organ transplants

Monday Ethics Musings, 10/7/2019: Questions, Questions…

/ Jack Marshall / 19 Comments

Thinking…

Wait, where are my clothes???

1. When will Mrs. Q make her debut as a regular contributor to Ethics Alarms? I’m working out the details. She’s ready, I’m behind, we’ll get it done. Very excited.

2. If everything is going to be done online, is it reasonable to expect those companies who force us to interact that way to be competent? Case Study: The Boston Globe just offered me a 6 month digital subscription for a buck. But an old password connected to my email address prevented me from entering the new one necessary to accept the deal. All links went to current subscription or subscribing at the regular price. It took 40 minutes of online chats with robots and a human being (who disconnected me one) to fix the problem, which was in how the Globe set up the offer acceptance page. I ended up using a password made up by “Sherry” because I couldn’t reset my password myself. This kind of thing happens all the time. I wouldn’t have a clue how to set up a website response system, but if that was my job, I would be obligated to do better than this.

3. What good are movie critics whose opinions and tastes aren’t shared by their readers? My view: not much. The job of a critic is to let readers know if readers would appreciate the movie or not. A critic who can’t or won’t do that, and most don’t, is useless. I was thinking about this when I encountered this article in The Guardian listing the films for which audience ratings and critical ratings diverged the most.

Much of the disparity today is caused by critics who allow their ideological biases to dominate their judgment: yes, bias makes them stupid. Another problem, harder to over-come, is that the judgment of people who see hundreds of movies a year and who are often steeped in the art of film-making often has no relevance to the movie average audience member at all. Yet another is the unavoidable fact that few critics are equally qualified to review all genres. Horror movies are especially frequent victims of this problem.

Incidentally, yesterday I watched a new horror movie, “A.M.I.” that exploited the inherent creepiness of online personal assistants like Siri and Alexa. It was pretty bad, but the final scene was so ridiculous (and predictable) that it almost justified the film. Almost. Continue reading →

Comment Of The Day: “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”

/ Jack Marshall / 20 Comments

I am backed up on Comments of the Day again, especially embarrassing after I announced that I would be posting one a day if possible. Getting one of the comments in the queue last night required trying to use my netbook while watching the Westminster Dog Show with my old Jack Russell feeling insecure and cuddling in my lap. The Update will be late today.

The post about the Oregon hospital being bullied by the local ACLU into placing an illegal immigrant on its transplant list simultaneously raised medical ethics issues and illegal immigration ethics issues, so I am grateful that Zoltar Speaks! resuscitates the topic with his comment. I am particularly greateful for his raising the question, “Is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both?”

My answer, which I think I have made clear over 80,000 posts, is that it is what an action does or can reasonably be expected to do, within the intention and goal of the actor, that makes conduct ethical or not. Unanticipated and unanticipatable results don’t count, and neither does pollution by non-ethical and unethical motives mixed in with the ethical motives, unless they warp the conduct and the decision to engage in it.

There are exceptions, of course.

Here is Zoltar Speaks’ 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:

On one hand there is the Hippocratic Oath that directly implies that medical need trumps things like legal status, so in that regard the policy change is a direct reflection of the core of the Hippocratic Oath and it can be said that they changed their policy to reflect the ethical core of the Hippocratic Oath and present that argument to the public and their actions on the surface can be regarded as ethical. (Yes it’s a run-on sentence)

On the other hand there is the fact that illegal immigrants are literally taking advantage of a near “border-less” country and existing systems in place across the United States that ignore their legal status will allow them to do whatever they want regardless of the fact that they are in the United States illegally and some existing systems in place that actually help them do anything they want because they’re illegal immigrants. The United States has been, and still is, enabling illegal immigrants and this policy change is another system changed that enables illegal immigration.

This leads me directly to a topic that we’ve talked about on Ethics Alarms in the past: is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both? If I remember correctly, I think the general consensus was that it’s the perception of the action that makes it ethical.

The perception of this action is two fold; first ethically complying with the intent of the Hippocratic Oath and second it’s another policy change enabling illegal immigration. Continue reading →

Comment Of The Day: “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”

/ Jack Marshall / 5 Comments

“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: Continue reading →

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

/ Jack Marshall / 42 Comments

There must be something wrong with me, for I don’t think this proposition is ethically obvious at all. In fact, I think it’s probably dead wrong.

Here is the story:

Silvia Lesama-Santos, 46, is a mother of four who has lived illegally here for at least 30 years. The transplant program at the Oregon Health and Science University denied her request to receive a new liver, telling her that she did  “not have documentation of lawful presence or immigration documentation,” which was required for her to be eligible for a transplant.

The ACLU of Oregon took on Lesama-Santos as a cause, and publicized her plight. The Oregon ACLU’s  head, Mat dos Santos, called the hospital’s policy “cruel and inhumane.”

The bad publicity, in turn, quickly forced the hospital to change its policy. “It was brought to our attention this evening that an archaic transplant policy was preventing an undocumented individual from being evaluated at OHSU,” the school said in a statement this week. “Upon learning of the policy, OHSU leaders acted immediately and terminated the policy. We deeply regret the pain this has caused the family. OHSU is committed to serving our entire community — all are welcome at OHSU, and this policy does not reflect our values.”

