Dr. Robert George gave a lecture Monday night at St. Thomas More Church in New York City, entitled “Clash of Orthodoxies: Law, Religion, and Morality In Crisis.” By way of showing the marked differences between understanding life-issues from utilitarian consequentialism and from natural law, Dr. George had the audience imagine a hypothetical scenario in which one’s exceptionally gifted young daughter, destined to make innumerable societal contributions, is in need of a liver transplant. Her’s being a rare blood type, the only available liver was possessed by a mentally disabled girl across town. From utility, it would indeed make sense to have the liver taken from the disabled and given to the gifted, considering the talented girl’s capacity for greatness versus the disabled girl’s incapacity for even normal human flourishing, added to the inconvenience she imposes on her caretakers. From natural law, the proposition is of course morally reprehensible. The point was only to show the repugnant result of reducing personhood to functionality. But this hypothetical, extreme as it sounds, is not far from reality.
At the Children’s Hospital of Philadelphia, a couple’s mentally disabled child is in fact being denied a kidney transplant on nearly the same grounds. The representing doctor of the nephrology department claims that the child is not eligible “because of her quality of life,” while the social worker reminded the parents of the lasting inconveniences of caring for an older disabled person. Elizabeth Scalia, joining “team Amilia,” a group advocating the parents’ demand for the procedure, comments: “Assessing people as units is evil. . . Amelia’s life is the life she has. She’s entitled to it.”
Read more here
January 18th, 2012 | 10:13 am
“Assessing people as units is evil. . . Amelia’s life is the life she has. She’s entitled to it.”
Absolutely right. How is this all that different from the science of the Third Reich? I mean, while she’s there why don’t they perform some experiments on her. After all, her “quality of life” isn’t as high as a “normal” person, right?
January 18th, 2012 | 10:54 am
But this hypothetical, extreme as it sounds, is not far from reality.
I would say it is quite far from reality. It is one thing to make decisions about who is eligible for transplanted kidneys. It is another thing to start killing “inferiors” for their organs. There are far fewer kidneys available than people who need them. There has to be some reasonably criteria for who gets a kidney and who doesn’t. It’s important to point out that we don’t have all the facts about the case in question, and even in the absence of many facts, it appears that the girl has both mental and physical disabilities and perhaps a much shorter life expectancy, even with a kidney transplant, than many others. I think it is not helpful to sensationalize this as a case of heartless doctors denying a kidney to a girl just because she is mentally retarded. It is a lot more complicated than that.
January 18th, 2012 | 10:57 am
It appears from Professor Camosy’s summary that the denial is not based on the mental incapacity of the patient ipso facto. It is based on the likelihood that the patient will not be able to sustain the required treatment that a successful transplant necessitates. (The subsequent program of medication which requires significant cognitive ability.)
This may be a questionable medical judgement and it is certainly tragic for all involved. But it is not denial of treatment for utilitarian purposes.
As to Professor George’s thought experiment, it (rather ungenerously) assumes a specific happiness-metric will be applied. In a real application of utilitarianism, the very dubious expectation of “useful” things from the recipient would weigh much less heavily. Meanwhile, the implications for others of abandoning the principle of the right to one’s own organs would weigh very heavily.
January 18th, 2012 | 12:48 pm
I agree, it’s not quite clear that this hypothetical is happening ‘in real life’. Since kindey’s a finite and in less supply to those who could benefit from them, some decision making process is going to say yes to some people and no to other people, like it or not. But I think the more interesting point is:
The point was only to show the repugnant result of reducing personhood to functionality
This seems pretty faulty logic to me that’s created by constructing an extreme hypothetical, like trying to argue capitalism is evil by constructing a hypothetical where you can hire contract killers to murder people you don’t like. Yea that would be bad, but it hardly demonstrates that capitalism should be rejected outright!
Likewise, what the hypothetical demonstrates isn’t so much the danger of making personhood depend on functionality but the danger of allowing ‘degrees of personhood’ where instead of all persons being equal, some are ranked ‘more valuable’ than others.
