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Morality Brain Teaser

I took a class called "Vice, Crime and American Law," a few years ago, it was very interesting... we had to write an essay that answered the following question:

You have several options:

1) There is a list of patients who have been waiting for a liver, you can strictly adhere to this list regardless of who is at the top, or how badly the patient needs the liver. Keep in mind: the person who is number 1 may have a less serious condition than the person who is number 5; patient #5 may only have a week to live...while patient #1 may have several months to live. But patient #1 did sign up before #5.

2) You can suggest a lottery. Draw a name out of a hat, and that person receives the liver. This way it relies all on chance, not on need. There is no need for you to look over the cases to decide who is in the most need the liver.

3) You review the cases and you decide who needs the liver the most.

These are your patients:

Dan: A homeless 45-year-old man, he has already had one liver transplant due to his alcoholism. He is currently at the top of your hospital's list for liver transplants [you have the right to veto anyone on the hospital's list, as long as you have good reason to]. Dan's problem is serious, but realistically he could live for another 4-5 months without being treated immediately.

Kristen: A 36-year-old lawyer. She is willing to donate enough money to the hospital to add on an additional wing to the hospital if she receives the liver transplant ASAP. Her condition is not as serious as some of the other patients, she could live for a few more months without the liver, but if she has to wait she would not donate the money to the hospital.

Megan: A single 24-year-old woman who has five children. She is unemployed, and doesn't have any insurance. Her condition is very serious, and she may not survive the operation.

Carl: A married 80-year-old man, who happens to be a noble-peace prize winner. His condition is very serious, but he has a very high chance of living through the operation.

April: A 7-year-old girl who is in desperate need of a liver. She is very sick and will likely die with the next 2-3 days if she doesn't have this operation immediately. The success rate of this operation is very low.

What do you choose to do? And why?

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Permalink Reply by Фелч Гроган on August 7, 2008 at 1:21am

Eat the liver with some fava beans and a nice chianti.

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Permalink Reply by Skylar on August 7, 2008 at 2:06am

I would divide them into two groups, urgent list and wait list.

The urgent list gets to go first.

Urgent: Megan, Carl & April

Waiting: Kristen & Dan

Then I would evaluate them by need and chances of success, and whoever is on the urgent list with the greatest need and then highest chance of success gets the liver. My job as the doctor is not to evaluate human "worth", it is to treat patients and not harm anyone.

I wouldn't take money, jobs, accomplishment, age or insurance into account. All things being equal on those counts, then I would pick the person who was on the list first.

April seems to have the greatest urgency. She will die in a few days without the liver, so I would give it to her.

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Permalink Reply by Fizzy on August 7, 2008 at 2:31pm

I think it's necessary to consider both urgency and operation success rates, so I would probably give the liver to Carl.

Saving a laureate might get enough good PR to make up for losing Kristen's money, too.

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Permalink Reply by LoLo on August 7, 2008 at 7:09pm

Here are some of the reasons given for choosing one over another, tell me what you think:

Reasons not to choose.....

1) Carl, being 80-years-old, is nearing the end of his life. There are other patients who are younger and have more of need to receive the liver than he is.

2) April, while a tragic case, has a very low success rate. She should be lower on the list, b/c chances are she won't survive once she has the liver anyway. The person chosen should be more likely to survive.

3) Dan should not get the liver b/c he has already been given a 2nd chance to live his life again, and he ruined it by drinking (more than likely).

4) Kristen would only be because chosen because of the money involved, it would help the hospital, but a bribe is still immoral; therefor she should not be chosen simply because she has more money than everyone else on the list.

5) Megan shouldn't not be chosen because given the information she is not very responsible with her life, and would probably not take care of her new liver.

Reason why to choose....

1) Dan, he is first on the list. We must honor the "first come, first serve" mantra because it is the fairest choice given. Others could have signed the list earlier to receive a better spot, but procrastinated.

2) Kristen, because she is willing to donate a large amount of money to the hospital which will likely result in lower mortality rates, better service, more doctors, etc. for the hospital. In the long run this addition to the hospital will save hundreds of more lives than it would have before.

