How Should The Medical Field Handle Patients

With Esld Caused By Alcohol Abuse In Regards To Liver Transplants. Essay, Research Paper

How should the medical field handle patients with end-stage liver disease (ESLD) caused by alcohol abuse in regards to liver transplants. This is the issue at hand within the writing of Alvin H. Moss and Mark Siegler, and the collective work of Carol Cohen and Martin Benjamin. Due to the scarcity of livers, the fact that they are a nonrenewable resource, and the expense of the lifesaving liver transplant, guidelines must exist concerning which patients in need of a new liver receive this transplant. Also, many questions are raised concerning patients with alcohol-related end-stage liver disease (ARESLD). Should ARESLD patients receive liver transplants. And if so, should they be given the same chance at receiving a liver as those whose end-stage liver disease is not alcohol-related. Also, should ARESLD patients be discriminated against. More specifically, the issue concerning discrimination towards ARESLD patients is the topic of dispute between the two writings. From the view of authors Alvin H. Moss and Mark Siegler on this issue, they propose that a general guideline in which patients with ARESLD should not compete equally with other candidates for liver transplantation (p. 670). Their proposition provides ESLD patients with a higher priority in receiving a transplant than those patients with ARESLD. Although their proposal discriminates against those patients whose disease was caused by alcohol abuse, they do not suggest, however, that ARESLD patients will never receive their liver transplant. The authors base their decision on the belief that the circumstances of liver transplantation differ from those of most other lifesaving therapies (p.670). The unique circumstances they are concerned with are that the donor liver is a nonrenewable, absolutely scarce resource; and that due to the expensive technology involved with the transplant, cost containment and public support are two very important factors and are essential to maintain. Moss and Siegler believe that as a result of the nature of liver scarcity, distribution of donor livers to those patients desperately in need must be based on some sort of medically unusual and strict standards. Receiving treatment for alcoholism is a critical point in Moss and Siegler s proposal. The view towards alcoholism as a disease shapes their opinion concerning the issue of liver transplants. Alcoholism as a chronic disease is caused by both hereditary and environmental factors. By viewing it as a disease, alcoholism differentiates from being a personal bad habit or a moral weakness. Also, by perceiving alcoholism as a disease it legitimizes medical intervention to treat it (p. 671). Moss and Siegler feel that by accepting therapy for alcoholism, alcoholics acknowledge their disease and accept responsibility for receiving treatment. Treatment received for alcoholism exposes the risks of heavy alcohol consumption to the individual and that with it the risk of ARESLD is increased. The authors note that ARESLD patients which could be acceptable candidates (p. 674) are those who are abstinent as a result of having received treatment. Moss and Siegler believe that because alcoholics cannot be held responsible for their disease, once their condition has been diagnosed they can be held responsible for seeking treatment and for preventing the complication of ARESLD (p. 672). Basing their proposal on the argument of fairness and morality, ESLD patients should have a higher priority in receiving a liver transplant than those ARESLD patients who fail to obtain treatment for alcoholism once they are diagnosed as an alcoholic. They credit their proposal, allocating organs on this basis, in being fair by holding people responsible for their choices, and in this case specifically, refusing alcoholism treatment. They also comment that this situation in discriminating against ARESLD patients who refuse alcohol treatment is unfortunate but not unfair (p.672). Moss and Siegler state that what is fair need not be equal (p.672). This is another strong argument supporting their proposal. As already mentioned, due to the absolute scarcity of donor livers, it is impossible to give every ESLD patient a functioning liver. The fact that some (few) ESLD patients receive livers while others do not presents an inequality. In treating ESLD patients fair, they believe distributing donor livers on a first-come, first-served gives each patient an equal chance, but is not always a fair approach. Instead, they accept the principle that similar cases should be given similar treatment. Applying this principle, Moss and Siegler believe that patients with ARESLD are unequal in relevance to others with ESLD and it is acceptable to treat them differently, since the liver failure of ARESLD patients was preventable. Public support for liver transplantation and with further research concerning ARESLD patients complete Moss and Siegler s arguments in support of their proposal. The argument here is that when deciding how to appropriately use a scarce and nonrenewable organ, public mores and values should be greatly considered and respected. In referring to liver transplants as a Gift of Life, each liver is considered a national resource for the public good and it should be used in the public s best interest (p.673). Surveying the public shows that infants and other patients with cancer should be given th