Yesterday, I read a post by Trisha Torrey over at About.com's Patient Empowerment area. It was about the possibility of a convicted child rapist named Kenneth Pike being considered for heart transplant. She presented the issues and asked for readers opinions. This is my comment:
"One of the reasons I am a monthly support of Doctors without Borders is that they provide medical care without judgment. The person who needs it most is the person who receives the care and it doesn't matter if they are a child or a Janjaweed.
Do I like that a convicted child rapist is getting a heart transplant? No. But I don't believe that the organ transplant system should get involved in moral judgments about who deserves a transplant in any way other than the medical. Once you start judging whether someone is a "good enough person" to get an organ, it's a slippery slope. Who decides? By whose moral standards do we make this decision? There was a case several years ago of a young girl in Oklahoma who needed a kidney transplant - she met all the criteria in terms of health, ability to take antirejection meds, etc., but was ultimately denied. The only reason that appeared to have impacted that position was the fact that she had Down’s syndrome. Apparently, somebody who did not have an intellectual disability was deemed more "worthy" of a transplant. Was that right? Absolutely not. And if that wasn't right, then neither is denying this man a heart transplant.
Beyond that, not giving him a transplant is a death sentence, which means he might as well have received the death penalty for his crime. Is his crime punishable by the death penalty? No, it isn't. And therefore, the legal problems with denying him a transplant are huge.
I still don't like the idea, but I am an organ donor and I believe UNOS should make this decision the same way Doctors without Borders makes theirs: purely based on medical need."
Today's update mentions that Pike has decided against the transplant and makes the argument that since 90% of commenters were violently against him being even considered for the procedure, it might be time for the system to award transplants considering somebody's "goodness," basing decisions on some sort of point system. Not surprisingly, I don't agree, in part due to the reasons I've already mentioned - I don't think these kind of decisions should be based on emotion or morals beyond medical ethics. It means we get pushed up against very difficult situations and positions, but if we start awarding medical care based on someone's idea of moral fiber and character (again, who chooses the criteria?), it's a slippery slope right down into injustice. Medical decisions should not be made by popularity poll. Ideas of what is right/moral change - just because the majority of people agree with a certain position doesn't make it right. Think about this example: at the time when the law prohibiting interracial marriage in the US was abolished, 70% of the population was against interracial marriage.
And then there's another wrinkle on this point system. Where would it leave people with disabilities? For most of us, accumulating any kind of points might be difficult due to physical or intellectual limitations and social barriers. If transplants were to be awarded as a sort of reward for good behavior, the kind of behavior that can be measured by points assigned on a form, it could end up to some sort of eugenics project, couldn't it?
There's a slippery slope here and it goes pretty fast downhill.