But this has nothing to do with functionality. I could imagine an alternative hypothetical where some sinsiter society rankes people based on race, gender, religion or other factors. For example, Japan in World War II where non-Japanese were accorded a bit more respect than animals. Did that have anything to do with functionality? Not at all. The smartest, most intelligent Korean woman was accorded no more respect than any other Korean woman forced to be ‘comfort girls’ to the dumbest Japanese soldier.
On the other hand, the hypothetical does nothing to address the ethics of using functionality as a ‘binary’ determination of personhood. In a binary determination, you either are a person or are not a person. If you are a person you’re no different than any other person. An example of this style is voting. You either are a citizen or are not. If you are, you can vote once in elections. If you’re twice as smart, rich, patriotic, or whatnot as other citizens, you don’t get two or more votes because of that!
January 18th, 2012 | 2:24 pm
@ David Nickol and Boonton:
Remember, though, that the mother’s intention is to provide a living related (or unrelated) donor for her daughter, NOT put her on the list for a cadaveric kidney. So, your contention that some rationing is necessary due to the scarcity of kidneys is incorrect. If the donor comes from her own family, this does not, as you say, “decrease the supply from someone else who may benefit.”
January 18th, 2012 | 2:34 pm
Tagged: http://rustbeltphilosophy.blogspot.com/2012/01/preference-without-judgment.html
(Also, way to go from zero to Godwin’s law in one comment, Steve.)
January 18th, 2012 | 2:54 pm
” Since kindey’s a finite and in less supply to those who could benefit from them, some decision making process is going to say yes to some people and no to other people, like it or not.”
If one actually bothers to read the entire original post written by Amelia’s mother, you would see that the availibility of a kidney is not an issue. They are not asking to be put on a transplant list – they have a large extended family full of willing potential-donors. The doctors are refusing to do the transplant because the rest of Amelia’s life “would not be worth it.” And that, to me, is what is appalling here.
January 18th, 2012 | 3:14 pm
David Nickol, see the article and Maggie’s post. Apparently it isn’t as complicated as you think.
January 18th, 2012 | 4:38 pm
Berta and Maggie,
As I said, there is a lot we don’t know. For example, some articles mention that adult kidneys are too large for children, and there are grave ethical questions in using healthy children as kidney donors (even if their parents give consent). We also know only the parents’ account of what was said. I am not for a minute suggesting they aren’t providing a truthful account, but I can’t tell you the number of times I have come out of, say, a business meeting and when I hear other people describing what happened, I think, “Did they really go to the same meeting as I did?”
So I think we need to be really cautious in jumping to conclusions.
January 18th, 2012 | 5:23 pm
Apparently it isn’t as complicated as you think.
bobster,
Who reading or writing on this blog is an expert in Wolf-Hirschhorn Syndrome and pediatric kidney transplants? I know I’m not. Why is there only one hospital involved? Can’t we even have a second opinion before we collectively decide this child must have a kidney transplant? The family says it will provide a donor, but do we know if they have a suitable donor, or are they just assuming someone in the family will be found to be suitable. I am usually more than happy to come down on one side or another of a controversy, but I truly don’t know many of the facts, and I am not sure this is a decision I could make if I did. I have no doubt this will be settled, either by the current hospital or another team of doctors, but I don’t know what the solution will be. I can see signing a petition to have this situation thoroughly investigated by independent doctors, but I would feel very strange signing a petition demanding a kidney transplant for this child.
January 18th, 2012 | 10:52 pm
Berta
I didn’t realize the mother was willing to donate her own kidney. Fair enough, since that’s a case of demand ‘creating’ its own supply I’d say more space should be given to ignore ‘rationing’ needs when it comes to donar organs.
Maggie & others
I’m certainly no expert on kidney transplants but I do have some experience with kidney failure since I helped care for my late father in law for about two years with kidney failure. Unlike other types of organ failure, kidney failure is not a death sentence. Dialysis is time consuming but manageable and can effectively replace your kidneys. On the flip side, it takes a lot of wear and tear on the body and over time will break you down. Of course, many people can go decades on dialysis, esp. if they aren’t already old or have other complications.
