I finally figured out what I want to do when I grow up. I want to be a bioethicist. Some prestigious hospital or university would pay me big bucks to, in response to a medical/ethical crisis like the birth of a cloned human being, issue Solomon-like wisdom and guidance for public officials, reporters, and everyone else on how to handle the new crisis. My friends and family would clearly see that I, as a newly minted bioethicist, had all the answers to life’s big questions because of my extensive training in ethics, religion, and science. Being an expert in ethics, religion, and science is like hitting a triple. Even my attorney friends would be impressed. Attorneys have all those big 50-pound law tomes bending their book shelves, comfy leather chairs you cold get lost in, and oil paintings of Clipper ships on their walls, but what do they know about DNA and cell formation?

Besides impressing my friends and family, I want to be a bioethicist because frankly – with no offense to those of you who have already paid your annual dues to the American Association of Bioethicists – I don’t think it’s a very hard job. Here’s one example. The headline from the Oakland Tribune announces “Debate Rages Over Heart Transplant; Prisoner Gets Organ But Family Man Misses Out” (2/26/02). The story is about a 32-year prisoner (whose name was withheld from the public), a two-time felon serving a 14-year sentence for armed robbery, being given a million dollar heart transplant at the world-famous Stanford Medical Center.

Many of the friends and family members of the other 4119 patients on the nation’s heart transplant waiting list were naturally appalled that government officials and medical professionals would allow a prisoner to jump to the head of the line. Some taxpayers, who know that we have numerous unmet needs in our society, including the plight of 7 million uninsured in the state, ripped up their organ donor cards upon hearing the news.

In response, Department of Corrections spokesman Russ Heimerich said that a 1976 U.S. Supreme Court decision compelled the state to pay for the heart transplant. The only other choice was to face a wrongful death lawsuit. The physicians who performed the surgery and representatives from the transplant agency said that the decision to give their particular prisoner the new heart was based solely on medical criteria. And then it was the bioethicists’ turn to jump into the debate. “The statement that someone should not get [an organ] because they are not worthy is very disturbing,” said Guy Micco, the director of the Center for Medicine, the Humanities, and the Law at UC Berkeley. Micco added, “because that puts value on one life compared to another, and we don’t have a ‘God Squad’ to do that.”

For those of us who inhabit the real world outside UC Berkeley’s ivory tower, we are compelled to make moral and equitable decisions based on limited resources. Other bioethicists think that the notion that society must give prisoners free and unlimited access to taxpayer-financed health care is not legally required nor it is morally right. Ben Rich, an attorney and bioethicist with UC Davis, interprets that court decision as saying that only the deliberate indifference to serious medical needs of an inmate violates the constitutional prohibitions against cruel and unusual punishment. David Perry, a professor at Santa Clara University, says that he is “not persuaded that the Supreme Court intended to give violent criminals a claim equal to that of the rest of us on highly scarce medical resources like hearts, livers, lungs and kidneys, especially when the decision to save one person’s life with an organ transplant almost inevitably means that someone else will die.”

Will anything be done about this problem? So far, I have not heard a peep from the Administration regarding whether they propose to sponsor legislation that would clarify for the Department of Corrections as to how they could provide a minimally sufficient level of care for inmates without being subject to lawsuits. However, there is one glimmer of hope. Senator Jeff Denham (R-Salinas), whose father died at the age of 54 waiting for a liver transplant, recently introduced SB 38, which would require that the organ donation forms produced by the Department of Motor Vehicles and the Organ and Tissue Donor Registry include a provision that allows the future donor to indicate whether he or she desires to prohibit an organ donation to any person who is incarcerated in state prison or a county jail.

The Legislature should act now to put the interests and needs of patients who are waiting for a life-saving organ transplanted ahead of those have been convicted of threatening or taking the lives of law abiding Californians.

Published in the Auburn Sentinel on February 6, 2003.

Postscript: SB 38 died in the Senate.