Ethical Health Care Issues
Rahmat Ogunnusi
HCS/545
June 22, 2015
Charles Barron

Ethical Health Care Issues
The society has great trust in health care organizations and their professionals to restore their health when befallen by an ailment. In doing so, especially when faced with difficult circumstances such as trying to determine who should get an organ donation first, health care professionals utilizes ethics of principles as a guide. The four ethics of principles states that people's autonomy should be respected, no harm should be done, health care professionals should do good, and justice should always prevail. The allocation of organ transplant is a form of treatment that also helps restore patient's life to a certain extent because there is always a chance that the recipient's system might reject the organ. Statistics shows that, in the US, at every given point in time, the ratio of available organ and the recipients are never proportionate. That is, the organs available are never enough for the amounts of recipients. Needless to say, the waiting list is always long, and proper strategies are always used in picking who gets the organ first. This situation as brought a lot of controversies as no one wants to die waiting for an organ and everyone thinks that their loved ones deserve to go first. Factors such as blood type, waiting time, right size donor and so on plays a big part in determining the priority of allocation. On the other hand, one of the biggest controversies that seem unethical is: whether or not the organ should be given to the sickest person on the list or to a patient who is less sick and consequently having a higher chances of living longer? When examining and evaluating how this issue applies to the principles of ethics, one can tell that simply allocating the organ to the sickest individual would be picking one side and won't be fair (justice). Also, doing this might pose as nonmaleficence as depriving another candidate of the organ simply because they are not very sick might eventually push them down the list of waiters, and their condition might get worse. Additionally, ethics also requires us to do good and doing good in this type of issue includes allowing everyone a fair share of life. Lastly, in terms of autonomy, I believe that a patient that is not as sick has to be given the right to choose another alternative of survival. Hypothetically speaking, let's say the rule is to give the less ill individual the organ; this strips that individual the right of knowing about other means of life sustenance. More so, in some instances, even though it is against ethics, some doctors just simply won't state all the alternatives to solving the patient's problem. Making the rule of allocating organ as such would only encourage this unethical act and further deprive the patient of their autonomy.
According to the US Department of Health and Human services, "more than 120,000 people in the U.S. are waiting to receive a life-giving organ transplant, and they simply don't have enough donated organs to transplant everyone in need. They balance factors of justice (fair consideration of candidates' circumstances and medical needs), and medical utility (trying to increase the number of transplants performed and the length of time patients and organs survive" (2015). The list is getting longer, and their chances of surviving are co-dependent on their chances of getting an organ donor. The number of prospective recipients are increasing faster than the donor and their chances of getting another shot at living life remains at the mercy of a system that deems it fit whether or not it is their turn to be a recipient. This is a crucial matter, and if care is not taken, an unjust allocation could be made if a factor such as the level of sickness remains a factor of allocation. The life depending nature of this situation requires that justice needs to prevail in its handling. Therefore, the HHS uses other factors such as blood type, waiting time, right size organ, donor/recipient immune system compatibility, how far from donor hospital, and so on.
Additionally, the simple fact of failing to allow justice serve when allocating organs could serve as a form of being nonmaleficence. According to the human resources and services administration, every 10 minutes, someone is added to the national transplant waiting list, and on average, 21 people die each day while waiting for a transplant" (2015). Given this, depriving another candidate of the organ simply because they are not very sick might eventually push them further down a list that is not getting any shorter. By doing this, harm is being inflicted on the patient of which is considered unethical. More so, giving an individual that is very sick the organ does not guarantee that they would survive because some recipients do not comply with the regimen, or the recipient's system might reject the organ.
Furthermore, the consolidation of doing what is just and not allowing harm come to the patient by ensuring that everyone get a fair shot at living life is a great way of doing good. On the other end of the spectrum, a greater means of doing good is the adoption of the system that the United Network for Organ Sharing uses when allocating organ recipient. UNOS puts the "information such as the person's blood type and medical urgency and the location of the transplant hospital about that candidate into UNOS' computerized network that generates a "match run," (2015). Once this is done, " a rank-order list of candidates to be offered each organ" is generated. (UNOS, 2015). Lastly, "Its policies and computerized network match donated organs with transplant candidates in ways that save as many lives as possible and provide transplant recipients with the best possible chance of long-term survival" (UNOS, 2015).
Conversely, ethics will not be complete without the mention of autonomy. "This principle states that an ethical theory should allow people to reign over themselves and to be able to make decisions that apply to their lives. This means that people should have control over their lives as much as possible because they are the only people who completely understand their chosen type of lifestyle" (Rainbow, 2002). Given this, when it comes to autonomy, I believe that an individual's level of illness or their chances of living longer should not be a big part of the determinant of them getting an organ. In some instances, some patients have other alternatives of surviving and they need to be given the right to choose. For example, in some cases of an end-stage renal disease, some of these patients can still survive and live a moderate life by going through a scheduled hemodialysis. On the other hand, in a case that this opportunity is not presented to them, and they are made to believe that getting a kidney transplant is their only choice, this would be considered unethical. Hypothetically speaking, if the actual rule is to give the less ill individual the organ; this strips that individual the right of knowing about other means of life sustenance. More so, in some instances, even though it is against ethics, some doctors just simply won't state all the alternatives to solving the patient's problem. In a nutshell, making the rule of allocating organ as such would only encourage this unethical act and further deprive patients of their autonomy.
Undoubtedly, allocation of organ transplant is to be taken seriously as it has to do with people's lives. The factors that contributes to its allocation makes logical sense except the one that suggests that people that has a higher chance of survival should get the organ before the ones that don't. This is an ethical issue that needs addressing. By such, I believe that factors such as the ones used by UNOS and the HHS (blood type, right size organ, geographic, waiting time, and so on…) should be used when creating policies of allocation. The factor in question strips the patients of their autonomic rights by depriving them the chances of choosing other means of survival, and it creates an unjust system that consequently could lead to failure in doing good, and ends up doing more harm to the society.

References
Morrison, E. E. (2011). Ethic in Health Administration (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.
Rainbow, C. (2002). Descriptions of Ethical Theories and Principles. Retrieved from http://www.bio.davidson.edu/people/kabernd/indep/carainbow/theories.htm
U.S. Department of Health and Human Services. (2015). How Organ Allocation Works. Retrieved from http://optn.transplant.hrsa.gov/learn/about-transplantation/how-organ-allocation-works/
United Network For Organ Sharing. (2015). How Organs are matched. Retrieved from https://www.unos.org/transplantation/matching-organs/