3) Megan, she is a mother who is obviously very poor. Her children need her, and they do not have a father who is willing to take care of them. Once she dies they will probably end up in an orphanage.

4) Carl, he is obviously a very moral human being, who is well known in certain communities. He is very likely to survive the operation, the doctors are quite sure that the liver would not be a waste on him because of the high chance of living through the operation. As Fizzy said, this would also be great PR for the hospital. It would likely make the news, and the more people who hear about it would probably donate their own money to your hospital.

5) April, because she is so young and has barely been given a chance to live. The rest of the candidates made it to adulthood, some are at the tail end of their lifespan, or haven't been responsible in their life. We should give April the liver because she is so young and hasn't been given a chance to live life as it should be lived.

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Permalink Reply by Fizzy on August 7, 2008 at 8:23pm

I'm not sure I agree with your reasons against Megan, though admittedly she was not my first choice.

Simply being uninsured and unemployed is not an immediate indicator, especially recently, of a lack of responsibility. The five kids at twenty-four may be (honestly, any kids at twenty-four makes me a bit uneasy, but that's me), but it isn't automatically so.

Otherwise, I basically accept your reasons for and against each patient. If I'm not selecting them individually, I guess I'll fall back on the first-come-first-serve system. Or maybe wheelchair races...

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Permalink Reply by LoLo on August 7, 2008 at 9:03pm

I like the idea of wheelchair races... should they be motorized or the regular kind?

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Permalink Reply by Fizzy on August 7, 2008 at 9:16pm

Hmm, if we let them use motorized chairs, we really ought to turn it into more of a Twisted Metal kind of competition.

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Permalink Reply by LoLo on August 7, 2008 at 9:51pm

That's brilliant! Oh Twisted Metal....and that scary clown....

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Permalink Reply by Alex Innominate on August 10, 2008 at 5:15pm

I would pick Megan, she has a family depends on her, the children will end in orphanage. Maybe she is a fantastic mother

if so, the children nead her.
April is the second choise, it wasn't an easy chois...
The other 3 are much easier.
Dan, the society doesn't has enough chances, to give him another, he might be lucky or not.
Kristen, this is bribe and backmail, reason enough to let her die

or just to put her on the last place on waiting list for the next months.
Carl would be the most negative PR I can imagine, I don't understand, why or how he would be positiv PR. If you are unpopular, would you go to this hospital? A hospital that let (much younger?) persons die, because nobody knows them? Never had a chance to get popular? A lot of people wouldn't understand this. I would be afraid to die on the corridor, because a famous one had headache and the half staff is serving him/her. It's hard to make a date, but he passed it.

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Permalink Reply by Jeff the Koala on August 11, 2008 at 9:20pm

My decision would depend on these factors:

a) Is Kristen still fit to bear children?

b) Is Megan's condition mostly the result of environmental factors?

C) In how many years will April become nubile?

Having then chosen the fittest and healthiest female, I would prioritize her welfare over all others and then use her reproductive vector to disseminate my oh so precious genes.

I've never understood why some people find these 'ethical' problems so disturbing!

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Permalink Reply by Wolf Martinus on August 27, 2008 at 6:14am

I'd say it would be desireable to set up a decision system up front, before the life and death scenario on an individual arises, and then go by it.

Something like awarding points for:

- expected success of the operation
- expected remaining life time
- urgency of need
- not being an alcoholic who has already wastet a donor organ
- not being a lawyer

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Permalink Reply by Doug on September 11, 2008 at 3:43am

Interesting question

Life is a lottery and science has brought us options that would never exist before.

The life of your average transplant recipient is one of constant drugs and treatment I am not sure I would want to undergo that kind of treatment but then I am not facing death.

My first suggestion would be the idea of a reality TV show of "Liver fight" where viewers vote for who gets the organ.

Seriously I don't think there is a correct answer it is just a decision that has to be made at the time with the best information available. I know sometimes it does come down to the toss of a coin but then that is life anyway. It is all random chance.