Flushed with success, the ACLU is planning  “to ask other hospitals to change similar policies,” ask, in this case, meaning “coerce.” Continue reading →

Wasting A Heart

/ Jack Marshall / 30 Comments

Heart transplant patient

I don’t have a solution to an ethics fiasco like this or know how it could be avoided, but there have to be some lessons buried here somewhere.

In 2013, 15-year-old Anthony Stokes was denied a place on the waiting list for a life-saving heart transplant  at Children’s Healthcare of Atlanta at Egleston because, the hospital explained, he had “a history of noncompliance, which is one of our center’s contraindications to listing for heart transplant.”

This means that doctors doubted that Anthony would take his medicine or go to follow-up appointments. In other words, he was too unreliable and irresponsible to be entrusted with a heart that could save the life of someone else more likely to make good use of it. When a doctor told the family that Anthony’s low grades and time spent in juvenile detention factored into the assessment, however, that gave the family an opening to save the boy’s life. They played the race card. Anthony was being sentenced to death because he was poor and black, and a white patient would naturally be a better risk. The media ran with the narrative, and there was national outrage. Fearing a public relations disaster, the hospital reversed its decision, and Stokes got his heart.

From the Washington Post today:

Tuesday afternoon, [Anthony] Stokes died after a vehicle he was driving jumped a curb, hit a pedestrian and collided with a pole in a car chase with police, according to WSBTV. The pedestrian was hospitalized for her injuries, but Stokes’s car was nearly split in half by the sign, according to the Atlanta Journal-Constitution.

Police said he had to be cut out of the Honda by first responders and rushed to a hospital where he later died…Stokes was driving a car that matched the description of one used by a person suspected of breaking into an elderly woman’s home. The chase began after officers responding to her 911 call attempted to pull Stokes over, according to WXIA.

Pensive and Rueful Observations: Continue reading →

Sarah Murnaghan’s Lungs: Unfortunately, Sebelius Is Right

/ Jack Marshall / 27 Comments
Secretary Not-A-Death-Panel

Secretary Not-A-Death-Panel

Secretary of Health and Human Services Kathleen Sebelius is refusing to intervene so that ten-year-old Sarah Murnaghan can jump ahead in line to get the urgent lung transplant that will save her life. Naturally, Sebelius is being attacked as  heartless, and conservatives are having a field day equating her decision with Sarah Palin’s infamous “death panels” characterization of Obamacare.

The manner in which organs are allocated for transplants is justly controversial, obviously flawed, and arguably unethical. Any real person whom the system will fail, however, instantly becomes sympathetic beyond the mere faceless numbers she is being compared to. Sebelius is quite correct: if the girl is moved ahead in line, someone else won’t get lungs, for this is musical chairs and a zero sum game.  If she was to make an exception to the policy for this case, it would be impossible for her to deny the next case, and soon Kathleen Sebelius would indeed become a one-woman death panel.

That’s not what she is doing now. What she is doing is adhering to an existing policy in which there are winners and losers, and the losers die, until the policy is reviewed and perhaps changed for the better. Her decision isn’t cold-hearted, cruel or unkind. It is responsible, fair and courageous. The alternative is to have no policy at all.

_________________________________________

Source: NBC News

A Strong Consequentialist Argument for Steve Jobs’ Liver…But Is It Right?

/ Jack Marshall / 2 Comments

Steve Jobs and friend

Back in June of 2009, when “Ethics Alarms” was but a twinkle in my eye, there was a momentary controversy when ailing Apple CEO Steve Jobs was able to use his enormous wealth to land on multiple regional organ transplant lists, thus vastly improving his chances of getting a precious liver transplant in time to save his life. The California native ultimately got a Tennessee liver, but critics cried ethics foul. The organ transplant distribution system is not supposed to be based on wealth: otherwise, why not just auction off livers to the highest bidders? Because most insurance companies won’t cover multiple listings, only the richest patients can afford to employ this strategy, meaning that a system that is supposed to be means-neutral favors the wealthy after all. Continue reading →

Ethics Hero:Wake Forest Baseball Coach Tom Walter

/ Jack Marshall / Leave a comment

Kevin Jordan and his kidney donor

Athletic team coaches habitually refer to their teams as “families”, but in the inspiring case of Wake Forest baseball coach Tom Walter, he meant it. When he found out that one of his players, freshman Kevin Jordan, was in serious peril because of failing kidneys, and that the student’s family couldn’t supply a safe match for a life-saving transplant, Morgan gave the young man one of his own.

You can read about Walter’s gift at Baseball America here and on Ethics Bob here.

Ethics and the Killer’s Liver

/ Jack Marshall / 6 Comments

Johnny Concepcion, a 42-year-old man accused of stabbing his wife to death,  received a liver transplant at New York-Presbyterian/Columbia University Medical Center in New York, raising the natural question, “WHAT?!!”

Or to be more precise: Wouldn’t it be more ethical to withhold a life-saving liver transplant from such a man, and give the liver instead to someone who isn’t a blight on society and likely to spend the rest of his life in prison?

No.

Continue reading →