As there are cons to dialysis, there are also serious cons to organ transplants. You do have to live your life on anti-rejection drugs. Even if you do that correctly, your body will eventually destroy the alien organ requiring either a new transplant or going back to dialysis (although I read there is one kidney that’s been transplanted for 20+ years and is still going). Reading the mother’s story, I noticed that one of the complications here is ‘HIV’. That sounds like a really serious red flag since the donar kidney is certainly going to carry bacteria and viruses with it and you’re introducing that to someone with a compromised immune system and on top of that you’re giving them drugs for life to suppress their immune system. Quality of life may not mean what you think it means here. It may mean an early death due to AIDS because you have to suppress her immune system.
While I don’t think the mother is an outright liar, some aspects of her story jump out as problems. First is her description of the doctor speaking with a thick accent with barely comprehensible English. A sign that he did not and maybe could not really communicate to her all the reasons he was reluctant to consent to a transplant. Second is her description of not doing a transplant and “when her kidneys fail in six months to a year, you want me to let her die because she is mentally retarded? ” Errr, failed kindeys should not result in automatic death unless this girl is living in the early 1970′s before dialysis machines were available. In fact if you follow the diet and fluid restrictions (not easy, something like the equivalent of two or three cans of soda worth of fluid a day….and fluid contained in foods counts too!), it’s quite possible to live 20 plus years on dialysis and longer. I think David raises a good point about just who is going to donate this kidney. It’s one thing if the mother or father are willing and able to do it, I think the ethics of allowing a healthy minor to donate in this case is highly questionable.
January 19th, 2012 | 12:09 am
” Since kindey’s a finite and in less supply to those who could benefit from them, some decision making process is going to say yes to some people and no to other people, like it or not.”
If one actually bothers to read the entire original post written by Amelia’s mother, you would see that the availibility of a kidney is not an issue. They are not asking to be put on a transplant list
It’s interesting how many Americans don’t really believe in equality.
“We hold this truth to be self-evident: that all men are created equal” – this is the source of America’s greatness, its potential and its promise.
Too many people believe that equality is something they are entitled to, but other people aren’t.
January 19th, 2012 | 6:56 am
I don’t think I’m entitled to Blake’s kidney, nor do I think I’m entitled to volunteer the kidney of a healthy child on Blake’s behalf.
January 19th, 2012 | 8:44 pm
I don’t think I’m entitled to Blake’s kidney, nor do I think I’m entitled to volunteer the kidney of a healthy child on Blake’s behalf.
So you’re saying that if you were in line for a transplant, you wouldn’t mind not being put on the list because some doctor thinks “your kind” are less valuable than other people?
You seriously expect us to buy this?
January 19th, 2012 | 10:02 pm
It would seem the straw men are always first in line to be saved with you.
January 20th, 2012 | 8:59 am
It would seem the straw men are always first in line to be saved with you.
What straw man? This is absolutely relevant.
You are always going on about how I supposedly hate gay people, but I would never, ever argue that it would be okay for a doctor to simply refuse life-saving medical treatment to a gay man just because, according to that doctor’s criteria for what makes a life valuable, the gay man isn’t worthy.
You and I appear to agree on one thing: that discrimination has levels – that is, not all discrimination is equally bad. You seem to think the “levels” have to do with human worth – that gays are worth as much as anyone, and are therefore entitled to anything they want, but developmentally disabled girls aren’t worth much, so they aren’t entitled even to medical care.
But I would argue that what distinguishes serious discrimination is what the person being discriminated against is deprived of. To be deprived of something fundamental, something necessary, is more serious than to be deprived of something trivial.
There is no right more fundamental than life, and discrimination that deprives someone of life-giving care they would be otherwise entitled to (were it not for the discrimination) is only one step up from outright murder.
January 20th, 2012 | 1:53 pm
That’s all well and good except for the following:
This does not appear to be a case of depriving anyone of anything.
This looks like a classic example of Mumia Moment. In case you can’t pick up what I mean by that, let me flesh it out.
