Playing the God Game

[AthenaAwakened]

If there is a limited supply of some item (eg organs) and a larger number of people who need them; and if you don't believe that any person is more deserving than any other, then it is hard to see why you should care how those items are distributed

How so? Is there only one reason to distribute organs to a needy populace and without that one reason, there is no reason?

(as long as the maximum number of people get them). So you shouldn't really care if the person doing the distribution believes that some people are more deserving than others.

The only reason you should care (assuming the maximum number of people are being helped) is if you, too, believe that some people are more deserving than others but you disagree with the person who is making the decision as to who those most deserving people are.

So the bad people need to be punished, unto death if necessary?

 

[Angry Floof]

The United Network for Organ Sharing (UNOS) was established in 1984 for the purpose of coordinating donors and recipients.

Sometimes people will their organs to a specific person, and there are other instances where the UNOS won't make the decision, but when UNOS is involved, they have a set of criteria for choosing recipients, including Culpability.


That cannot be an easy decision for anyone involved. Doctors and patients' families and attorneys, etc., are often part of the process. I can't imagine being the one to decide that an otherwise qualified recipient should not get an organ because they have demonstrated that it will most likely be wasted (drug addicts, etc.). Sometimes this decision is made because the recipient is so old that they will likely die in a short time anyway. It sounds so callous, but with limited organs and a list of people including children, young moms and dads, soldiers... All I can say about that is that I'm grateful these choices are not left to me. I don't know if I'd have the courage to even try taking that responsibility.

A lot of people who feel conflicted about taking culpability into account are evidently trying to resolve the dilemma in their own minds by reframing it as taking into account whether the organ is likely to be wasted by a recipient who can reasonably be expected not to take good care of it. But that's not a good stand-in for culpability. For all the people who would shrink from denying a liver to an alcoholic because he brought it on himself, but are okay with denying him a liver because he's probably going to keep drinking, how many of them would also be okay with denying a kidney to somebody because she's probably going to destroy it in three years by going off her anti-rejection drugs, because she can't afford them, and although Medicare will pay for dialysis for life, and Medicare will also pay for an unlimited sequence of destroyed kidneys, Medicare will not pay for more than three years of anti-rejection drugs?

If people applied the same logic to the kidney that they apply to the liver then they'd callously tell the kidney patient she's not a good risk and the kidney will buy more years of health for a wealthier candidate, the same way they're willing to callously tell the liver patient he's not a good risk and the liver will buy more years of health for a candidate without addiction issues. But they don't. Why don't they? What's the difference? Culpability. It's not the kidney patient's fault she's being screwed by Congress's* insane Medicare regulations.

So since we're evidently going to take culpability into account, let's face it squarely and not try to sneak it past our conscious selves through the back door.

(* And yes, bills to fix this legal monstrosity are introduced every year and never get passed.)

I can't tell if you are reading something into my post and speaking to me, or just commenting in general.

All I can say (and did say) is that the whole question is difficult for everyone involved. There's nothing in my post that indicates a seeking of easy resolution or comfort. I prefer to struggle with conscience than to seek comfort on such a complex and important issue.

I posted the links and quotes for information about the organization that was set up to help match donors to recipients. That's just fact. It seems the UNOS might be mistaken by some as an authoritarian unit dictating rules regarding donation. It is not.

 

[EricK]

How so? Is there only one reason to distribute organs to a needy populace and without that one reason, there is no reason?

Suppose there are 6 organs available. Method 1 of distributing them gives them to these 6 people; method to gives them to those 6 people; method 3 gives them to those other 6 people and so on. If you think everybody is equally deserving then why should you care which method is used - all the outcomes are equally good from your point of you, aren't they?

(as long as the maximum number of people get them). So you shouldn't really care if the person doing the distribution believes that some people are more deserving than others.

The only reason you should care (assuming the maximum number of people are being helped) is if you, too, believe that some people are more deserving than others but you disagree with the person who is making the decision as to who those most deserving people are.

So the bad people need to be punished, unto death if necessary?

Where did I say anything about bad people?

 

[Bomb#20]

I can't tell if you are reading something into my post and speaking to me, or just commenting in general.

I was commenting in general on the thinking of the decision makers that was displayed in the link in your post. Yes, I understand that you weren't endorsing their thought processes, just reporting them.

