Denying Mrs. Burgone the organ transplant could be ethically justified under certain conditions and circumstances. However, denying her organ transplantation surgery under these circumstances is not one of those instances and cannot be ethically justified. The decision is arbitrary and serves no purpose for any stakeholders in the outcome of the issue. Moreover, the ethical justification purported to be at the heart of the decision is logically flawed and ethically untenable.
Consistency with the Notion of Equal Access to Medical Care
The notion of equal access to healthcare justifies many types of decisions that may, unfortunately, lead to undesirable outcomes in individual cases (Tong, 2007). Typical examples of that notion in relation to organ transplantation cases would include decisions to conserve public financial resources by cutting off eligibility as a function of objective criteria, such as the statistical likelihood of surgical success and post-surgical survival. Likewise, it would be justified to make the decision to deny certain patients based on the extreme under-supply of suitable transplant organs so that every available organ goes to the patients with the lowest risk of rendering the procedure a waste of a precious organ that could be used to save the life of another patient with a much higher likelihood of success based on empirical data.
Therefore, if the policy for cutting off Mrs. Burgone at the age of 70 were the result of the need to conserve financial resources based on the cost-benefit analysis in relation to elderly patients' surgical success, survival rates, and longevity after surgery as compared to those same criteria applied to younger patients, the policy and the denial of surgery to Mrs. Burgone would represent an ethically justified decision. That analysis would have to reflect the relative difference between her surgical success, survival rate, and projected longevity in comparison to those of younger patients requiring similar surgical procedures. However, the ethical justification of that analysis would be predicated, very specifically, on two issues: (1) payment, and (2) organ availability.
In this particular case, there is no legitimate issue of financial concerns since the patient can afford to pay for the surgery. For the sake of argument, assume that also includes the costs of lifelong follow-up care which usually exceeds the substantial costs of the initial transplant surgery itself (Victory, 2006). Therefore, if the surgery were any type that did not involve the consumption of other very limited resources that could otherwise benefit other patients (i.e. non-transplant surgery), the policy denying the procedure to Mrs. Burgone would directly violate both the specific notion of equality of access to healthcare and also general ethical principles.
The fact that organs for transplant surgery are in extremely short supply is a legitimate justification for establishing strict criteria intended to ensure that the available organs are directed to those patients who are most likely to survive, even at the expense of the lives of patients who are much less likely to survive or to survive as long after surgery. In that case, even patients like Mrs. Burgone could be rightfully denied transplant surgery under the doctrine of the "greatest good" for all members of society, which, in this context, would mean the highest chances of achieving optimum welfare of the greatest number of organ transplant recipients. That is simply a function of the fact that if Mrs. Burgone is permitted to purchase an organ despite her much lower chance of survival...
Under a single-payer framework, the ethical justification would be even stronger, since, in principle, that justification only holds up to the extent surgical expense are borne by public funds (Beauchamp & Childress, 2009; Munson, 2012). Conversely, where individual patients pay directly for their own care, there is absolutely no ethical justification for withholding care from a patient who is capable of paying for it fully and without requiring any public resources. Since Mrs. Burgone can pay for the entire cost of her surgery (and we assume for the sake of argument, for all of her necessary follow-up care), the single-payer issue does not apply to this scenario in any respect because the reasons given for denying her surgery are supposedly matters of fairness in principle and not cost.
The fact that the supposed justification for denying Mrs. Burgone the transplant surgery is "fairness" in principle rather than fairness in any practical sense is precisely the reason that the decision cannot be justified ethically. In principle, there must be some cost or negative consequence to others to justify denying surgery to Mrs. Burgone that she wishes to pay for without relying on public funds. Assuming for the sake of argument that the surgical procedure at issue did not involve any precious commodity in short supply such as transplantable organs, there would be absolutely no benefit to others of denying a patient any form of care just because other people might not be able to afford it. For example, there is no ethical justification for denying brain surgery or any other expensive medical procedure to Mrs. Burgone on the basis of arbitrary criteria (such as age) if that surgery is available without limitation from private medical practitioners who are paid directly by the patient. In principle, the age-based eligibility criterion serves absolutely no articulable public interest and shadenfreude is not a recognized ethical concept; in fact, it is the exact opposite of ethical morality.
