The choices involved with organ transplants are never easy. There are more patients in need of new organs than the number of available organs, which means that doctors and transplant committees have to make decisions that are not palatable to many of us. They have to evaluate the possible quality of life of patients after they receive the transplants, and factors like longevity are a concern, but so are less quantitative ones, like their ability to contribute to society. Also, factors that are less specific to the patient can come into play, such as the ability of family members or other benefactors to provide the hospital with financial incentives to lean in a particular direction. Using both utilitarian and Kantian ethics, analyzing the cases of Jerry, Lisa and Ozzy is not easy by any means; however, it does reflect the decisions that face transplant committees today, and will continue to do so as life span continues to increase.
Utilitarian ethics believe, in general, that an action that is good benefits the general happiness. If the sum of the happiness an action creates exceeds the amount that it wipes out, the action is good. In the case of Jerry, the happiness created is significant. He continues to be able to raise a solid family; when he retires, he will be able to actively involve himself in his grandchildren’s lives. His longevity is the greatest, at 10-15 years with high probability. While he did damage his heart through steroid use, he did not do it knowing what steroids would do.
In the case of Lisa, the action that her heart transplant creates is also significant. The publicity of this transplant would bode well for the hospital, in terms of future cases and donations. Her longevity is the shortest, with less than eight years being the most likely scenario, given her other health conditions. However, her father’s ability to donate $2 million to the hospital would create happiness for many other people, as the hospital is in need of the funding.
In the case of Ozzy, it is true that he is reaching out to former addicts, and that he has turned his life around. He could also live 10-20 years longer, but his probability is not as high as Jerry’s, because of the likelihood of relapse into drug use. He also does not have a family, and he has no one willing to offer huge donations to the hospital on his behalf. On the simple calculation of utilitarian happiness, it would appear that Lisa should receive the heart.
However, Kantian ethics are somewhat different. The first version of his categorical imperative says that one should follow an ethical principle only if one is willing for it to become a universal law for everyone. It would not be ethical for anyone who had a $2 million benefactor to be able to come in and outweigh all of the other ethical considerations in a case. In this instance, if it were Ozzy that had the $2 million benefactor, it still might be better to give the heart to Jerry, because the public relations benefits that come from giving Lisa the heart would not be nearly as helpful after giving the heart to a drug addict, and so the utilitarian response would be different. From a Kantian perspective, the best idea is to give the heart to Jerry, because factoring in longevity of life and contribution to society makes more sense as a universal law.