First published 2005-2006.
I feel sorry for medics. Not because they all have to study for a further gazillion years after the rest of us graduate, but because they are faced with difficult decisions on a daily basis.
George Best is back in intensive care (again). The surgeon who gave him a liver transplant is calling for alcohol abusers to be kicked off the donor list, or least to have some form of assessment that proves they won’t revisit the booze fairy. Apparently, Best now has a kidney infection as a result of his immunosuppressive drugs, which was probably catalysed by his continued post-op binge drinking.
That’s entering rather dangerous territory. As arrogant as some medics may be (cough, Oxford graduates, cough), they really aren’t in a position to play some form of divine being and decide who deserves a transplant. Imperial’s own version of the Hippocratic Oath states: “I will not permit considerations of gender, race, religion, political affiliation, sexual orientation, nationality, or social standing to influence my duty of care.” That, to me, essentially means that a good doctor doesn’t judge their patients.
I respect that giving body parts to save someone’s life is an invaluable gift and a difficult decision for the family to have to take on the deceased’s behalf. I also accept that Best’s self-destructive behaviour strengthens the argument of people who don't like organ donation – why give away the final legacy of a loved one only to see it abused? This does severely jeopardise the number of people signing up to be organ donors.
But it’s still wrong to just leave someone for dead, whether or not their condition was self-inflicted. When someone slits their wrists in front of you, the right thing to do is dial 999 and get help, not watch them die whilst telling them that they don’t deserve to live anyway.
And Best’s surgeon also seems to have forgotten that when someone is suffering a life threatening condition - whatever it is, and however it was caused - it is not just them that suffer but also those around them. A doctor’s responsibility also extends to those people who are suffering as a direct result of their patient. It really is just harsh to make flippant remarks regarding who deserves one of very few livers when their family are entirely innocent in the matter.
There is now a vast danger of doctors being forced into turning patients away on the grounds of lack of resources, rather than for medical reasons. If there were copious amounts of organs available for transplant, measures such as removing alcoholics and smokers from the waiting lists would not even transpire.
Medics would be saved the burden of harsh judgements if resources were not an issue. In an ideal world, every patient would get the drugs and treatment they require, but the fact that there are shortages does not mean we should create a list of lesser/greater individuals.
There are two morals to the story. One is to do things in moderation – don’t make your self unnecessarily sick and put doctors in such difficult positions. The other is to carry a donor card, regardless of who you think the organs may go to. Nearly half of all liver disease cases are alcohol related – but over half aren’t. The more organs there are, the better the chances for those on the waiting list. Don’t hold them back.
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2 comments:
The problem with your slit wrists analogy is that the person who slit their wrists is not jeopardizing someone else's survival.
Unfortunately, the survival rate of alcoholic transplant patients is not good. There are some shining examples of them kicking the booze and doing well, but more often than not the reverse is true; they return to drinking and eventually either reject the organ or irreversibly damage it requiring a second transplant.
In such cases they potentially rob other critically ill patients who have a greater chance of success after transplant the opportunity to survive and live.
It's a horrible decision for anyone to have to make, but until enough people are donors that we no longer have a shortage of organs then such decisions must be made and they must be made on the basis of which patients are most capable of handling the changes in lifestyle post transplant and who are most committed to a successful outcome.
Active alcoholics simply provide a very poor surgical risk for transplant both in light of their risk of rejecting the organ because of continued drinking and even in being able to heal after surgery because of poor nutrition and damage to multiple systems.
It's sad but true.
I do agree with your sentiments, definitely. I guess that's why my final conclusion was to urge as many people as possible to become organ donors so that these tough decisions needn't be made.
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