“Hello, is this the Oregon hospital? Yes, I live in Mexico, and I need a liver right away. When can I schedule a time to come to the US and get a transplant? That sounds perfect! See you soon!”

The post about an Oregon hospital being publicly shamed into accepting an illegal immigrant for a potential liver transplant attracted the varies and thoughtful response here I hoped for. I have an unusual gut reaction to it, for me at least: I am sure that my position that the hospital is wrong (and that the ACLU is very wrong to bully the hospital into changing its policy) is ethically correct, but I feel badly about it anyway.

Here is what I told myself to make me feel better: Would anyone argue that the same woman would have any right or claim to an organ transplant from an Oregon clinic if she lived in Mexico?  Would the ACLU dare argue that she had a right to be placed on a waiting list? Would even an Oregon hospital think twice before rejecting such a request? Would the ACLU be able to create a public outcry against her rejection? Let’s see: No, no, no, and “you’ve got to be kidding.”

Yet logically and ethically, I see that alternate universe version of Silvia Lesama-Santos being more deserving of a transplant, and receiving a lifesaving organ that a citizen in similar need would receive otherwise, than the actual Silvia. The actual Silvia, unlike my theoretical one, broke our laws. The actual Silvia has already benefited unjustly from doing so. My compassion for the theoretical Silvia is not reduced by my objection to her conduct and disrespect for our immigration laws; given the choice between whether to give a liver to her or the real Silvia, I would choose her, and it wouldn’t be a hard choice. She is more deserving than the real Silvia, unless one reasons that breaking out laws and continuing to avoid accountability for doing so over 30 years is a positive accomplishment. And yet the alternate Silvia has no right to a liver at all.

There. I feel better now.

Here is JutGory’s Comment of the Day on the post,,Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need:

Boy, a lot of near misses here. There seem to be a lot of competing values here, but the dots do not appear to be connected, so, knowing nothing about the topic, there is little to dissuade me from weighing in:

As some have suggested, the starting point for the medical profession should be to help all in need, without regard to any other consideration, except that you triage patients to do the most good for those most likely to survive.

Competing with that is the problem, mentioned by some, is that there is a limited supply of organs. While the profession may desire to help all who need it, the law of supply and demand makes that impossible. They can’t help everyone in need. They have to choose.

How do they do that? Some of the restrictions on choice are imposed by the system (federal or state laws). However, I would presume the medical profession itself would be neutral, preferring only fairness to possible recipients.

Enter the Saudi Prince: that wealthy individual, sitting in an airplane on a runway in Kansas City, waiting for a liver to become available somewhere between Bangor and San Diego, or Miami and Seattle. He could be on any list, in any metro area, and only a few hours away. He might be the ideal patient.

But, it seems unfair that a Saudi Prince in Kansas might deprive a homeless person in Portland a liver, when wealth is the only reason the Saudi Prince could even get a transplant in Oregon.

To prevent this abuse, the medical profession institutes a residency requirement. While not wanting any organ to go to waste, preference is given to locals. If you are nearby, you are preferable to someone requiring shipment a long distance and (for sake of egalitarianism) someone who can afford to fly into town. (That is not necessarily a bad thing when you are dealing with limited resources.)

Enter the Illegal Immigrant from Mexico. This is the person who has no greater legal connection to Portland than the Saudi Prince, both are foreigners. But, the medical profession, trying to be fair, tried to enforce residency as a qualification. Now, that requirement pits poor Mexicans against rich Arabs and the medical profession’s failure to control for class distinctions is revealed. So, as good little Marxists at heart, the medical profession has to kow-tow to the leftists who want the rich Saudi Prince to die.

Okay, that last part was a bit forced. But, I think the medical profession is trying to be fair and help the most people possible. The real world interferes with egalitarianism, unfortunately.

My verdict: this is a situation where strict adherence to rules is the best for fairness. It may mean a Mexican peasant dies, but the Marxists should be happy that, for every Mexican peasant who dies, several Saudi Princes will die too. In all seriousness, there is no great result. Some will always die. Pick your set of rules and act accordingly. There may be bad results, but there will always be bad ones. But, no one is favored for race or class. That is probably a good thing.