Health Care Ethics – Mickey Mantle Liver Transplant Case Study

Health Care Ethics Assignment Instructions

Mickey Mantle received a liver transplant in 1995. He was a Baseball Hall of Fame center fielder for the New York Yankees whose liver was failing because of cirrhosis and hepatitis. Although the waiting period for a liver transplant in the United States is about 130 days, it took only two days for the Baylor Medical Center’s transplant team to find an organ donor for the 63-year-old former baseball hero.

According to the director of the Southwest Organ Bank, Mantle was moved ahead of others on the list because of his deteriorating medical condition; however, there were mixed feelings about speeding up the process for a celebrity. Mantle was known for overcoming immense obstacles, and many argued that the medical system should provide exceptions for heroes. He was also a recovering alcoholic, which further complicated the ethical implications of the case. Because of Mantle’s medical problems, doctors estimated that he had only a 60 percent chance for a three-year survival; whereas, liver transplant patients typically have about a 78 percent chance for a three-year survival rate.

As in the case of the liver transplant for Mickey Mantle, should the system make exceptions for real heroes? Why or why not?

As in the case of the liver transplant for Mickey Mantle, should the system make exceptions for real heroes? – Sample Answer

The practice of medicine has drastically changed with regard to ethical issues and their relevance. Medical science can as at now intervene in ways that were not possible in the past; patients today are more and better informed; litigation is common more than ever before; physicians have to be more aware of the cost implication of  of their treatment for society and have to juggle among many thongs for example their obligations to the hospitals they work in, the health region and the government.

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Health care ethics basically deals with what is wright and wrong and extends to what we ought to do and what we should refrain ourselves from doing. It has to do with how to handle moral problems that physicians have to graple with in the course of their caring and treatment of patients; more often, clinical decisions must put into consideration more than the medical condition of the patient. Ethical issues arise when not all values can be respected.The values in conflict must be prioritized and the essence of ‘doing ethics’ is to justify breaching the values that are not respected. (Somerville, 2008).

Health care ethics of come to the fore especially when medical practioners are faced with two patients having a similar health problem and from two distinct background  (poor and the rich) the major question is who shuold be treated first? There has been a great debate over these and ethical issues arise with regard to both the procurement of the transplant organs as well as their fair distribution of the same especially considering the fact that these organs are very scarce. Deciding who gets a transplant is therefore often a decision about who lives and who dies. The major debate is how then should physicians allocate highly scarce human organs sucg as livers, hearts and lungs? What criteria or procedures of distribution are the fair or just? To answer and unlock the above dilemmas we need to critically look at who comes first with regard to organ transplant and these is discussed at length below:

Read also Legal and Health care Issues, Ethical and Moral Issues For Health Care Organizations

In the United States for example, more than 122,000 are waiting for organ transplants. The patients and their families hold hope for a second chance of life. To ensure fairness to all, the United Network for Organ Sharing (UNOS) manages the list of those individuals all across the country and outside, ensuring that all the available organs go to those who are best matched. This system is developed out of  National Organ Transplant Act (1984), which established the Organ Procurement and Transplant Network (OPTN) which is a national organ sharing system in order to guarantee among other things, fairness in the allocation of organs for transport. UNOS maintains a database for all patients waiting for organ transplants.

Read also Liver Physiology And Anatomy

In the transplant centers, the patients are evaluated by physicians in charge of transplants  to determine if and when they should be placed on the waiting list. There are rules and these rules vary depending on the organ in question. The general critria is- a patient’s medical urgency, blood, tissue and size match with the donor, time on the waiting list and the proximity to the donor. All these come into play. Factors such as the patient’s income, celebrity status, race or ethnic background do not play a role in determining organ allocation as might have been the case of Mickey Mantle.

Transplant organs are a scarce resource for which limited supply has to be allocated in some way. From the scenario discussed in the foergoing paragraph, it is evident that hospitals deal with organ patients on on a first come, first served system in which elligible recipients of all ages are screened for their likelihood to survive operation thrive are put on a waiting list in their home regions (and sometimes more than one region). The next available organ goes to the closest, sickest patient who is the medical match for the organ.

The only preference is given to recipients who are under age 18. As for those overage 18 theres no prioritizing by age, it is just by whether an organ is available and is a good match for for the next recipient in line. All said and done, it is still debatable as to which criteria or procedure is the most fair or just. Below is the criteria or procedures though debatable:

-Ability to pay; That organs be given to the sick who have the ability to pay. This essentially promotes inequality and seems unfair to the poor.

-Preference to donor or kin; In such a case, racists may refuse to to donate their organs unless promised that they will only go to hte people of their races.

-Benefits to recipients;  This criterion is often phrased in terms of “medical utility,” where priority among the needy is given to the one with the best prognosis. Meaning culculating as to who will make the most efficeint use of the scarce resorce i.e health, age, and the ability to comply with the regimen of anti- rejection drugs and many others.

The above discussed are some of the ethical practises that physicians empoly. Mickey Mantle was no doubt a celebrity and a hero for that matter but ethical considerations surpass heroism. As one can imagine, these factors are usually very difficult to assess objectively. Personal bias with regard to “social worth”is always likely to creep as might have been the case with Mickey Mantle.

Another line of thought that one should consider is for example; should one’s past choices be considered when deciding whether one deserves an equal shot at a life- saving and very scarce resource? If for instance we have two patients who have equal needs and prognosis but there is only one liver available. Should it therefore matter that one patient’s liver was destroyed at through no fault of theirs, while the other patient was an alcoholic for a decade? Bear in mind that the above scenario is distinct from an estimate of medical utility or how much a patient can benefit from the liver or useit efficiently. Alcoholics even at present have to show a period of abstinence from the substance and enough discipline to stay on a post- transplant immuno- suppressive drug  regimen before they are placed on a waiting list. It would be that it is fair to rank alcoholics lower on the priority list but not exlude them. The same case will apply to smokers.

As seen it the above arguments, medical ethics if properly followed and applied lay emphasis on health, age, ability to comply with a given regimen, support system and rule out a history of non- compliance, continuing substance abuse and many others. A persons social status or standing does not feature anywhere and therefore no special preference or exceptions should be accorded to heroes or heroines. They should be subjected to the same treatment and parameters that other individuals are subjected to. Health care ethics should be strictly enforced to ensure fairness to all deserving cases.

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