Invaluable

Because someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ.
Richard Gibson “The Heartless Matter of Organ Transplantation and COVID Vaccination”

The “right” person, huh? And how on Earth is that determined? Mr. Gibson suggests that “it is simply a matter of maximizing outcomes and minimizing risks,” and “getting the best ‘value-for-money’.” But then he goes on to suggest that some failures to minimize risk are less salient than others. Not being vaccinated against the SARS-CoV-2 virus is a legitimate reason to be denied an organ. But putting oneself at risk by engaging in extreme sports is not. But if it makes sense to say that a person who is vaccinated against the virus is a much less risky investment than an unvaccinated person, why shouldn’t the hobbies of the extreme sportsperson be taken into account?

There is, in my opinion, nothing wrong with creating some sort of risk criteria when deciding how to distribute a scarce resource, especially one that some group of people need to ensure their continued survival for a time. By the same token, there’s nothing wrong with deciding, as the person or persons in control of a scarce resource, that it will go to people whose values best align with one’s own. But using one as a cover for the other strikes me as disingenuous. I tend to be of the opinion that people are generally partisan and arbitrary; they make decisions based on what they understand their interests to be, and then attempt to slot them into a greater framework. Not out of dishonesty, but out of culture and upbringing. I don’t believe that I’ve ever encountered a person who adopted an ethical viewpoint under which the decisions that they were accustomed to making on a day-to-day basis were considered wrongful without some explicit desire to change those decisions.

While there is something of an understanding that all human lives are precious beyond measure, in the everyday world lives are worth the resources that people are willing to marshal to protect and extend them. Mr. Gibson hints at this when he notes that the people who die while waiting for organs to become available to transplant are “deemed less worthy” than those who are given organs. A bit earlier in the article, he was more direct: “Some people are more deserving of organs than others.”

But what makes one person deserving and another not, at the end of the day, are the triage decisions of the people in control of the procedure. Those they prioritize to save become more deserving. Those that must be deprioritzed become less worthy. So why not own those decisions? If not being vaccinated is automatically too risky to be allowed to receive a transplant, but endangering one’s life out of a sense of sportsmanship doesn’t upset the ‘value-for-money’ calculation, why not just own up to the idea that the final decision has more (or less) to do with factors other than a “simple” years-of-life determination?

There is no way to distribute a scarce resource in such a way that those who receive less than they feel they need (or nothing at all) will be forced to concede that the distribution was “fair.” When it comes down to it, “fair” often simply stops having any meaning to the person being told that they’re going to die due to being the 11th in line for 10 life-saving transplants.

The idea that “there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ” presupposes that there is one “right” person every time there is an organ to be received. That there is some calculus that can be done that consistently places one person on top of the heap. But people have never worked this way. It has never been possible, as near as I can tell, to boil ethics down into a form of mathematics. The difference between 2³ = 8 and prioritizing one set of patients over others is that 2³ = 8 is always free of any value judgments.

Of course, the thing that I’ve realized while writing this is that even the expression of values is driven by values. People hide their value judgments because they understand that being seen as free of them is valued. I value openness, so I prefer people to wear their values on their sleeves. I wonder how well that irony is appreciated.