Paper 2 – Critique of Cohen and Benjamin’s Argument
Cohen and Benjamin assert that alcoholics should not be categorically excluded from access to liver transplantation. They argue that alcoholism is a disease and not a choice, and end stage liver damage requiring transplantation is a consequence of this disease. Furthermore, they argue that even if alcoholism is a choice, medicine should not incorporate moral judgments in the considerations of treatment decisions for the patient. They support this reasoning through three arguments: 1) it is impractical and almost impossible to make distinctions on morality, 2) the voluntariness condition to establish responsibility cannot be met, and 3) the implications and consequences of such system would be undesirable. Although these arguments are logical, they overlook certain details that question their applicability in liver transplantation cases.
Cohen and Benjamin argue that to exclude patients from liver transplantation based on past history of alcoholism would be to exclude based on evaluation of moral character. They assert that whether a transplantation candidate is “an abusive parent or a dutiful daughter” or “cheat[s] on their income taxes or their spouses” would then also have to be considered. Therefore, this system is impractical and impossible due to extensive and intrusive investigation necessary to gather information on a patient’s moral behavior. Assessment of moral character is further problematic because fair and
“The principle of nonmaleficence states that we should act in ways that do not inflict evil or cause harm to others” (Morrison, 2011). Specifically, we should not cause preventable or intentional harm. The principle of nonmaleficence can be applied to transplant allocation because the modern array of medical interventions has the capacity to do good or harm, or both, thereby involving principles of nonmaleficence. An example of this would be the procurement of an organ though exploitation of payment to the
In this society, organ transplant surgery has been perfected to where no risk is present. However, organs still have a high demand with low supply. In addition, the only people eligible to receive organs are those who came to their ailment at no fault of their own. In other words, they did not smoke, drink, or eat in manners that caused their diseased organs. The people who donate organs have to be perfectly healthy as well to eliminate unhealthy organs for donation.
Although there is no cure for Hepatitis B there are ways to help reduce re-infection once a new liver is received. Continued use of lifelong antiviral medication can decrease the re-occurrence of Hepatitis B, but because of the lack of cellular immunity if antiviral medication is stop re-occurrence can occur (Wagner, 2009). Mrs. Bay is married with two young children and is very active in her community. A great family and community bond will give the support system needed to recover from a liver transplant. She will have a chance to be in her children’s life and will be able to continue to support the community. “Trying to select organ recipients based on self worth, self-destruction behavior, and a potential for rehabilitation is difficult to justify from an ethical perspective” (Butts & Rich, 2008, p.300). Although this true, some people might not feel comfortable giving a liver to a person who states they would not make any promises to stop drinking when a new liver is received. Mrs. Bay would be a great candidate for liver transplantation because she will be more complaint to take antiviral medication indefinitely thus decreasing the risk of re-occurrence.
Liver Allocation is an ethical dilemma for healthcare providers and patients. An article published in the American Journal of Critical-Care Nurses entitled “The Power of The Liver Transplant Waiting List: A Case Presentation” discusses a 60 year old woman with cirrhosis was placed on the liver transplant list under the category “status 7”. Status 7 is an inactive state and are considered unsuitable to receive transplant surgery. Liver allocation is done by an organization called the United Network for Organ Sharing (UNOS), and the way they rank patients to receive a transplant is by a Model End Staged Liver Disease (MELD). It is scored from 6 to 40, and those with a high scores are the ones to receive a liver transplant (Hansen, Yan, and Rosenkranz,
The article “Need an Organ? It Helps to be Rich,” by Joy Victory informs readers of how medical systems work for those who are in need of an organ transplant. In the article, Victory talks about a 34-year-old man named Brian Shane Regions - who is in need of a heart transplant, but is not able to secure one because he is not insured. Therefore, not having insurance, Brian is put into an unfortunate situation because he is simply not getting any treatment for his heart failure. This is a great example of how patients without insurance could not be provided with an organ donor. Victory argues a variety of issues concerning how the organ donation system is unfair to certain people. A transplant cost a bundle amount of money, which leads to the rich only able to have the procedure done. While the poor cannot afford the cost of the transplant, creating an unfair situation for the less fortunate. The transplant centers can do anything as they please because they simply care more about the money. However, not all transplant centers treat their patients unfairly, several centers are truly able to support the uninsured patients in need of a transplant. It is simply unfair for the patients, who do not have enough money to pay for transplant and the medical systems are unethical.
The issue of inmates receiving priority over deserving law-abiding citizens when it comes to organ transplants could possibly be resolved satisfactorily. One of the ways this could happen is by having the Supreme Court make amends to its original ruling by going more in depth about the health-care criteria inmates are entitled to.
Moreover, the lack of access to health care is morally wrong because it is a fundamental right for humans to maintain self-dignity, fairness in the dispensing of health care, and the inclusion of all in society. Kantian’s ethical theory would argue that it is a moral duty to distribute health care more evenly so that the disadvantaged members of society have a similar chance at access to care. The consequence of those health disparities among the disadvantaged affects everyone’s quality of care and affects communities’ adversely. As a result, the cost shift from annual emergency room visits by the uninsured cost the public over $100,000 billion annually and as a result, distributes approximately an additional $1000 to each family’s insurance premium (Lachman, 2012)). Another example of distribution injustice is the unfair allocation of health care among race and gender. Studies have shown that there is a racial and gender bias in end stage renal failure patients, there is a disproportionate number of white males referred to transplant specialists as opposed to blacks and women. Additionally, their wait on the transplant list is longer, if they ever make it onto the waiting list (Beauchamp, 2013).
