Dear Dr. Brilliant Cliché,
I am a mental health worker. Today I received the strangest request. One of my clients, who has had a less than reputable past which includes drug abuse and alcohol, is now older and sober; but he is paying the price. He has gone into kidney failure and he will die if he doesn’t get a transplant. His life can be temporarily prolonged with dialysis but only a transplant can make him well. Today, the transplant center called me to ask if he is mentally capable of receiving a transplant. They told me that kidneys are very scarce and if he will be noncompliant with treatment his body will reject the organ. This would be a waste when it could have gone to someone else. Additionally, the medications required after a transplant will be very harsh on his mind and body. Essentially, they needed me to tell them if he is worth saving. This is an argument I can run many ways in my head. What is your opinion?
Life or death
Mental health is not relevant to this case at all and neither is your own opinion. Our cultural standard demands that, right or wrong, one cannot withhold lifesaving procedures based on mental health, sex, or race. Not even for economic reasons although in reality health insurance withholds treatment all the time from people.
If this man’s insurance covers it or he is willing to pay for it himself and the kidney is available, in our culture, he has a right to it. If dialysis is an equally effective treatment alternative then it is between the patient and his doctor to decide those options. If dialysis is a lesser treatment, you cannot substitute it simply because you might feel he is less deserving of the kidney than someone else. Even if you feel he might not be compliant with treatment follow up, this doesn’t justify the right to withhold treatment. It would just require extra effort on the treatment provider’s side to help him with compliance issues.
All you can say as a mental health professional and licensed doctor is whether the patient is able to understand the proposed procedure, risks and benefits, and if he is mentally capable of signing his own consent.
Medical ethics is a fascinating field but like law it is not simply based on ethical right or wrong. What determines right or wrong? What is right for the individual often conflicts with what is right for the community as a whole. Therefore many ethical decisions in medicine are based on legal rulings and or community standard.
Dr. Brilliant Cliché
Granny says: This confuses me. If the transplant issue is a matter of law, why is the transplant center seeking this mental health worker’s opinion? Are they taking the law into their own hands and playing God? That seems unlikely. I would like to know the reasoning behind this unusual request.
However, if you want Granny’s opinion- if this issue of who gets the kidney WERE to be decided on intrinsic worthiness, it would not be possible to make such a decision without a thorough investigation into the next kidney patient on the list as well. The patient who was described seems no less worthy of an organ than anyone else. Everyone has problems and no one is without fault…but this man has faced up to his wrongs and through his own efforts he has overcome problems which many people lack the character to address. In my eyes, this would make him more worthy, not less. We cannot judge people by the mistakes they make. If we are to judge them at all, it would be to judge their willingness to accept responsibility for those mistakes and their efforts to right the wrongs. Anyone can coast along an even path…it takes a strong individual to survive an earthquake. Many people who resort to drugs are in terrible emotional or physical pain for reasons not entirely their own. I do not judge them. I feel at least an initial compassion for them. It’s the boneheads who don’t even bother to try that I have no use for.
Dr. Brilliant clarifies:
No this isn’t a legal issue technically. I said medical ethics decisions function like law based on a community standard.