Record Medical Administration Service for File Rationale

¶ … Record

Medical Administration Service for File

Rationale in Support of Selection of Heart Transplant Recipient

Because time was of the essence in formulating this decision, this memorandum for the record sets forth the decision-making process and that was used to select the most appropriate candidate for a heart transplantation procedure. It was my responsibility as lead surgeon to select the most appropriate heart transplant recipient from a pool of three candidates, each of whom had suffered from several health-related issues that adversely affected their suitability for the transplant procedure. Therefore, in order to formulate as subjective an analysis as possible in a timely fashion, a utilitarian ethical analytical approach was used to identify the candidate that held the most promise of using the gift of additional life from the heart donor to its maximum advantage. The utilitarian ethical analysis showed that of the three potential heart transplant candidates, the 12-year-old patient, Lisa, was the most appropriate for the reasons discussed further below.

UTILITARIAN ETHICAL ANALYSIS OF HEART TRANSPLANT CANDIDATES: In sum, as propounded by John Stuart Mill and John Locke, a utilitarian ethical analysis of the three potential candidates for the heart transplant can be used to weigh the respective pros and cons of each candidate to determine which course of action represents the greatest good for the greatest number of people over time. In this regard, Andre and Velasquez advise that, "Utilitarianism is a moral principle that holds that the morally right course of action in any situation is the one that produces the greatest balance of benefits over harms for everyone affected" (2012, p. 37). Although all three candidates for the heart will likely be convinced that they are the most appropriate recipient for the organ, it is important to determine which candidate offers the most chances for a successful outcome in terms of length and quality of life (Rosen, 2003). For this purpose, a utilitarian decision-making process can be used following the three-step process as follows:

1. Identify the various courses of action that could be performed;

2. Determine all of the foreseeable benefits and harms that would result from each course of action for everyone affected by the action; and,

3. Select the course of action that provides the greatest benefits after the costs have been taken into account (Andre & Velasquez, 1989, p. 37).

Notwithstanding the purely human -- and therefore emotional -- issues that are involved, the decision to select the most appropriate heart transplant recipient demands a pragmatic cost-benefit analysis of the various potential outcomes. In this regard, Hollingsworth, Hall and Trinkaus (1991) suggest that, "Utilitarianism closely resembles cost/benefit analysis. Cost benefit analysis, like utilitarianism, suggests that decision makers should only undertake those actions where the benefits exceed the costs" (p. 18). Therefore, the respective negatives and positives associated with each of the three potential heart transplant recipients is set forth in Table 1 below which showed that, from a utilitarianism perspective, Lisa is the most suitable candidate.

Table 1

Utilitarian ethical analysis of heart transplant candidates

Negatives

Positives

Jerry -- Male, 55 years old

1. Age (55 years)

2. Damaged heart due to steroid use when younger.

3. Presumed to have healthcare insurance.

1. Potential for living another 15-20 years is very high (due to retire in 5 years).

2. Four family members, including one autistic child and another who aspires to work in outer space, depend on candidate for their livelihood.

Lisa -- Female, 12 years old

1. Lifelong healthcare problems, some of which affect her suitability for a heart transplant procedure.

2. Survivability into her 20s is considered unlikely even with the transplant.