Manners in Matters of Life and Death

This week with ethicist Randy Cohen, we'll take up a life-and-death question. Our guest is a doctor who's wondering whether it is proper to use her influence to push a particular patient to the top of the waiting list for a liver transplant.

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DEBBIE ELLIOTT, host:

Helping a friend is always a good thing, right? But what if lives are in the balance? This week with ethicist Randy Cohen we're discussing a real life and death dilemma. Our letter comes from a listener who'd like to be known only as Alice. She's on the line with us now. Hello, Alice.

ALICE (Caller): Hi, Debbie and Randy. Thanks so much for taking my call.

ELLIOTT: Alice you're a doctor and you wrote to us about a friend who needed some serious help.

ALICE: Yes, that's correct, Debbie. I'm a doctor practicing in a major academic medical center. And the question I have has to do with liver transplantation and something that I was struggling with last year. A friend of a friend, it's a young woman who was in completely good health until she suddenly developed liver failure and was in the intensive care unit of a different hospital, not the one where I was working but she was waiting for a liver transplantation to save her life. I mean this woman would almost certainly die without getting the liver transplant that she needed.

She was on the national list to receive a liver from a cadaver because she was so sick she wasn't eligible to receive a live transplant. And another way that she could have gotten a transplant would have been through a directed donation from the family members of a recently deceased loved one who heard her story and found it compelling and would decide to donate the organ to this particular woman.

So a close friend of mine who's a friend of the patient approached me and asked me whether I would be willing to post flyers in my hospital to try and solicit an organ donation for this patient.

ELLIOTT: But you weren't comfortable with that.

ALICE: Well, I wasn't really. I got the sense that by advertising for a liver donation that I might actually be diverting the much needed organ away from an equally sick person on the waiting list who just happened to be less well connected, or less resourceful. I did mention it to a couple of people, and the consensus seems to be that it does go against our duty as physicians representing the patients, you know, generally, and specifically in the hospital where I'd be posting the flyers. So I was very conflicted about it and I pose the question to Randy.

ELLIOTT: Randy, what do you think?

Mr. RANDY COHEN (Ethicist): I'm with Alice's colleagues on this one. It's a terribly difficult question. The desire to help a friend or friend of a friend, especially someone in such a perilous circumstance, is admirable and understandable, but I think Alice's concerns are well placed, that she should not do this, she should not post flyers, that organ allocation should be made, I believe, on strictly medical criteria, not on the basis on who has the best network of friends or who has the most money or who's the most charming person. I believe she can't do this, painful as it is, she ought not do it. Once we start allowing directed donations, which is legal in most places in the United States, but it now brings social factors in as important criteria for who gets an organ, and you end up with a system that is not at all egalitarian.

ELLIOTT: So Alice, what did you end up doing? Did you end up posting the flyers?

ALICE: No, I did not. I knew in the end that this was neither the ethical, nor the professional thing to do. And I explained that to - to my friend, that this is just not done within our hospital. It wouldn't be acceptable for somebody on staff to be posting flyers for a particular patient, whether that patient be in their care or not. And she understood that. I have to say if this were my husband, God forbid, or somebody very close to me, I might feel entirely differently.

ELLIOTT: Randy, did Alice make the right choice?

Mr. COHEN: I think she did. And when Alice says, quite rightly, that if it were a family member of her own the situation might look quite different, that's why we don't allow, for instance, family members of crime victims to serve on juries of the accused in that crime, because we cannot in such situations make a dispassionate decision. And that's why questions about transplantation should not be left to those who are passionately involved. Questions about how we will allocate organs have to be made by the medical community and the larger community as a whole in open discussion at moments of calm.

ELLIOTT: And Alice, what happened with your friend's friend?

ALICE: Fortunately, she did receive the liver that she needed. Because she came in so sick the acuity of the onset of her disease, her otherwise good health, and her young age I think all worked in her favor in terms of the national waiting list. So she was very high up on that list. She was very sick and it took a couple of weeks. And then, you know, her turn came up and she got the liver through the national program. She did very well. And she continues to do well.

ELLIOTT: Alice, thanks for your letter.

ALICE: Thank you so much.

ELLIOTT: If you find yourself in a quandary, even one without life and death consequences, you may want to consult the ethicist. Go to our Web site, npr.org, click on Contact Us, and select Weekend All Things Considered. Put the word ethics in the subject line and don't forget to include a phone number where we can reach you. Randy, thanks again for being with us.

Mr. COHEN: Thank you, Debbie.

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