Prisoners and transplants

A heart transplant performed on a prison inmate in California is creating a debate about whether prisoners deserve access to any and all medical care, and whether they should receive equal access to extremely scarce resources, such as organs for transplants.

As the prison population in the U.S. ages, demand for health care services will increase, just as it does in the rest of the population. The combination of high rates of chronic diseases that affect the kidneys and liver, and an aging prison population mean that more prisoners will need transplants to survive.

But should such scarce resources be offered to those who forfeit their rights as convicted criminals? How much health care should prisoners receive, and should their priority be different than those who are not incarcerated?

A right to health care?
Almost thirty years ago, the U.S. Supreme Court ruled that prisoners were entitled to receive adequate medical care, effectively creating prisoners' rights to health care. The irony is that there is no such right for law-abiding citizens, and in fact many inmates receive much better medical care when they are incarcerated than they had when they were free.

But what counts as "adequate" medical care for prisoners? Should they receive only basic care such as first aid and basic medications, all available treatments, or something in between?

Since prisoners forfeit many rights when they are convicted of committing crimes -- their freedom, the right to vote, etc. -- why should they gain a new right to health care when they are imprisoned?

One answer is that by using prison as a means of protecting the public, society creates an obligation to keep prisoners safe and treat them humanely, which ought to include health care.

The reality of prison medical care is that prisoners receive the same range of services available to anybody else. Politicians and prison officials recognize that providing health care is an expensive proposition, but have come to view it as a necessary cost of protecting society.

Past deeds and future desserts
But what should happen when prisoners and the people who are being protected from them are competing for the same scarce resources, like kidneys, livers, hearts or other organs for transplant? Should the fact that prisoners broke the law lower their priority compared to law-abiding patients? If so, on what grounds?

Any policy that would award lower priority to prisoners would be based on some sense that prisoners deserve less based on their value to society, and would introduce the notion of social worth to the entire transplant system.

While prisoners' actions may make them seem like less worthy transplant candidates than many other members of society, the same can be said for alcoholics whose actions lead to the destruction of their livers and who need a transplant to survive, or smokers who contract heart disease. Yet we don't base transplant priority on patients' lifestyle choices.

We put people in jail and take away their freedoms based on judgments about their unlawful actions, but that ought to be separate from making judgments about their social worth for access to organ transplant.

The truth is that if social worth becomes a criterion for judging who gets transplants first -- or maybe who gets them at all -- then we all had better take a hard look at our lifestyles and behaviors.

In the end, the fact that the system offers heart transplants to inmates says more about what's wrong with health care for people outside of prison that it says about how we treat those behind bars.
By Jeffrey P. Kahn, Ph.D., M.P.H.
Source: http://archives.cnn.com/2002/HEALTH/02/04/ethics.matters/index.html