All I can say (and did say) is that the whole question is difficult for everyone involved. There's nothing in my post that indicates a seeking of easy resolution or comfort. I prefer to struggle with conscience than to seek comfort on such a complex and important issue.

Agreed.

 

[untermensche]

Deciding which humans have more "value" than other humans will always have its flaws.

We should conduct a lottery when any new organ is available.

And in truth that would be playing god.

Some survive and some don't by sheer chance.

 

[EricK]

Deciding which humans have more "value" than other humans will always have its flaws.

We should conduct a lottery when any new organ is available.

And in truth that would be playing god.

Some survive and some don't by sheer chance.

Do you think assigning them at random has fewer flaws than all other methods? If so, why?

If not, so you think a group of methods are equally flawed, why do you care which one of them is chosen?

 

[dystopian]

Doctor's shouldn't and aren't legally allowed to just make decisions like that. Deciding that a non-smoker gets the lung instead of the smoker who'se higher on the waiting list would violate about a dozen laws in just about every country; and rightly so. Who gets the organ and who doesn't is and should be down entirely to just two things: who is higher on the list, and who is at greater risk of dying in the short term if they don't get that organ. Average these two criteria out and you arrive at a name who gets the organ. Whether or not someone smokes has nothing to do with either of these things, and it is neither the doctor's job nor their right to withhold medical treatment to people based on their lifestyle. The fact that this is even in question is deeply disturbing.

You base this on... what exactly?
Lifestyle is definitely a matter in the case.
And how should that be disturbing?
Priorities are made constantly, organs is just one example.

I base it on the law and egalitarian principles. More than that, I base it on the fact that anything else represents a slippery steep slope.

A smoker may statistically speaking be less likely to live to old age than a non-smoker; but there's lots of smokers who outlive the average non-smoker. That non-smoker who gets the organ instead of the smoker could get hit by a bus the next day. He could still get lung-cancer. If you can not *guarantee* which organ recipient will live the longest, then you're forced to decide based either on arbitrary value judgements (this is a better person than that person, etc), or through cold unfeeling logic.

Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary. If society can decide that serial killers don't get transplants, then they can decide that about anyone, for any reason.

Deciding it based on "this person has x % chance to live longer with the transplant" is a better alternative, but could just as easily devolve into producing the same situation as the previous scenario. After all, one could create a medical argument that homosexual intercourse is riskier than heterosexual intercourse; therefore gay people get bumped down on the list. This method also makes no distinction between people who are less healthy through no fault of their own, and people who consciously decide to engage in risky behavior.

Deciding based purely on a system that's a mix of 'first come, first served' and 'this person will flatline in the next hour, and this person might flatline in the next 2 weeks'; is the only truly fair system as everyone gets treated the same before it. This means there's no risk of people injecting their personal values into the decision making process; and everyone has a chance.

Besides, this whole argument could be a non-issue. There's no organ shortage. There's a donor shortage; and there's only a donor shortage because governments don't enact opt-out systems en masse and because there's not enough money going toward researching things like cloning or printing organs.

 

[dystopian]

If there is a limited supply of some item (eg organs) and a larger number of people who need them; and if you don't believe that any person is more deserving than any other, then it is hard to see why you should care how those items are distributed (as long as the maximum number of people get them). So you shouldn't really care if the person doing the distribution believes that some people are more deserving than others.

The only reason you should care (assuming the maximum number of people are being helped) is if you, too, believe that some people are more deserving than others but you disagree with the person who is making the decision as to who those most deserving people are.

That makes absolutely no sense.

If you don't believe that any person is more deserving than any other (as I do),

then you *should* in fact care how those items are distributed, because you'd naturally want to eliminate the possibility of certain kinds of people receiving more than other kinds of people due to anything other than chance. The belief that nobody is more deserving than others implicitly requires supporting egalitarian distribution. You're confusing 'not believing some are more deserving' with 'not giving a shit'.

 

[TV and credit cards]

What we've done in the past is routinely used as an indicator of what we will do in the future. It is your life's resume. If you harm society, if you harm yourself, this is your resume and a fair indication of your future behavior. If you are burdening society to your own selfish ends (from a criminal standpoint), doesn't society get to judge you? We are not playing god. The individual did with these destructive choices.
I have no problem drawing the line here. At least here.

