Second chances
Gallegos tells Senate he needs new liver (Kristen Mack, Houston Chronicle)
State Sen. Mario Gallegos, who basked in praise from his colleagues this week as the Senate was called to order for the 2007 session, may respond to another call before the session ends.
He's waiting for a liver transplant.
While I certainly sympathize with the plight of Gallegos, I'll ask the same question I did when Pat Summerall got a liver transplant after years of alcholism blew up his liver:
Should the transplant system somehow take into account the extent to which personal behavior has contributed to one's illness?
It's all well and good that folks like Summerall and Gallegos claim they wait(ed) in line like anyone else who qualifies for a transplant, but I guess I wonder why it's fair for people like them ever to be ahead of folks who have wound up needing a new liver through no fault of their own.
Please discuss. I'm interested in hearing different perspectives (and what the state of thought is in the medical ethics community, if TP cares to chime in).
UPDATE: Laurence Simon has the same question.
Posted by Kevin Whited @ 01/13/07 12:59 | Other | Technorati
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The bigger question is why anyone with the capacity to pay what a willing seller would take for a piece of liver (since only a piece is needed) should have to wait in line at all.
Posted by Tom Hanna @ 16:26 on 01/13/07
TP can rarely resist chiming in. ;-)
Seriously, this debate is as old as bioethics itself. To my knowledge, it harkens back to what is colorfully known as the "God Committee," a group of Seattle physicians and laypeople who were charged with making decisions regarding dialysis in the 1960s. Dialysis had recently been invented, and it worked, but was also extremely expensive and there were limited dialysis machines.
So, the Seattle hospitals involved formed a committee to determine who would receive dialysis, and who, quite frankly, would be left to die. (This is not a slam on the hospitals; I'm merely pointing out the ethical quandaries posed by the basic problem of economics). Many of their criteria were based on social worth, i.e., is the candidate married, is the candidate an alcoholic, is the candidate homeless, does the candidate have a good job, does the candidate have kids, etc.
Needless to say, this approach was extremely controversial then and now. Social worth is obviously a slippery concept to the extreme, and there seem some pretty plain dangers and problems involved in having one group of people assess social worth (with life and death consequences) of another group of people.
The short answer, as far as I'm aware, is that most bioethicists see very serious problems with allowing questions of social worth to drive organ allocation decisions. This is why the transplant network today is generally organized only on the basis of need. Alcholism presents a special kind of issue because an argument can be made that a lifelong alcoholic who has shown little ability to remain sober is unlikely to benefit as much from a transplant as someone else (because they have a higher likelihood of damaging the transplanted liver with excessive alcohol consumption).
This argument itself is controversial, because it sounds perilously close to asserting that alcoholics have less social worth than non-alcholics, which raises the set of problems encountered in the God Committee.
Anyway, I certainly understand your concerns and think them relevant (as do most bioethicists and most people in general), but the general, albeit not uncontroversial perspective in the academic community (entirely FWIW) is that allowing assessments of fault and culpability to drive organ allocation decisions raises many more problems than it might resolve.
Posted by TP @ 10:51 on 01/14/07
It should be a simple matter to determine if can circumvent the established waiting list, and deserves a new lease on life ahead of say an illegal alien.
Did the Senator ever vote for wasteful bureaucratic spending? Did the Senator vote to raise taxes? Did he vote against the innocent unborn? Did he vote against school vouchers, forcing parents of the poor and minority children to be subjected to a deficient level of education as well as forced public school PC indoctrination? Did he turn-tail and flee to another State trying to sabatoge the "Peoples' Business?"
If the answer is "yes" to any of the above, I think he needs to head to the back of the line.
Posted by Royko @ 11:27 on 01/14/07
A sticky problem indeed. At some point, does it come down to whether you are going to let people on the transplant list at all if they've played a part in the destruction of whatever organ they seek? Because eventually, that person will get in line ahead of a "more deserving" person.
Let's also not forget that much (I'm not saying all) of this destructive behavior is disease-driven. One thing TP didn't mention is that alcoholism is a serious disease, without a cure at the present time. Nobody knows when it crosses over from being indulgence to disease, but once it gets there, it's no longer a matter of will power or being strong enough. It's a disease, like lung cancer or heart disease, two other diseases that can begin with bad behaviors.
Should we screen heart transplant patients for people who ate too much bacon or who didn't exercise enough? Should we screen lung transplant patients for people who stupidly married smokers, even though they didn't smoke themselves, or who were foolish enough to live next to polluting industries?
Posted by another precinct chair @ 12:48 on 01/16/07
Judge not, so that you will not be judged. We all have sins in our closet. How about if the self-abuser is someone deemed "important", such as a famous actor, a great writer, or a sports hero ? Always exceptions made for them, aren't there ?
Posted by Damar Minyak @ 03:29 on 02/09/07
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