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Wickedness, Moral Responsibility, and Access to Transplantable Livers

Published online by Cambridge University Press:  07 December 2017

RYAN TONKENS
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Abstract:

Under the current conditions of scarcity of transplantable livers, difficult decisions need to be made about access. There is a growing consensus that it is morally justified to give people with ARESLD lower priority than those whose need is not self-caused. The purpose of this article is to critically examine the conditions under which such prioritization is morally justified, by challenging arguments put forth by Walter Glannon and Daniel Brudney. There are serious theoretical and practical problems with these views, which have to do with the nature and scope of the (putative) moral duty not to contribute to the competition for scarce transplantable livers, and the difficulty in determining whether people are responsible for their weakness or even wickedness of character. These problems need to be resolved if we are to be morally justified in determining access based on causal and moral responsibility for being in need.

Keywords

allocation of transplantable liverscausal responsibilitymoral responsibilityalcohol-related end-stage liver diseasewickedness of characterDaniel BrudneyWalter Glannon
Type
Special Section: Open Forum
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 1 , January 2018 , pp. 62 - 74
Copyright
Copyright © Cambridge University Press 2017 

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References

Notes

1. Moss, AH, Siegler, M. Should alcoholics compete equally for liver transplantation? JAMA 1991:265(10):1295–8.CrossRefGoogle ScholarPubMed

2. Thornton, V. Who gets the liver transplant? The use of responsibility as the tie breaker. Journal of Medical Ethics 2009:35(12):739–42.CrossRefGoogle Scholar

3. Veatch, RM, Ross, LF. Transplantation Ethics. Washington, DC: Georgetown University Press; 2014.Google Scholar

4. Glannon, W. Responsibility and priority in liver transplantation. Cambridge Quarterly of Healthcare Ethics 2009:18(1):23–35.CrossRefGoogle ScholarPubMed

5. Brudney, D. Are alcoholics less deserving of liver transplants? Hastings Center Report 2007:37(1):41–7.CrossRefGoogle ScholarPubMed

6. See note 5, Brudney 2007.

7. See note 4, Glannon 2009, at 24.

8. See note 4, Glannon 2009, at 25.

9. This is not to suggest that there is no disagreement between Glannon and Brudney. For one thing, these authors disagree about the extent to which individuals actually meet these conditions in reality. For example, see note 4, Glannon 2009, at 28.

10. Burnham, B, Wallington, S, Jillson, IA, Trandafili, H, Shetty, K, Wang, J, et al. Knowledge, attitudes, and beliefs of patients with chronic liver disease. American Journal of Health Behavior 2014:38(5):737–44.CrossRefGoogle ScholarPubMed

11. Sanderson, SC, Waller, J, Jarvis, MJ, Humphries, SE, Wardle, J. Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK. Patient Education and Counseling 2009:74(2):221–7.CrossRefGoogle ScholarPubMed

12. This could be part of the motivation behind some jurisdictions giving higher priority to organ donors on organ transplant waiting lists than to nondonors. Whether this tool for prioritization is a morally justifiable one is interesting to consider, but is beyond the scope of this article.

13. See note 5, Brudney 2007.

14. See note 5, Brudney 2007, at 45

15. Doris, JM. Persons, situations, and virtue ethics. Nous 1998:32(4):504–30.CrossRefGoogle Scholar

16. Varga S. Embodied situationism. Australasian Journal of Philosophy. June 20, 2017; available at http://dx.doi.org/10.1080/00048402.2017.1341538 (last accessed 15 Aug 2017).