 

[Bomb#20]

I base it on the law and egalitarian principles. More than that, I base it on the fact that anything else represents a slippery steep slope. ... Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary.

Deciding based on egalitarian principles and abhorrence of slippery slopes is deciding through value judgments.

If you can not *guarantee* which organ recipient will live the longest, then you're forced to decide based either on arbitrary value judgements (this is a better person than that person, etc), or through cold unfeeling logic.

It doesn't count as deciding through cold unfeeling logic if we feel really bad for the people who die because we're too squeamish to use cold logic.

Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary. If society can decide that serial killers don't get transplants, then they can decide that about anyone, for any reason.

If society can decide that people who'll probably live 2 weeks longer than the guy who'll flatline in the next hour don't get transplants, then they can decide that about anyone, for any reason.

Deciding based purely on a system that's a mix of 'first come, first served' and 'this person will flatline in the next hour, and this person might flatline in the next 2 weeks'; is the only truly fair system as everyone gets treated the same before it.

No, they don't. One gets an organ and another doesn't. That's not treating them the same.

This means there's no risk of people injecting their personal values different from mine into the decision making process;

FIFY.

...you'd naturally want to eliminate the possibility of certain kinds of people receiving more than other kinds of people due to anything other than chance. The belief that nobody is more deserving than others implicitly requires supporting egalitarian distribution.

"He lives, you die." is not an egalitarian distribution. "But that third party got an organ, and she's the same "kind" of person as you, so that's practically the same as you getting one." doesn't make it egalitarian.

 

[dystopian]

Deciding based on egalitarian principles and abhorrence of slippery slopes is deciding through value judgments.

Saying that everyone should have equal access is the exact opposite of deciding based on value judgements about a person's worth.

If society can decide that people who'll probably live 2 weeks longer than the guy who'll flatline in the next hour don't get transplants, then they can decide that about anyone, for any reason.

False equivalency. In one situation society can and *does* decide who lives based on arbitrary value judgements of a person's worth. In the other situation, society follows a non-arbitrary non-value judgement driven ruleset. A ruleset that actively *prohibits* society from deciding who gets a transplant and who doesn't for "anyone, for any reason."

No, they don't. One gets an organ and another doesn't. That's not treating them the same.

It is, since we're talking about a supposedly limited resource here. Both would-be recipients are regarded according to the exact same criteria. Both have a more or less equal chance of receiving the transplant.

This means there's no risk of people injecting their personal values different from mine into the decision making process;

FIFY.

You don't seem to understand the basic concept of egalitarianism. The scenario I describe is the opposite of injecting personal values into the decision making process. When you treat everyone by the same standards, giving everyone an equal chance, you eliminate personal values from the equation. The only 'injecting' of personal values comes into play with the 'everyone should be treated equally' assumption at the base of the process, but it is eliminated *everywhere else*; unlike as is the case in any other system where you not only start with a value judgement in the base underlying assumption, but encourage them from then on.

"He lives, you die." is not an egalitarian distribution. "But that third party got an organ, and she's the same "kind" of person as you, so that's practically the same as you getting one." doesn't make it egalitarian.

Once again, you don't seem to understand the basic concept of egalitarianism. We're talking about a limited resource. So long as it remains a limited resource, someone *must* lose out. You can't divide a heart two ways and still make it work. So long as that is the case, it is egalitarian to ensure that everyone is treated the same when determining who ultimately winds up with the heart.

 

[credoconsolans]

Teen heart transplant recipient killed in police chase

In the politics forum there is a thread about this. I am posting this here to discuss the morality of choosing who does and does not get a transplant. Where do we draw the line? Should a smoker get a new lung? Should an alcoholic get a new liver? Should a drug addict get the surgeon's time and a hospital resources?

What do we do this broken people when they get sick?

Life is not fair and not everyone is going to make it.

Donated organs that are compatible are an extremely limited resource. And as such, doctors and ONLY doctors, make the decision based on who has the greatest chance of survival and maximum use of said limited resource.

That means someone willing to care for the valuable, limited resource (this excludes addicts of any sort), strong and otherwise healthy except for the part that needs replacing.

Everyone else...I'm very sorry for.

If we had enough organs, everyone would have a chance. We don't, so we have to choose.

 

[Angry Floof]

This is an excellent topic of discussion for showing how utterly useless and even dangerous it is to apply black and white thinking to very complex issues of human life and health.

