Organ transplantation is a significant technique that can prolong a person’s life, enhance the quality of life, and considerably minimize the overall healthcare costs in patients who have end-stage liver, renal, and heart disease. Distribution of limited resources has ethical, moral, and social implications. Given that some causes of end-stage diseases are preventable; the questions arise as to whether the finite resources should be awarded to individuals who could have prevented their disease. While appealing to personal responsibility to prioritize patients has the potential to produce beneficial outcomes, lifestyle choices should not be used as a criterion to influence lifestyle choices.
Personal behavior is influenced by an individual’s lifestyle choice. Lifestyle refers to a person’s way of living; the activities that an individual or a particular group engage in (Mayes 3). In this context, lifestyle choices can be defined as the decisions which people make concerning how they live. These decisions shape almost every aspect of contemporary medicine, and at the same time, are particularly pertinent to clinical decisions regarding organ transplantation or surgery.
However, deciding whether personal choices, as well as the extent to which these choices should shape surgical decisions, are complex. For example, should a 57-year-old smoker and drug dealer undergo a costly and potentially futile organ transplant? What about Sansa, a 23-year-old social worker, who has sustained bone fracture for the second time while playing hockey? Presented with such questions, there is no definitive answer as to who the most deserving candidate for an organ transplant is, although the scenarios present how personal prejudices might adversely and undeservedly bias the organ transplantation decision-making process.
When determining how an individual’s personal behavior should influence who gets to receive an organ transplant, patients should not be categorized by the traditional vices: a sedentary lifestyle, drinking, and smoking. Instead, lifestyle choices or personal behavior should be defined using a systemic and more structured set of the framework. Intrinsic individual behaviors are those which encompass any level of personal patient choices. Consequently, besides the negative examples listed above (poor dieting, alcohol consumption, and smoking), intrinsic lifestyle choices can also include positive lifestyle choices. Hence, in the same manner, smoking might increase the lifetime risk of needing organ transplant for lung cancer, is the same way engaging in exercise may increase the chance of needing an organ transplant due to sporting injury (as illustrated in the Sansa case). Therefore, both positive and negative lifestyle choices have the potential of increasing a person’s likelihood of needing organ transplantation.
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Compared to intrinsic lifestyle choices, determining extrinsic lifestyle decisions is increasingly challenging. Fundamentally, extrinsic lifestyle choices are those that people do not exercise individual autonomy. On this note, Marmot and Bell (4-10) emphasize that environmental, economic, cultural, and social behaviors are antecedent to personal behaviors associated with diseases. He argues that structural factors (geographic location, household income, education level) and not lifestyle choices should be the main target of interventions to prevent certain health-related issues. Accordingly, these socio-economic factors are inherently related to several negative health behaviors including alcohol and substance abuse, sedentary lifestyle, and socio-economic status is, consequently, correlated with that of a person’s parents. A presumption that intrinsic lifestyle choices imply a person’s true choices might be a fallacy. Therefore, personal behaviors have a part to play in health status but focusing on the individual without considering the social determinants of the health issue fails to address the complexity of who is deserving of medical surgery.
One of the ethical principles that are usually applied to the issue of organ transplantation is that of beneficence, that is, “the moral obligation to act for the benefit of others” (Bedford and Jones 17). This argument is based on the theory of utility which calls for the greatest good for the largest number. Based on the utility principle, presented with a choice between two or more possible causes of action, the morally justifiable act is to that which leads to the greater good. It can then be argued that transplanting an organ into an individual who has caused the damage leading to the requirement for a transplant is less likely to produce the greatest good for the greatest number. In this situation, the lifestyle choice is considered because objective evidence exists indicating that lifestyle choices will indicate the possible outcome of organ transplant. Moreover, the issue of cost presents a compelling line of reasoning. In a healthcare system with scarce resources, Bedford and Jones (17) note, economics plays an important role in informing the allocation of those resources to optimize benefits.
However, if the patients who make unhealthy lifestyle decisions are denied access to the organ transplants they need to survive, it becomes complex to determine where the line should be drawn. Organ transplantation is a costly business and the government seeks to get value for its investment. The policy makers together with the healthcare practitioners could as well say that organs are only allocated to, for example, parents of young children or individuals in valued professions, instead of the childless, unemployed, or the older people.
This paper has argued that a patient’s personal behavior should not influence clinical decisions regarding whether or not he or she should receive an organ transplant. Also, the due difficulty of defining what actually constitutes an autonomous choice, Priority must, therefore, be given to patients subject to their clinical needs and not personal beliefs that the patient’s behavior or lifestyle has led to their condition.
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