Mumia Abu-Jamal was convicted of killing a cop back in the 1970′s. When I and many other’s first heard th details of his case, it sounded like a total injustice. He was a frequent radical radio commentator, often attacking the police. The only evidence was a confession that cops taking him to the ER supposedly heard. The bullet that killed the cop supposedly didn’t match the gun he had on him and so on. It was a case that was very easy to jump on board as soon as you heard about it because the right answer seemed so clear. It all fit a very convincing narrative. There was an altercation, a cop was killed and here at the scene was this well known trouble making radical who was also shot so of course he did it so why not ‘help the case along.
Only problem, after other people started digging, the ‘Free Mumia’ case seemed to fall apart. The bullets do match, he refuses to say exactly what happened the night of the shooting, and so on.
Of course, the right likes to think this is just a liberal problem. Since liberals supposedly hate cops, they’d be suckers for a story like that. But it happens to both sides. Mike Hucklebee ended up getting a when he pardoned a notorious rapist because he brought the kool-aid being sold by anti-Clinton conspiracy theory mongers who claimed he was an innocent man framed by the ‘Clinton machine’. The freed rapist when on to rape and then murder a woman. It happened with the Terry Schiavo case as well where the husband was trashed with lies against his character because it ‘fit’ so well a preconceived pro-life narrative of the disabled person beng ‘offed’ by the system.
And it seems to be happening here too. How else to explain what seems to be some very basic things being missed here such as the odd fact that the girl having HIV isn’t even addressed? Or automatically equating being denied a kidney transplant with a death sentence when the fact is dialysis is the standard of care for kidney failure.
The best way to explain this is Mrs. Scalia and others here have been suckered into a ‘Mumia moment’. From the POV of a pro-life activist, the narrative of a doctor trying to shorten the life of a mentally retarded woman on the grounds that her life ain’t worth living is just so appealing all incentive to approach the story critically disappears.
January 20th, 2012 | 4:49 pm
That’s all well and good except for the following:
Except for one thing: if it is true that there are exceptional circumstances, you didn’t know that when you first objected to the girl being granted equal access to medical treatment.
It isn’t reflected in your argument.
I don’t know if the girl is or is not a viable candidate. But I can see that, whether she is or not, the problem is real, because people are willing to defend – rather passionately – the idea that disabled people have no right to equal access when the resources in question are scarce.
January 20th, 2012 | 6:43 pm
How else to explain what seems to be some very basic things being missed here such as the odd fact that the girl having HIV isn’t even addressed?
I don’t think the girl has HIV. I believe the mother was pointing out where highlighted items on a form were, and one of them was right under HIV, and the other under (as I recall) Hepatitis C. But HIV was not highlighted. (This confused me, too, the first couple of times I read it.)
Also, if you read the mother’s own account, you’ll see that at one point the doctor says the medications the girl will have to take after a transplant may cause brain damage. The mother asks if other children who have transplants would have to take the same medicine. The doctor says yes, but it is different for their daughter, because she already has brain damage. The doctor and the social worker also discuss the issue of who will take care of the child, especially if something happens to the parents. Later the mother says:
Even by the mother’s own account, the doctor gave reasons other than mental retardation for not proceeding with a kidney transplant—the child is already brain damaged, and she would have to take medication that might do additional brain damage.
January 20th, 2012 | 11:15 pm
Boonton —
The child doesn’t have HIV. It was on the list of disqualifiers, right above “brain damage,” which was what the doctor had highlighted. She does have Wolf-Hirschhorn Syndrome, which I had never heard of before this story broke, but which does seem to have rendered her very physically fragile in many ways. It does seem very likely that her *physical* difficulties and prognosis on their own would complicate her profile as a potential transplant recipient — as HIV would do — and I agree that there must be much that those of us outside that decision-making process don’t know.
Nevertheless, HIV isn’t a factor in this case.
January 21st, 2012 | 11:19 pm
Blake
Except for one thing: if it is true that there are exceptional circumstances, you didn’t know that when you first objected to the girl being granted equal access to medical treatment.
Except I never objected to equal access to medical treatment. I noted that since the number of kindeys was smaller than the number of people who could benefit from a kidney transplant no matter what system is used to make decisions someone is going to be told ‘no’ somewhere down the line.