 

[fromderinside]

This is an excellent topic of discussion for showing how utterly useless and even dangerous it is to apply black and white thinking to very complex issues of human life and health.

How about this for black and white. Policy: First come (time of need) first serve. Period.

 

[Angry Floof]

This is an excellent topic of discussion for showing how utterly useless and even dangerous it is to apply black and white thinking to very complex issues of human life and health.

How about this for black and white. Policy: First come (time of need) first serve. Period.

Yep, that's pretty black and white. I'm sure that would work perfectly. Why didn't anyone think of this before? There's never any other circumstances or factors to consider than who got their name on the list ahead of the rest. Brilliant! Those doctors and transplant organizations are so stupid. LOL.

 

[fromderinside]

How about this for black and white. Policy: First come (time of need) first serve. Period.

Yep, that's pretty black and white. I'm sure that would work perfectly. Why didn't anyone think of this before? There's never any other circumstances or factors to consider than who got their name on the list ahead of the rest. Brilliant! Those doctors and transplant organizations are so stupid. LOL.

Apparently not. You rewrote what I said by inserting got their names on the list ahead of the rest instead of using my simple time of need.

In my view time of need is the time when one qualifies for transplant not when one gets one's name on a list.

Remove all judgment factors beyond time of prescription and you're view is good. Its a bit like making trades fair by forcing everyone through the same pipe rather than permitting those who can pay to get their orders taken first by taking shortcuts. Eliminate shortcuts. Eliminate money and station. Still easier than anything we think about now. I see your LOL and raise you two LOLs.

 

[Angry Floof]

Yep, that's pretty black and white. I'm sure that would work perfectly. Why didn't anyone think of this before? There's never any other circumstances or factors to consider than who got their name on the list ahead of the rest. Brilliant! Those doctors and transplant organizations are so stupid. LOL.

Apparently not. You rewrote what I said by inserting got their names on the list ahead of the rest instead of using my simple time of need.

In my view time of need is the time when one qualifies for transplant not when one gets one's name on a list.

Remove all judgment factors beyond time of prescription and you're view is good. Its a bit like making trades fair by forcing everyone through the same pipe rather than permitting those who can pay to get their orders taken first by taking shortcuts. Eliminate shortcuts. Eliminate money and station. Still easier than anything we think about now. I see your LOL and raise you two LOLs.

I stand corrected. "First come, first served" is still black and white, though, whether you calculate time on a list or time left to live or however you determine "first." This just shows that even deciding on that is not so simple.

If only it were so cut and dried, but a lot of human beings are not so comfortable with giving a liver to an alcoholic and allowing another otherwise healthy person to die, especially if that person is young, a parent, someone who has contributed to the betterment of their community, etc.

The response to this is never easy. Trying to make it easy is to oversimplify a great many factors, not to mention unique situations. Mitigating circumstances matter to people, whether a few armchair doctors agree or not.

 

[untermensche]

Deciding which humans have more "value" than other humans will always have its flaws.

We should conduct a lottery when any new organ is available.

And in truth that would be playing god.

Some survive and some don't by sheer chance.

Do you think assigning them at random has fewer flaws than all other methods? If so, why?

It has fewer flaws than systems that attempt to assign value.

First come first served is really just a random system, so it doesn't have more flaws than a random lottery.

The lottery would only be an alternative to systems that attempt to assign value.

 

[RavenSky]

Yep, that's pretty black and white. I'm sure that would work perfectly. Why didn't anyone think of this before? There's never any other circumstances or factors to consider than who got their name on the list ahead of the rest. Brilliant! Those doctors and transplant organizations are so stupid. LOL.

Apparently not. You rewrote what I said by inserting got their names on the list ahead of the rest instead of using my simple time of need.

In my view time of need is the time when one qualifies for transplant not when one gets one's name on a list.

Remove all judgment factors beyond time of prescription and you're view is good. Its a bit like making trades fair by forcing everyone through the same pipe rather than permitting those who can pay to get their orders taken first by taking shortcuts. Eliminate shortcuts. Eliminate money and station. Still easier than anything we think about now. I see your LOL and raise you two LOLs.

