Monday, March 13, 2006

My Opinion On The Survival Lottery

Organ transplantation, one of the greatest achievements of modern day medicine, is able to prolong one’s life by replacing a diseased major organ with a healthy one from a donor. Unfortunately, the current demand for transplant organs far exceeds the supply resulting to thousands of deaths per year due to lack of replacement organs.

Arguments arise in connection with procurement of these transplant organs as well as their “fair” distribution. Giving justice to the distribution of these limited resources is debatable. John Harris formulated a “survival lottery theory” which is particularly related to decisions involving life-extending treatments. This theory considers that only few characteristics of patients are relevant to the allocation or distribution of resources. According to the author, we don’t have a good reason to prefer one person to the other. He said we should choose and if we must choose, it should be by lottery.

The survival lottery theory was postulated in response to some inequities of the QALY (Quality Adjusted Life Years) theory. One implication of the QALY theory is that a person who has more years of life to gain from a life saving treatment such as organ transplantation should be given a higher priority than a person who has lesser years of life to gain. A consequence of this is that treating younger people is likely to be a higher priority than treating older people. John Harris realized that these implications value some lives over the other with regards to how long a person is likely to live. For him this should not be the case. He believes that an old person who has less more years of life expectation may value his remaining life just as much as a younger person with more life expectation.

Why not kill A and use his organs to save Y and Z. This is a horrible suggestion but there are two arguments against the present norm of leaving Y and Z to die. The Utilitarian Argument and the Fairness Argument. In the Utilitarian Argument, we ought to do what will have the best consequences. It is a better consequence if more people will live. Also under the Utilitarian Argument, if we intentionally kill a healthy person and in so doing save at least two unhealthy individuals who otherwise would have died, then more people will live than if refuse to kill the healthy person. So, under this argument, we ought to intentionally kill a healthy person when doing so will save at least two unhealthy persons who would have died otherwise.

Another argument is the Fairness Argument. In the Fairness Argument, if we are faced with circumstances in which inevitably we will kill a person, we must decide on a fair basis. To refuse to outright kill A and leave Y and Z to die instead simply because they are unlucky to have diseased organs is unfair to Y and Z. The Fairness Argument does not spell out what we should do, it only claims what we should not do, that is to outright refuse to kill A to save Y and Z.

We might think that it would be unfair for A to be singled out for death that is why John Harris proposed the survival lottery theory that does not involve singling anyone out. The survival lottery would involve everyone being given assigned lottery number. When patients are found in need of organs and no organs from the already dead were available, a computer will randomly pick a number. The person picked by the lottery would then be sacrificed, his organs harvested to save as many people as possible. Participation to this lottery would be involuntary more like a military draft. The survival lottery seems to satisfy the demands of the Utilitarian Argument. More lives are saved with this lottery system than our present policies. The lottery system at least has an air of fairness in it. The fact that some individuals have diseased organs is terrible but no one person is singled out to bear the burden of this sad fact rather, everyone is put in some risk.

Some of the debates raised against this proposal are: 1) the survival lottery would undermine our security, something we all reasonable desire; 2) the survival lottery fails to “respect individuality” because it treats A, Y and Z “merely as interchangeable units”; 3) The survival lottery involves “playing God” with human lives; 4) the survival lottery involves us in killing whereas refusing to practise the survival lottery involves us in letting death and killing is worse than letting death; 5) the survival lottery is inconsistent with recognizing that every person has a fundamental right to self defense.

In my humble opinion, the survival lottery is the only one that claims to give consideration both to “fair chances” and to utility. On the first argument, I can say that we would be more likely to live longer lives with this theory than without it. Others say the proposal fails to “respect individuality.” Yes it does, but so does our current system involved in organ transplantation. A, Y and Z are also treated as interchangeable units under our present scheme but Y and Z automatically lose.

Others will say that the survival lottery involves “playing God.” So does our current practise. When we choose not to save Y and Z when we could, we are playing God too. In response to argument number 4, this is not true. If we could readily save Y and Z, then this is killing them “as sure as shooting them” is. It is to simply assume that saving Y and Z is worse than allowing them to die. Regarding argument number 5, my answer to that is the right to self-defense does not show why we should let A live rather than Y and Z. If Y and Z live, they do so “over A’s dead body.” But if A lives, he survives “over the dead bodies of Y and Z.” So if killing A violates his right to self-defense, then killing Y and Z to save A violates Y and Z’s rights to self-defense.

These arguments can go on and on. It’s a good thing that we can’t apply the survival lottery theory at our present time because organ transplantation has not yet come to perfection. The survival lottery theory remains only a proposal that we can debate on.


Blogger AL said...

Hei Doc!!!
God you are back!!!

12:23 AM  

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