Chapter 2 Guidance on answering selected questions from the book

Question

Consider the following quotation.

To the seventy-six-year-old woman with liver failure, we must say: ‘For all your children and grandchildren, we can’t spend this much on you.’ To the patient with one heart transplant: ‘I’m sorry but we can’t afford to give you more than one heart because it costs too much and because another person awaits the next heart.’ To life-long smokers: ‘Sorry, no lung transplants. You could have stopped smoking.’ (Pence, G. (2002) Brave New Bioethics (Rowman and Littlefield), p.110)

Do you think that we need to be more blunt about rationing? If we do, do you agree with these comments?

Guidance

There are three issues to discuss here. The first scenario deals with age: should organs not be given to those who are older (and are therefore assumed to have lower life expectancy) and instead used for those who are younger? The primary responses in the literature are strikingly different.
One approach is based on consequentialism and asks simply that we use organs to produce the largest number of high quality years of life. Based on such an approach why should the organ be used for someone who will benefit with, say 10 years of good quality life, when we could give it to someone who could use the organ for, say, 60 years of good quality life? Colloquially it might be said it is a waste to give the organ to a person with limited life capacity.
The other is to focus on rights. This approach argues that we cannot start to value the lives of different people. The concept that we might see one person’s life as more valuable than another’s has formed the basis of some of the most horrific regimes in history. We must recognise the unique value of each life. Such an approach might argue life expectancy or life quality should be irrelevant in the allocation of organs.
The second issue is whether we should limit the number of organs we give someone. At first this sounds surprising. We would not do this in the context of other forms of medical treatment. We would not say to a diabetic: “You have already received fifty doses of insulin and so we won’t give you any more!” Of course, the difference is that organs are far sparser than insulin and we are not in the position that giving insulin to one patient means another goes without, which is true for organs. It may be that the author of this quote has in mind the suggestion that each person should be given their own personal “health care budget” that they can spend during their life as they wish. Such an approach has few supporters as it works against the interests of those with serious illnesses.
The third view suggests that those who have contributed to their ill-health have to take responsibility for that and so should be disfavoured in the allocation of organs. There are several difficulties with this view. A major one is that even with something like smoking it is far from straightforward that smokers are to blame for their smoking. Socio-economic forces play a major role in smoking. Further there are plenty of conditions for which a person might be blamed (stress caused by overwork) which we do not deny treatment for. Even if we wanted to, it seems too complex to work out the extent to which a person’s ill health is their own fault.

Readings

Harris, J. (2005) ‘It’s not NICE to discriminate’, Journal of Medical Ethics 31: 373.

Herring, J. (2018) ‘Rationing by Fault’ Theology 121: 122