Ethics, Medicine & Scarcity – Who Makes The Big Decisions?

22 Jul

Saw an interesting article this morning and it got me thinking. The headline was ‘Binge-drinker Gary Reinbach dies aged 22’. Caught your attention too? (,27574,25816364-401,00.html)

Apparently Gary had a history of heavy drinking since he was 13 and had cirrhosis of the liver. He was in hospital awaiting a kidney transplant but was refused because ‘doctors….fear(ed) he would not stay sober for six months after the operations.’

The NHS Blood and Transport service said the case ‘highlighted the dilemma faced by doctors because of the shortage of donated organs.’ SO it seems the problem is ours, the general public who simply don’t donate enough organs? Really? The facts are simple, organs are scarce and they are to be given to those who are the best possible scientific match without recourse to subjective judgements re behaviour or life style.

It is not an ‘economic’ (supply and demand) decision but an ethical/moral decision. It is about the power of life and death and who makes that decision. It is about the criteria for making that decision for there is no guarantee that a ‘binge drinker’ will care less for their new kidney than a teenager with a life ahead of them on whom we have no history or pattern of behaviour, or anybody else for that matter. How do we make a decision now about future behaviour that is ethical and accurate? Isn’t the primary criteria for a kidney the best scientific match?

If we were serious about these subjective criteria, very few people would meet them because lifestyle plays a prominent role in people needing organ transplants in many cases. Such things as diet, fluid intake, exercise, medication use etc all impact. These are often long term habitual behaviours that we have no gaurrantee will change.

My personal challenge is that to make the decision a young man of 22 is not worth a life saving operation is not only a life denying decision for him but an indictment on our society. What value do we place on life and who are we to play God?

There are a number of other questions which need to be addressed as well including: the failure of medical science to deliver on its promises to deliver positive health outcomes for all regardless of who you are, the failure of society (us) to demand that equality and the result that medical people are placed in the unenviable position of having to choose.

This is a question which has been facing the medical fraternity and hospital administrators since the mid-70’s and is now being faced daily due not only to the scarcity of organs but the scarcity of funds for the high cost ‘miracle’ treatments which keep us alive long past our previous use by date. Perhaps there are no answers, but perhaps we need to remember all patients are made in the image of God and any decision to allow someone to die is more than just a scarcity question.

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