A Critique on “Alcoholics and Liver Transplantation”

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Introduction

Alcoholism and alcoholics have been quite a hot spot issue in regards to liver transplantations. One of the main criticisms that fall alcoholics for their transplantations is, are they really worth spending the scarce organ on? There are many ethical and medical arguments that have been debated by professionals to eliminate the persons that have alcoholic disorders from the list of worth candidates for transplantation (Huang, 2007). The paper will look to describe and explain the viewpoints of the article Alcoholism and Liver Transplantation by Carl Cohen, Martin Benjamin, and the Ethics and Social Impact Committee of the Transplant and Health Policy Center, Ann Arbor. The authors of the article present key points that logically deny the medical and ethic arguments to take alcoholics out of the screening process for liver transplantation. A critical assessment of the viewpoints portrayed in the article will be analyzed to assess the argument presented for this debatable topic.

Alcoholism is thought to be very immoral in society and alcoholics are looked down upon for indulging in such an act. Most alcoholics conduct their daily lives immorally putting others in society at risk for their disorderly conduct (i.e. drunk driving, physical abuse, family unit disturbance and abuse). Apparently, alcoholism is a disease that usually concluded from certain factors that are out of the control of persons indulging in it, and thus, should not be held responsible causally or ethically for alcoholism or even the liver failure that comes from it.

View Points in Alcoholics and Liver Transplantation

The authors of the article present the case of two main arguments being used to reject patients with alcoholic cirrhosis as candidates for liver transplantation; Medical Argument and Moral Argument. Both arguments are presented in the article with the premises dissected to understand the position of those who agree with the viewpoint. However, the authors use logical deductive reasoning to persuade otherwise.

Moral Argument

The Moral argument presented in this article states that Alcoholic cirrhosis is brought about by the own conduct of the person indulging in heavy alcoholism and alcohol abuse. The authors condemn this argument because they believe that if persons that suffer from high alcohol consumption should not be give the preference for treatment due to their personal conduct than, other diseases that come about from negligence or appalling personal conduct show also be treated in the same light. For example, if a person that is a reformed heavy chain smoker, eventually needs coronary bypass treatment due to negligence of their doctors advice to quit smoking or lifestyle changes should be disqualified from received medical treatment that they so desperately need. The authors agree that medical professionals are not justified to denying a patient any sort of treatment including transplantation on a definite basis just because alcoholism is considered a moral failing. The assumption for which the foundation of the moral argument is laid is completely rejected by the authors of the article.

Medical Argument

The premise of the argument is surrounded upon the scarce amount of liver organs available to transplant into severely ill patients. It is argued that alcoholics would be survive poorly after the transplantation due to their binge habits of alcoholism, therefore, they should be excluded from the receiving process. The authors denounce this argument as well on account for two reasons. The premise that liver transplantation will fail or do poorly in alcoholics than compared to other groups can be doubted or considered false due to not enough data being available to support this argument. The second premise, of transplantation failing due to, could cause the elimination of other groups that have a prognosis that is as bad or even worse than what groups of alcoholics are suffering from.

Critical Assessments of Viewpoints

The authors of the article have presented a logical case to neglect the reasoning presented for eliminating groups of people from liver transplantation due to their alcoholism. However, they were unable to create a median point, or a means by which liver transplantations for alcoholics can be done to satisfy social, moral, and political views. Using the logical premises of categorically eliminating groups of recipients due to defects being unjust was the most convincing point that justifies including alcoholics for transplantation and indiscriminate treatment. To better convince the audience for including this group of people, the authors should have included information on clinical experiments or screening of persons recovering alcoholism, their success rate, and success after transplantation. It would have given the argument more substance and strong ground to complete reject the medical argument presented.

Many doctors would have to side with Dr. George D. Lundberg (1983), who once stated his editorial:

If I had one liver to transplant and 50,000 possible recipients, I wouldn’t let the fact that a great creative genius might drink deter me from giving him or her a needed new liver to allow another 30 years of creativity. (cited in Altman, 1990).

In the United States alone, alcoholism is a very common origin for end-stage liver diseases estimating for about 24 % of liver transplantation in 1998 (Weinriech et al, 2000). This is a large percentage making it the second largest reason for transplantation and therefore needs to be thought. However, the authors of the article were unable to give substantial examples or conclusions to support alcoholics for critical medical treatment. However, they did point out the injustice of categorically excluding alcoholics, under this basis, other groups of people can also be categorically eliminated, which is also unjust and can bring about negative criticisms. The authors did not provide any realistic solutions to the argument that can be implemented to evenly be accepted by all concerned parties (society, legislation, medical professionals). The article was lacking in statistical data that could have been used to support their viewpoints. Lack of such data brought about a weakness in their argument to gain supporters. One issue that really was brought to light was the political apprehension of allowing alcoholics to be given transplantation. This indicated that legislation should come to a middle ground in order to allow equal opportunity to all citizens, disregarding personal moral vice or moral virtue.

Conclusion

The authors of the article Alcoholics and Liver Transplantation did a sound job of denouncing the arguments (medical and moral) for excluding alcoholics as liver transplantation receivers. However, there was no possible solution given or suggested to conclude a median point or a program to include alcoholics using a certain process. Singling out alcoholics for moral vice by giving them a low priority for liver transplantation is unjust. A system needs to be developed in which the option of priority is refrained from, and instead a system is built upon the full recovery of alcoholism after the transplantation of a new liver. Doctors are professionally responsible to remain firm on the commitment of medicine for having a non-judgmental regard. This makes if mandatory for physicians to deliver needed care to all patients who are in dire need of it without being predisposed with verdicts about the patients worthiness being involved.Instead the article should have advocated a more toned assessment given by an addiction specialist instead of automatically being implicated to the 6-month rule (Weinrieh et al, 2000).The article could have also included statistics based on the survival rate of patients with alcoholic cirrhosis, an example of them being reported from Dr. Thomas Strazl, at the University of Pittsburg, that showed 73 % for one year and the second year having 64 % (Altman, 1990). Using such statistical data would have made their viewpoint and argument more persuasive.

References

• Altman, L. K. (1999, April 03). Doctors World; a question of ethics: Should alcoholics get transplanted livers? The New York Times. Retrieved April 14, 2013 from <http://www.nytimes.com/1990/04/03/science/doctor-s-world-a-question-of-ethics-should-alcoholics-get-transplanted-livers.html?pagewanted=all&src=pm>
• Cohen, C.; Benjamin, M.; & Arbor, A. (1991). Alcoholics and liver transplantation. JAMA, 265 (10), 1299-1301. Retrieved April 14, 2013 from <http://www.carl-cohen.org/docs/Alcoholics%20and%20Liver%20Transplantation.pdf>
• Huang, J. (2007). Ethical and legislative perspectives on liver transplantation in the Peoples Republic of China. Liver Transplantation, 13, 193-196. Retrieved April 14, 2013 from <http://onlinelibrary.wiley.com/doi/10.1002/lt.21081/full>
• Neuberger, J.; Adams, D. ; MacMaster, P. ; Maidment, A. ; & Speed. A. (1998). Assessing priorities for allocation of donor liver grafts: Survey of public and clinicians. BMJ. Retrieved April 14, 2013 from <https://www.bmj.com/content/317/7152/172.full>
• Weinrieh, R. M.; Van Horn, D.A.H; McLellan, A. T.; & Lucey, M. R.(2000). Interpreting the significance of drinking by alcohol-dependent liver transplant patients: Fostering candor is the key to recovery. Liver Transplantation, 6, 769-776. Retrieved April 14, 2013 from <https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/jlts.2000.18497>