I am a pre-medical student, currently working on my Bachelor of Health Science undergraduate degree. As such, I have taken a number of courses related to the inner workings of the body. However, my degree also requires I develop my knowledge in other areas such as psychology, healthcare reform, and the like. One of the courses I took last semester was an ethics course. As future healthcare professionals, my colleagues (classmates) and I took a look at some ethical dilemmas that we would be sure to face in the field. Our tutorial had us look at these types of dilemmas and reflect upon them. I found this to be quite interesting, and as such, have decided to post a mini-series on some of the situation’s we had examined. In my next four posts, I am going to share four of them with you- deciding between organ transplant recipients; the content of the Hippocratic Oath; decisions regarding course of treatment for geriatric patients with altered cognitive abilities; and finally, resources allocation in hospital settings from a Canadian perspective (or more specifically, Ontario).
Heart Transplant Recipients
One situation we analyzed was taken from the standpoint of an individual on a transplant committee. There was 5 patients who needed a new heart, but only one heart available. e were also to go off the premise that whoever did not receive the transplant would definitely die.
1. Mob Boss: The first patient was an elderly man who was the head of an organized crime group- he was the “Don Corleone” type of character. He was quite old, but he was wealthy and had promised to donate a large sum of money to the hospital if he was given the transplant.
2. The Widow/Mother: The second patient was a middle-aged woman who had recently lost her husband. She was also the mother of two children.
3. The Police Officer: We were then told about the third patient, a young police officer who had recently graduated from “the academy” and was about to start his career as a young, fit, law enforcer.
4. The Politician: Our fourth candidate was a politician. This man had promised that during his term in office, he would work towards putting into place a new healthcare reform.
5. The Celebrity: The last patient was a famous celebrity. At first, many of us would probably not have considered this character, but then we learned that he had planned on being the spokesperson for an ad campaign and organization that promoted things like blood donations, organ transplants, and charitable donations.
A short ethics lesson
Before I share how I responded to the situation, there are 4 concepts that healthcare providers must assign significance to and uphold in any ethical decision:
i.) Non-Maleficence- do no harm
ii.) Beneficence- going beyond simply non-maleficence and actually doing good (benefiting the patient)
iii.) Autonomy- allowing a patient to have the freedom to choose their own course of treatment
iv) Justice- in regards to fair allocation of resources
You will notice in my response below that I appear to take on a consequentialist view in this situation. I’m not saying that my decision is right, and I’m not saying that it is wrong. It was what I viewed as best at the time, and it comes down to what course of action could employ the ultimate use of beneficence, while still adhering to a fair allocation of resources.
I believe that no one, single person is more entitled to life more than another. A bus driver deserves to live just as much as a lawyer; a waitress should be given the same standard of care as a famous musician. It is crucial, as a health care provider, to adhere to this standard ethical guideline when treating patients. However, this being said, it is my belief that as a health care provider, I will have an obligation to serve the greater good, especially in an instance, such as this, of choosing a recipient for an organ donation. For this reason, my choice would be to have the heart given to the police officer.
First, I would like to address my concerns with the other candidates. As I have previously mentioned, I feel that every life is sacred and every patient deserves the same standard of care. All candidates in this scenario are deserving of the transplant, and all have the potential to affect the community in a positive manner, if given the opportunity. With that being said, I think that the police officer has the best chance of doing the greatest amount of good for the community at large. It is true, the “mob boss” has a large family and has offered a large sum of funding for the hospital. However, he is the oldest (presumably) and so has the least amount of viable years to live. In addition to this, although I am not an expert on tax auditing, it would seem logical that the government would intervene and investigate the origin of the funding, which could end up meaning no funding at all. This is why I would not choose the “mob boss”. It is sad for a child to lose a parent, and even worse to lose two, but the reality of the situation is that the widow would be bed ridden for an extended period of time, unable to care for her children. I feel most guilty about not awarding the healthy heart to this case, but it is likely that this woman’s children would end up in foster care either way and it is better to inflict heart break on two people than to inflict it on thousands. The actor and the politician are very similar cases in my opinion. Both of these patients are public figures who claim to do incredibly wonderful things for the community. Considering the nature of politicians, I am quite sceptical as to whether or not she will live up to her word. But to play the devil’s advocate, I am going to assume that there are plans for health care reform. Based on this optimistic assumption, let us consider that a politician is always the face of a political party, but not the entire brain. If there are, indeed, plans in the works, an entire team will have been working on the proposed political agenda. Because of this, if this patient dies, then her prodigy will continue the projects which she has already started- if such plans existed, that is. In the same way, the actor is simply the face of a campaign and not the entirety of it. The masterminds are often those behind the scenes, and so, the organization will continue to function- they will simply need to find another spokes person. This actor’s death will most likely also be good for the organization’s publicity as well. As always, we must consider the greater good. I would also like to mention that it is my opinion that this candidate is the least deserving of the transplant. The brutal reality is that humans are creatures of habit. If this gentleman lives a lifestyle of wild partying and drug use, then it is likely that he will return to that same life and waste the new heart.
It is possible to find fault in all people, and it is possible to find reasons to deny the new heart to the police officer just as easily. He is in a dangerous field of work and could be killed on the job at any moment. Although this is true, we must acknowledge that it is also possible for anyone to die at any time. I could be walking to class one morning and the roof could cave in and crush me; someone else could be taking their dog for a walk and have a rabid squirrel randomly attack them. The point is, we never know what is going to happen until it does. There are 3 main reason why I chose the police officer to receive the new heart. First, he is the youngest, and so the heart will probably be put to use the greatest amount of years if he were to receive it. With a longer lifespan, he will be able to do more good for the community than the rest of the candidates. Secondly, because of his occupation, it is likely that he will stay healthy and fit. Because of this, it is less likely that he would need another organ transplant and has the greatest chance of keeping the organs viable if he did die and somebody needed him to donate. Lastly, the police officer seems to me to be the candidate who will serve the community the best. With the other patients, it is questionable, but his job is to keep the streets clean and the citizens safe. He may not be able to positively influence as many people as the “mob boss’s” money or the politicians proposed plan, but both of these candidates affect on society is a gamble. In closing, I chose the police officer simply because I believe he do the largest amount of good for the community.