Everyday Ethics

STEVEJOBS.jpgUPDATE: Interesting NY Times article asking some of the same questions as my original post about Steve Jobs’ liver transplant. Check the NY Times piece out! Because of this article, and because of the many comments I received on my own, I’m putting up an updated version of my prior post today (below), but with some changes to reflect better information. Unfortunately, by putting up this new version, the old one was deleted, so some of the comments on it may no longer apply. Anyhow, enough disclaimers! Here goes:

I read on Gawker that the Wall Street Journal is reporting Steve Jobs had a liver transplant in Tennessee two months ago. After fudging and phumphering about his medical condition for months (even years) since being diagnosed with pancreatic cancer in 2004, this past winter he announced he had a ‘hormone imbalance’ and took a medical leave after he was observed to have dropped an alarming amount of weight.

I get why he’d want to keep his condition quiet. All apart from the natural desire of any regular citizen to have privacy during a serious medical event–and they don’t come more serious than pancreatic cancer–Jobs is the driving force behind one of the biggest tech companies in the known universe. Stock prices dive or skyrocket with the very beat of his pulse. His decision to keep the world guessing about his condition isn’t the source of my ethical ears pricking up.
No, what’s making me just the faintest bit queasy about this story is Jobs getting a liver transplant when he has a disease with such an incredibly high mortality rate. [Updated version–sorry, in my first version of this post, I failed to mention that Steve has the slower-growing and less lethal but still very serious form of pancreatic cancer, a neuroendocrine tumor.] I know a little about pancreatic cancer–my mother was diagnosed with it a year and a half ago. She has been doing remarkably well (thank god and a great doctor) but there’s always the specter of the disease’s return hovering over our family, as it [the adenocarcinoma kind] has something like a 95% recurrence rate. And when it recurs, well… the odds are astronomically bad. While the kind Jobs has isn’t as terrifying, the efficacy of liver transplant to cure it or prolong life is still a matter for debate among doctors.

So I have to wonder, if indeed the transplant is because of pancreatic cancer metastasizing (and that is by no means established yet, so this is all hypothetical for now), is Jobs taking a liver from someone who would have a better chance of surviving? [Is what I’m thinking a total conspiracy theory? A holdover paranoia from the case of Mickey Mantle?] And, did he cut to the head of the line because he’s rich and famous? The rich do have resources, such as being able to register for transplant lists in multiple locations, that most people simply don’t have.
For the purposes of this blog, let’s extrapolate from Jobs’ case, the details of which we can’t really know, to the larger issue of whether the rich get special medical treatment when it comes to organ transplantation, and whether that’s a violation of ethics. Do they get to jump the line? And would we do the same if we could?
Yikes, what a tricky question. I can only look at it through the lens of my own experience. If my mom’s cancer were to return, would I want her to get a transplant even at someone else’s expense? Well, I want her to live, as long and as healthily as is possible. But at the expense of another, someone whose odds are far better than hers? Yeah, if I were faced with the decision today, I’d have to say probably, since she’s my mom. I don’t think I’m the most objective observer on this question, so I went to the source. I asked my mom what she had to say about this.
Her answer was basically, “That’s what transplant review boards are for.” Sure, she said, she’d want to be on the transplant list, if her odds were decent. And she would have no way of knowing who else was next to receive a donated organ, whether their chances were any better or worse than hers. Unless she knew the guy behind her was meant to save the world, why not take her shot at life?
Yay, Mom. I love you so much, for your practicality, your wisdom, and your optimism. I need to see these things modeled in my life–they are a great power of example.
OK, enough mush. Back to ethics, and to Steve Jobs’ case.
Barring any unlikely conspiracy theories about Jobs getting unusual medical treatment because of his rock star status in the computer world, what’s left for me to feel uneasy about is only his having been able to register for the transplant in multiple regions because of his nearly unlimited financial resources. Ethically iffy, but not illegal.
My own conclusion is that I feel relieved, like my mom, that transplant lists are handled by those who know both the medical issues and the likely outcomes, and who have spent years of thought and study on these questions of medical ethics. We put our faith in them not to allow unfair treatment benefitting the elite, and we take comfort in the UNOS procedures that have been set out to keep things equitable. Yet I feel niggling concern that there are lingering inequities that stem from the wealth of people like Jobs, and a healthcare system that is dangerously unbalanced.
Do you agree?

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