The New York Times Sunday advice column “The Ethicist” has been indulging itself by joining in the mass Times mourning over the election of Donald Trump and the failure of the paper’s years long propaganda campaign against him. The past four featured questions have been “Is It Fair to Judge a Friend by the Way She Voted?”, “Can Voters Be Held Accountable for Their Candidate’s Behavior?”, “Am I a Hypocrite for Calling Donald Trump a Liar?”, and my personal favorite, “My Mom Voted for Trump. Can We Let It Go?” It has taken a month to get back to genuine ethics dilemmas and conflicts, but at last Prof. Appiah is where he is supposed to be all the time.
This weeks query was “A Guy I Know Had a Liver Transplant. Now He’s Boozing Again.” [Gift link! Merry Christmas!]It raises more than one ethics question worthy of discussion, including:
1. Should alcoholics who have destroyed their livers be eligible for liver transplants?
2. Is the recipient of a liver transplant behaving unethically if he or she returns to the same lifestyle that ruined the first one?
3. Do the friends of the now boozing liver transplant recipient “have an obligation to tell this man’s wife that he’s still drinking?”
The first one came up for debate nationwide when Mickey Mantle, the hard-drinking baseball great, strangely came up at the top of a liver transplant list despite being predominantly responsible for his first liver’s demise. Organ transplant waiting lists are created using several formulas and weighted values, which makes sense when distributing rare commodities. On the other hand, this is a slippery slope that slides directly into punishing people for not exercising enough, eating too much pizza, smoking or favoring dangerous hobbies, like motorcycle racing, and withholding medical care or insurance coverage of the adverse results. Alcoholism, as I learned the hard way, is not volitional though alcohol abuse is, and good luck telling the two apart.
2. The second question is also squarely in an ethics gray area. Once the liver is in an individual’s body, he or she should have complete autonomy. Sure, it’s irresponsible for someone with obligations to others to take unnecessary risks with his or her life, but that’s true with or without a new liver. I can’t define a special obligation to those who did not receive a particular liver that should affect the recipient’s decisions going forward. What happens to the new liver won’t help or harm those who didn’t get it.
3. The third question is the easy one, and Golden Rule 101. Would you want to be told if your loved one was secretly endangering his or her health? Sure you would. However, if the wife in this case has been paying attention to her alcoholic husband, I doubt very much that anyone needs to tell her that he’s drinking again.
But did he vote for Donald Trump????
Ethics Alarms 
So let’s start with something that I find is very typical among humans, which is an expectation that an answer exists. Nuance and complexity can cause people discomfort, especially on emotional topics. The subject of organ transplants can be a very emotionally charged one, especially if you are on a waiting list, are an organ recipient, or know someone who is in need of or has received a transplant. I submit that due to the tendency to experience discomfort with complex and/or nuanced topics along with the emotional nature of some topics people will descend into purely emotional responses. For example, insisting that anyone who is an alcoholic should be banned from receiving a liver transplant.
Regarding point one, alcoholics and liver transplant eligibility… the main difference between alcoholism and alcohol abuse is that alcoholism is a diagnosed medical condition (the psychological condition is “Alcohol Use Disorder”), while alcohol abuse is an action. You can abuse alcohol (e.g., binge drinking) and not be an alcoholic, or be an alcoholic in recovery who has not had a drink in years, so is not abusing alcohol. Part of the issue with the terminology stems from the terms alcoholic and alcohol abuse being used as synonyms.
Related to the point and the item that I started with is the complexity of organ transplants in general and having physiological/psychological conditions that can affect a transplant decision. Even for professionals the complexity of such issues can be mind-melting to the point that it becomes so abstract it can not be understood (easily). People expect something to be black and white… it is far less mentally taxing and with complex/nuanced topics it is far too easy for people to come up with “common sense” solutions that are based (almost) purely on emotion.
Insofar as point two is concerned, it is either a simple ethical discussion or a complex one. The difference is that for the simple ethical discussion, a key condition that must be met is that the individual received an organ transplant, and “what aboutism” arguments are simply non-starters. While an organ could be transplanted several times, that is a VERY unlikely scenario. Consequently, once a person receives an organ transplant everything is history. The complex ethical discussion allows for any points to be made, including the hypothetical re-transplanting an organ.
Point three was already more than adequately covered.
Anyway just a few thoughts.