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...task force is choosing among decision-making processes. Their choice is a practically informed moral judgment between what they consider better or worse ways of deciding how to allocate organ transplants. The strongest negative implication of the "limited capacity" scenario is an increased possibility that a patient who might benefit from a transplant could be denied one through lack of funds. The task force has decided that other Medicaid programs are more important; perhaps they are, though it should be noted, for example, that the kind of heart defect suffered by Baby Fae kills a substantial number of infants...
CLEARLY VERY real limits on available organs and funds require some compromise on the issue of transplants, yet the limited capacity approach can be only part of the solution. The issue of organ transplant distinguishes itself from other pressing medical controversies, like abortion, because it creates a competition that entails the somewhat morbid prospect of the buying and selling of organs, and thus lives, for profit. The "limited capacity" scenario allows for "retrospective review," i.e. hindsight, because it slows down transplant technology. However, this slowdown could actually limit the possibility of resolving the competition by removing the constraints--by developing...
...question remains of how to judge who gets the available transplants. Benefit is not a clear-cut question, yet clearcut decisions must be made. However, it would be neither ethical nor possible to create a central computer-like authority to dole out judgments of patients. The power of organ transplant technology will be controlled by somebody, be they the wealthy patients, the needy patients, the state law makers, the hospitals, or the doctors; we must decide, then, who should control that power...
What the task force wants to do is pull up on the reins of a technology that saves lives and is on its way to saving more. The limiting of organ transplants to a small scale effort solves the problem of monetary drain on Medicaid. It does not, however, solve the overall problem. This ultimate resolution of expanding transplant availability, the only resolution that satisfies the strongest ethical implications of the problem, would be delayed, perhaps indefinitely, by the group's plan. What is missing is an assessment of what the constraining effects of the task force-advocated policy would...
Politically, the question is one of power; who should make and control the set of standard procedures for deciding how to allocate organ transplants. Since voting majorities of the public often take sides by condemning or condoning the role of technology, legislators and policy makers respond to these extremes. Though perhaps inevitable, this response need not preclude reassessment of the relation between science and public policy. What is obvious is that science expands the frontier of our living conditions. What needs to be recognized is that science is an ethical frontier, rapidly outmoding our ways of making decisions...