The Case
Dr. Smith has a patient, Mr. F, who is in critical need of a liver transplant. However, Mr. F is a former heroin addict who has been receiving methadone treatment for the last six months. He is doing well so far, but there are some ethical questions about his suitability for receiving a transplant.

When the Ethics Committee considers a case, we begin by defining the ethical principles. This means we define the components of the problem in the case and look at what ethical principles we will need to consider before making a decision. To bring you up to speed, I have outlined the ethical problems we are considering in this case.

The Problems
In the medical community, drug addiction is classified as a disease, as opposed to merely an unwise, but controllable choice. This is the main problem we must consider in this case. Specifically, I’d like you to think about the implications of classifying drug addiction as a disease.
Additionally, we must consider:

• Should Mr. F’s potential for relapse effect our decision?
• Does Mr. F’s current status as a stable, healthy, and functioning individual outweigh his former drug addiction as a factor in approving him as a candidate for transplantation?
• Should Mr. F receive the transplant given that he is on a methadone maintenance program?
  

As you can see, the situation is complicated—which is why Dr. Smith sent it to the Ethics Committee.

Your Task
As you prepare your opinion on this issue, please spend some time with your colleagues thinking about this case. Specifically I would like to you determine the ethical principles associated with each problem I have defined for you. I would also like you to think about who may be affected. I have attached a document, Ethical Principles for Consideration, that the ethics committee uses as a guide in its decision making process. Please review this document and determine, two things. First, which of the ethical principles listed relate to each component-problem posed by this case. Second, determine how and to whom do those principles apply.

To help you organize your work, I have attached the committee’s Relevant Ethical Principles Template. For this case, I have filled in the problems we are considering for you. You should complete the template by filling in the ethical principles you believe are related to each problem.

Finally, I have attached a document titled Decision Making in Transplant Cases. This document will give you some background on some of issues doctors must consider when deciding whether or not to perform an organ transplant.

I hope you find your Ethics Committee work interesting and that you recognize the gravity of your position and its potential effect on our patients. Please consider each ethical case you review carefully. We look forward to gaining your insights.

Sincerely,
Chris Jones, M.D.
Chair, Ethics Committee
Lincoln Regional Medical Center