Process of transplantation: “patient is identified as ill and organ failing, doctor assesses if eligible for transplant” (Ethics of Organ Transplantation, 2004, p. 6). “If so, doctor refers patient to local transplant center to be placed on the list” (Ethics of Organ Transplantation, 2004, p. 6). “The transplant center evaluates the patient’s health and mental status as well as the level of social support to see if the person is a viable candidate” (Ethics of Organ Transplantation, 2004, p. 6). “Organs can come from recently deceased people, cadavers, or living persons” (Ethics of Organ Transplantation, 2004, p. 6). “The waiting list for donors is maintained by the United Network for Organ Sharing (UNOS)” (Ethics of Organ Transplantation, 2004, p. 6). Now that I’ve set the basic principle for what an organ transplant
The OPTN says that just because someone is in prison doesn’t mean they should not be considered for an organ transplant, the “screening for all potential recipients should be done at the candidacy stage and once listed, all candidates should be eligible for equitable allocation of organs” (648). On the basis of social worth, physicians shouldn’t discriminate by using social value as criteria for medical decisions. Sade says that psychosocial factors may be used as selection criteria, however, because they might shed light on whether or not adequate social support systems exist for the transplant recipient. “The prison sentence is payment for the crime; the prisoner owes nothing more to society, certainly not his or her life” (647). The transplant center brings up the issue of money. When a non-prisoner has a transplant operation, they fund the surgery with the help of insurance and public health programs like Medicare and Medicaid. Prisoners have neither private nor public insurance aside from what the prison system has in their budget, so this begs the question, “should the prison pay for a heart transplant for a convicted criminal?” The answer is no. Most prison systems can only afford to provide general health care, but not the large amount of funds needed for a heart transplant. Sade says the bill for aftercare of a prisoner’s heart transplant done in California in
This means that there is no way one could be arrested for an illness, thus disqualifying alcoholism as a disease. The law puts in place sanctions against alcoholism in order to control behavior that is caused by the wrong choice, not because of a disease. Schaler (1991) contends that one should argue that alcoholics need support and education about the effects of alcoholism and how to curb the habit. It is suggested that the notion of treatment for alcoholism is misinformed.
Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. Alcoholism is a complex disease with physical, social and psychological consequences, but it can be treated through detoxification and anti-anxiety drugs. What will be explained in this essay is basically the history of alcohol, signs of one possibly being an alcoholic, possibilities to why one becomes an alcoholic, and treatments for it.
Available became controversial. While the question of the dialysis machine is still controversial, the health system was caught in another ethical dilemma regarding organ transplantation. Organ transplantation is closely linked to the issue of cleanliness because patients with kidney failure can get an organ transplant as an alternative to hemodialysis. The issue is complicated by the fact Medicare is financed by organ transplant, and there are those who believe that the distribution of rare transplant is not right. There are thousands of terminal patients whose lives can be saved by organ transplantation, but there are no formulas of work that can be used to determine which of the thousands of patients will be given priority. It is left to the discretion of medical officers to decide who is worth saving. The ability to keep someone alive by replacing one or more of their major organs is a splendid achievement of medicine of the 20th century.
Does the environment that one grows up in contribute to alcoholism or is alcoholism determined by genetics? It wasn’t until 1991 that alcoholism was considered both a medical and psychiatric disease by the American Medical Association. Alcoholism is defined in the dictionary as a chronic disorder characterized by dependence on alcohol, repeated excessive use of alcoholic beverages, the development of withdrawal symptoms on reducing or ceasing intake, morbidity that may include cirrhosis of the liver, and decreased ability to function socially and vocationally. (dictionary.com). It is also defined as an addiction to the consumption of alcoholic liquor or the mental illness
Innovative advances in the practice of medicine have increased the life span of the average American. This along with the growing population in the United States and has created a shortfall in the number of organs available for transplant today. The current system of allocation used to obtain organs for transplant faces difficulty because of two primary reasons according to Moon (2002). The two perceptions that stop potential organs donors are that the allocation criteria is unfair and favors certain members of society and/or that organs may be allocated to someone who has destroyed their organs by misuse (Moon, 2002). Many individuals decline to donate organs because anyone requiring an organ transplant is placed on a waiting list and it is possible that individuals who have destroyed their organs by their own actions or convicted criminals could receive donated organs before someone whose organs are failing through no fault of their own and positively contribute to society. When a celebrity or wealthy individual requires a transplant they are often viewed as "jumping" the waitlist but
Alcoholism is a chronic, progressive and potentially fatal disorder which leads to physical and psychological harm, and impaired social and vocational functioning. It is characterized by tolerance, physical dependence and/or pathological organ changes, all of which are the direct/indirect consequence of the alcohol ingested (Light 5). Alcoholism, also known as "alcohol dependence," can be recognized by four obvious symptoms.