Aug 10, 2009

looking for Solomon in triage

A medical ethics hypothetical.
On a Wednesday night in a small town, four men, Smith, Jones, Lee, and Gonzales, suffered immediate liver failure. All four rushed to the town's only hospital, hoping to receive a transplant within an hour--lest they die. The only problem: the hospital had just one liver available for the next sixty minutes.

As the Triage Nurse quickly jotted down their information, all four men began to argue about who should receive the transplant.

"It should be first-come, first-serve," Jones said. "Simple as that." Of course, Jones had arrived in the emergency ward first, shouting "Dibs!" (This was over Smith's protests that he had shouted "Dibs" in the parking lot as they raced toward the hospital.)

"You might as well play rock-paper-scissors or draw straws," Smith said in reply. "That's not rational--that's sheer chance." He argued that they should consider which had contributed the most to society. "After all," Smith said, "I'm a brilliant scientist, and have four brilliant children, all scientists. I cured whooping cough, and my children are working together on a cure for AIDS. I have to survive so I can supervise their research. I should get the liver."

"But I'm the sickest," said Gonzales. "We all have an hour to live, but my liver failed a half hour before any of yours, time I spent driving here from out in the sticks. I should get the liver." He coughed, as if to punctuate his point.

"Not so fast," Lee cut in. "I'm clearly the youngest here. I have the most to live for. I deserve the liver."

"I'm oldest," Jones said, his voice rising. "Age before... beauty."

"Pearls before swine," Lee said sharply, and the conversation broke down into indiscriminate shouting and hollering. Fists were about to fly, when--

"EVERYBODY SHUT UP," shouted the Triage Nurse. "That's it. We're going to..."

Put yourself in the place of the nurse. If you had to decide who got the emergency liver transplant, how would you go about it? What principles or criteria would determine your selection? After all, only one can get the liver--and you'll have to live with the choice for the rest of your days. (Presume, for the sake of argument, that there is simply no other way to save any of the four lives; it's transplant or nothing.)

If you have a solution that, morally and practically speaking, might satisfy all four men--in other words, all four men would agree that the right choice had been made--and that would ease your conscience, put that solution in the comments. I'll share mine, and the situation that's prompted this post, in the very near future.


Elaine said...

Honestly? I'm inclined towards some form of drawing straws. Obviously they all have plenty to live for, and excellent reasons why each one should be the one to get the liver. You could spend the whole hour making that argument, when instead the men who are about to die should get time to say goodbye to their loved ones.

Of course, in the real world I imagine it'd be whoever's insurance company responded first and was willing to pay for it. :(

TeacherRefPoet said...

1. Which one will bribe me?
2. Which one is best looking?

Jim Anderson said...

Elaine, lottery is certainly an attractive option for several reasons, as I'll be blogging about later.

TRP, now I'm going to have to tell everyone which hospital employs you.

Aaron said...

Have each of the men rank the men who aren't them. Obviously this is flawed, but maybe a clear winner emerges. In the unlikely event of a non-tie, it could be reasoned that the men have a similar value structure and therefore this is the most just way to decide in this town.