The counter objection here was that the mother was willing to give her own kidney. I said I had no problem making exceptions if someone ‘brought their own supply’ of kindey’s with them. This, though, leaves ‘unequal’ treatment still in the cards. If the mother’s kidney is 99% compatitable with some other kid who needs it but only 60% compatitable with her own daughter, she is going to insist on her daughter getting it and since we can’t force her to donate against her will, you are left with ‘unequal treatment’ no matter what.
Now it turns out that it’s not really clear if the mother even can donate a kidney or intends to donate someone else’s kidney. Herein there’s a real ethical problem with taking someone else, who is perfectly healthy, and subjecting them to the risk of a kidney donation…esp. if that healthy person is a minor child being ‘volunteered’ by the mother.
because people are willing to defend – rather passionately – the idea that disabled people have no right to equal access when the resources in question are scarce.
‘Cept no one has done so…except maybe a doctor who can’t speak clear English whose words are given to us filtered through a witness with a clear agenda. You said before I had accused you of hating gay people. I never said that. I think you hate truth and honesty much more than gay people. Gay people are a distant third place for you. Hope that makes you feel better.
David, ST,
Thank you for correcting me on HIV. When I read it, it sounded like she had HIV. Let’s clear up our language use. In order for the objection here to be valid and not a ‘Mumia moment’, it doesn’t have to be shown that the doctor is saying no due to mental retardation. It has to be shown that the doctor wants the patient to die sooner rather than later *because* she has mental retardation. That was not said or even communicated by our poorly communicating doctor in this story.
Let’s work with HIV as an illustration. Say she did have HIV and that’s why the doc. says no. Is that discrimination against people with HIV? well if its because having HIV makes a kidney transplant highly unlikely to work and possibly quite dangerous to the patient, then no. If its because the doc thinks it would be better if people with HIV died off quickly then yes.
Concern that the transplant would be wasted because the patient wouldn’t be able to keep up the medication after her mother becomes too old to do it for her is a valid concern, esp. when dialysis is available in liu of a kidney donation. Maybe the doc. should give the mother the benefit of the doubt, esp. if she can provide a donated kidney in an ethical manner (i.e. not from another child, either her own or another from the family). From the emotions I can gleam in the mother’s story I’m guessing this is a hard case where the daughter is almost certainly going to die an early death no matter what and the mother is hoping the donation will end up as a type of Hail Mary Pass that will somehow beat all the things bearing down on her daughter.
January 22nd, 2012 | 11:58 am
Except I never objected to equal access to medical treatment. I noted that since the number of kindeys was smaller than the number of people who could benefit from a kidney transplant no matter what system is used to make decisions someone is going to be told ‘no’ somewhere down the line.
So doctors can just decide which people are valuable and which people aren’t. Because we’ve got to say “no” to someone. Is this really your argument?
And when doctors decide that blacks or gays or Jews aren’t valuable – using some arbitrary made-up measure to suggest that “Those People” don’t live a life of the same quality and importance as us WASP types – you’ll be okay with that?
Or is it just disabled people who can be stuck with the “no”, because you happen to share the doctor’s opinion that it’s just self-evident that “Those People” aren’t worth as much as, you know, Important People?
January 22nd, 2012 | 12:03 pm
us WASP types
BTW this was facetious. I am not a WASP.
January 23rd, 2012 | 9:01 am
So doctors can just decide which people are valuable and which people aren’t. Because we’ve got to say “no” to someone. Is this really your argument?
Actually that’s exactly what I didn’t say.
January 23rd, 2012 | 8:32 pm
So I think we can distill this thread down to a simple test that honest pro-lifers here will not disagree with. The test is claims of ‘eugenics’ must not simply refer to doctors citing a disability or condition as a reason to deny treatment or a type of treatment, it must be the doctors denying treatment because they assert that their goal is to get someone with such a condition to die sooner.
Blake’s assertion that simply making choices under limited resources is ‘unequal care’ does not hold up. No matter how you cut it, if 20 people need a kidney and there’s only 5 kidney’s out there, at least 15 people won’t be getting a kidney. That is a simple mathematical fact but it does not mean that any system of making such a choice must be premised on doctors or anyone deciding some people ‘aren’t worthy of life’ or ‘are not equal in their status as human beigns’.
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