You are a transplant surgeon faced with an ethical dilemma. There is a 16-year-old child in kidney failure who needs a kidney transplant. The mother asks you to take a kidney from the father and give it to the daughter. However, the father has already donated a kidney to the daughter before (and after many years, that kidney was rejected). Taking the second one would require him to go onto dialysis and severely decrease his life expectancy. He is in jail, and the jail agrees to pay for medical expenses. The father, who is divorced from the mother, consents to the procedure, saying that he is willing to sacrifice years from his life in order to improve his daughter's quality of life. It is important to note the daughter will not live substantially longer with the kidney transplant, but she will have a much better lifestyle.
The principle of autonomy grants patients the right to make decisions (even bad ones) about their health care. The principle of beneficence compels physicians to act in their patient's best interests. Yet the principle of non-maleficence says to "do no harm." (One should point out that nearly all procedures do harm, but we weigh the benefits with the costs. A blood draw harms the patient by causing pain, breaking the skin, etc., but benefits outweigh the costs).
What do you do? The mother and the father both consented to the procedure (and the daughter assented). You want to act in the patient's best interest and do no (unjustifiable) harm. Yet who is the patient? In a transplant, both the father and the daughter are patients. You would be taking years from the father to improve the quality of life for the daughter. Is that morally praiseworthy or blameworthy?
It's a complex case, further complicated by biological reasons (if the daughter rejected the first kidney, wouldn't she reject the second?). No surgeon would actually take this case. Luckily, this is based on a true story; a relative was found to be a match and underwent the kidney transplant without complication.
"If the father wants to run into a burning building to save his daughter, he can do so, but I cannot hold the door open for him."
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1 comment:
A medical preactitioner most likely will face ethical dilemmas not once in their career, ranging from small issues to matters of high importance. Interesting story.
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