Should lifestyle factors be considered in the allocation of scarce life saving medical resources?


From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 799, Decision Scenario #9

Dr. Sarah Brandywine hurried into Dr. Kline’s inner office. Dr. Kline was transplant coordinator at Mid-western General Hospital, and he was expecting her. She had called him for an appointment as soon as she had realized the dimension of the problem with Mr. Wardell.

“So tell me about Mr. Wardell,” Dr.Kine said, nodding toward the chair beside his desk.

“He’s fifty-one-year-old man who came to the hospital two days ago because he was frightened by the jaundice and ascites he developed over the course of the last week,” Dr. Brandywine said. “He have been experiencing fatigue and loss of appetite several weeks prior to the jaundice. His liver is swollen and lumpy.”

“Sounds like cirrhosis,” Dr. Kline said. “I’m sure you did liver function tests, but what about a biopsy?”

“We did both yesterday. And I called you right after the final results. There’s so much scarring that Mr. Wardell has little liver function left.” She shook her head. “I want to put him on the transplant list.”

“What’s the cause of his disease?”

“It’s alcohol induced.”

“No way.” Dr. Kline shook his head. “No livers for alcoholics. No ifs, ands, or buts about it.”

“This is a man with two kids.” Dr. Brandywine tried to keep her voice level. “One’s twelve, and the other is eight. Their mother died two years ago, and their dad is all they’ve got left.”

“Oh, God, the kids make it particularly sad.” Dr. Kline’s voice took on a pained expression. “But look, thirty thousand people a year from alcoholic cirrhosis, and we can’t treat them at all.”

“I know we can’t, but can’t we treat some?” Dr. Brandy wine leaned forward. “Is being an alcoholic enough for an automatic turndown?”

“I’m afraid so.” Dr. Kline nodded. “These are people who created their own problem. There are far being enough livers to go around, so it’s only fair for us to put folks with problems not of their own making on the list and to leave others off.”

“But, look, this guy’s got two kids depending on him.” Sarah squeezed her hands into fists. “If I can get him into a rehab program, can we promise him the chance at a liver then?” She quickly added. “Not a guaranteed liver, but a chance at one.”

“The answer’s still no.” Dr. Kline paused. “I’m not saying alcoholics can’t be reformed, but I am saying they’re bad risks. If we give a transplant to somebody whose liver was destroyed by biliary cirrhosis, we’re likely to get a good, long-term survival. But if we transplant somebody who’s been drinking for the last ten or twenty years, we’re not likely to get food, long term results. The guy may promise to stop drinking and maybe he’ll do it for a while. But chances are good that, within a few years, he’s going to be back in the hospital with liver failure again, and alcohol is going to be the cause.”

“I admit the numbers are against me.” Dr. Brandywine inhaled deeply, then let her breath out in a long whoosh. “There’s nothing I can say to convince you?”

“We can’t afford to risk wasting a liver,” Dr. Kline said. “That’s what I’ve got to convince you of.” He shook his head. “It breaks my heart to think about Mr. Wardell’s children, but I’ve got to think about the parents with cirrhosis who aren’t alcoholics.”

Critical Thinking

Should lifestyle factors be considered in the allocation of scarce life saving medical resources? Defend your position using ETHICAL principles.  Using the DIALECTICAL PROCESS  state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own.

Use this template or form to make certain that you include each part of the process-parts a to e

Label your parts with the letters a to e to make very clear that you have done each part.

Dialectical thinking: the 5 parts

  • a. Take a position on this question or issue Be as exact as you can be.  Be precise in your use of language (ethical principles and values).
  • b.  Provide the reasons why you think this position is better defended by reason and evidence than are the alternative positions Position defended using reasoning (ethical principles and values) in support of the judgment (conclusion of the  argument).  You state the reasons why the position you take makes sense and has evidence and reasons (ethical principles and values) to support it other than your feelings or personal preference or your opinion or what you were brought up to believe or what just about everyone you know thinks or believes.   Philosophers have offered such reasons (ethical principles and values) and evidence for the positions they have taken and you should consider them and if you agree you can and should so state them in support of your own position.
  • c.  State the reasons why you found the other positions flawed or less defensible than the one you are defending
  • d.  State the criticisms of your position
  • e.   Respond to the criticisms- rebuttal- how do you defend your position in light of those criticisms
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