Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, :
Roy was a star Major League Baseball player. After his retirement, he developed a severe alcohol problem that leads to advanced liver cirrhosis. Without a liver transplant, he will die. He is currently a patient at Legends Hospital.
It is a long-standing policy at Legends, and at most (but not all) hospitals across the country, that patients must demonstrate 6 months of sobriety before receiving a liver transplant; active alcoholics are widely believed to be at excessive risk for poor outcomes from their continued drinking.
Roy, unfortunately, arrived at the hospital drunk and in partial liver failure 3 days earlier; he cannot wait 6 months.
Dan Diver, MD, the senior transplant surgeon, tells the team to list Roy as a candidate for a liver transplant. "He's an alcoholic, and he'll likely lose the liver," Diver acknowledges. "But there's always some possibility that he'll turn himself around. And if he does, do you realize what a successful transplant for a famous patient like Roy will do for organ donation? Consider how many more people will agree to be organ donors! In the long run, we'll save thousands of lives!"
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Should Doctors Perform Genital Cutting on Girl?