Curiously, the scenario makes no mention of the strongest ethical justification for denying Mrs. Burgone the transplant surgery that she is willing and able to pay for without burdening public resources. Namely, it is presumed that any donor organ that Mrs. Burgone would receive will necessarily be at the expense of another patient on a waiting list for the same organ. If the ethical basis for the age-based eligibility criterion is the relative likelihood of surgical success and the likely projected longevity after surgery, it is perfectly ethically justifiable to prefer to direct the transplant organ to those patients who have the lowest statistical likelihood of rejecting the organ, or dying during or shortly after surgery, or of living much shorter lives afterwards. All other factors being equal, it is more ethical to provide the organ to a patient projected to live four more decades after surgery than a patient projected to live approximately one decade afterwards. Again assuming for the sake of argument that there is an available donor liver that is perfectly suitable to Mrs. Burgone but much less well suited to a younger patient (or that is suitable to no other patient), then there is no ethically justifiable basis for denying the surgery to Mrs. Burgone if she is willing and able to pay for the entire cost of the surgery and follow-up care.
Organ Transplants in Relation to the Concept of "Decent Minimum" Health Care
The concept of "decent minimum" health care does not necessarily require that public funds be spent to provide a donor organ for every person who needs one. In principle, the concept of equal access to healthcare requires that the governmental authorities charged with decisions about allocating public funds for healthcare make the most cost-effective decisions possible. With respect to providing the greatest benefit to the largest number of people in society, that requires establishing a hierarchy of the relative value of all medical expenses with those…
In theory, such evaluations could be useful, but as is, they are fairly useless. Plus, the validity and necessity of evaluations are up for debate themselves, besides the actual results from the evaluations being up for debate. Thus, the bioethical dilemma in those who abuse their bodies before and after receiving organ transplants lies not necessarily just with the recipients, but also with society, and with the medical field with
Ethical Considerations Behind Organ Transplants The idea of organ transplants has suffered several criticisms over the years from the civil society, to the various religious groups and even philosophers. It is challenging to have one perspective on the idea of transplants and apply it universally since not everyone will share the religious view, or the philosophical view. In the context of this memorandum, the utilitarian philosophy will be the baseline for
In the U.S. For instance, Abuona (2003) indicated that the very first criterion is the donor's geographic location as compared to that of the recipient followed by the histocompatibility matching and blood group compatibility. The third criterion is a point system that each of the waiting-list patients accumulate in regard to the following variables; waiting time, medical urgency, as well as the age of the patient. This allocation technique
Transplant Medicine The Major Histocompatibility Complex (MHC) contains over 128 functional genes. This is the densest part of the human genome and is responsible for most autoimmune diseases. This region also determines vaccine responsiveness, adverse drug reactions, disease progression and transplant rejection. The MHC genes are multigenic with a high degree of allelic polymorphism. There are over 7,500 different alleles and over 5,458 expressed MHC antigens currently known. (DeFranco, Locksley &
Organ Donation Why Organ Donating is a Social Responsibility Life is a sentence. It begins with a capital letter, has something in between, and then a punctuation mark at the end. Organ donation allows part of our physical body to be of use to someone else for short time after we have passed. It is a beautiful gift to be able to make someone else's life a little longer. This gives them
2009). The susceptibility is highest is the first month of the transplantation and decreases afterwards. it, however, remains high even after 12 following. Susceptibility is highest among kidney recipients who are more likely to develop the infection 12 months after the transplantation. They have a lower mortality rate than liver transplant recipients. The study also reflected a trend in increasing antimicrobial resistance among these susceptible recipients. The E-coli strain