Up to a point, that is part of what already happens but it cannot be the only consideration. Blood type and size compatibility must be factored in. Distance and availability of recipient and medical facilities must be factored in. Once those are all addressed, if there are still more than one potential recipient, then it is based on who needs it most/soonest but only up to the point that the person could realistically survive surgery. Once a person becomes too sick to realistically survive surgery, they have to be (at least temporarily) removed from the list.

 

[Bomb#20]

Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary.

Deciding based on egalitarian principles and abhorrence of slippery slopes is deciding through value judgments.

Saying that everyone should have equal access is the exact opposite of deciding based on value judgements about a person's worth.

So when you said "Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary.", you didn't mean what you said? What you actually meant was "Deciding through value judgements about a person's worth is hugely problematic because such judgements are entirely arbitrary?

So what are you arguing here? Are you arguing that value judgments about topics other than a person's worth aren't entirely arbitrary? That to say "Alice is worth more than Bob" is entirely arbitrary, but to say "Equality is worth more than additional years of life for organ recipients" is not totally arbitrary? Or are you saying that deciding through value judgements about topics other than a person's worth are not hugely problematic, even though those value judgements are entirely arbitrary too?

If society can decide that people who'll probably live 2 weeks longer than the guy who'll flatline in the next hour don't get transplants, then they can decide that about anyone, for any reason.

False equivalency. In one situation society can and *does* decide who lives based on arbitrary value judgements of a person's worth. In the other situation, society follows a non-arbitrary non-value judgement driven ruleset.

Just as an intellectual exercise, put yourself, for a moment, in the position of a person who doesn't already subscribe to your idiosyncratic views. Do you have any idea how self-deluding what you just wrote sounds to unbelievers? How on earth do you figure the ruleset you're advocating is "non-value judgment driven"?!? It's ridiculous! The only reason driving selection of that ruleset in place of alternative rulesets is that the people who advocate it value it!

A ruleset that actively *prohibits* society from deciding who gets a transplant and who doesn't for "anyone, for any reason."

Oh, come on! Every ruleset actively prohibits society from deciding who gets a transplant and who doesn't for "anyone, for any reason." Your own example, a ruleset that says serial killers don't get transplants, actively prohibits society from deciding a serial killer gets a transplant for any reason. You might as well claim basing law on the Bible is non-religion driven because it actively prohibits society from basing law on the Quran or the Bhagavad Gita.

No, they don't. One gets an organ and another doesn't. That's not treating them the same.

It is, since we're talking about a supposedly limited resource here. Both would-be recipients are regarded according to the exact same criteria.

So what? In the alternate scenario, serial killers and non-serial killers are regarded according to the exact same "No serial killers" criterion. Being judged by the same criterion is not the same thing as being treated the same.

Both have a more or less equal chance of receiving the transplant.

That's utter nonsense. People do not have equal chances of receiving an organ under a 'this person will flatline in the next hour, and this person might flatline in the next 2 weeks' policy. A friend of mine has been in dialysis for years. She's low down on the transplant list and will probably die without ever getting a realistic shot at a new kidney. She's 60 and most of the people who are sick enough to get a kidney under the "sickest go first" rules are over 70. People with kidney failure spend their lives playing Russian Roulette. The powers-that-be usually give the kidney to the guy who has to play with five bullets, rarely to people like my friend who only have to play with one bullet. Is it "egalitarian" to give a kidney to one-bullet-girl instead of to five-bullet-man? Maybe not. But my friend is playing with one bullet over and over, year after year, always hoping the next depressingly predictable screw-up with her Heparin levels won't kill her. The cumulative odds that all her "might flatline in the next 2 weeks" chances will one day catch up with her without her ever being perceived as a five-bullet girl make a sick joke of your claim that both have a more or less equal chance of receiving the transplant.

This means there's no risk of people injecting their personal values different from mine into the decision making process;

FIFY.

You don't seem to understand the basic concept of egalitarianism. The scenario I describe is the opposite of injecting personal values into the decision making process.

Why, because your values aren't "personal"? Yes, I understand the basic concept of egalitarianism. The people who value equality above competing values get to have their way; and whenever actual equality is impossible, the people who value equality above competing values get to choose which of the alternatives to equality we'll all be required to use as a stand-in for equality; and regardless of how unequal that may be, they'll get to call their choice "equal".

When you treat everyone by the same standards, giving everyone an equal chance, you eliminate personal values from the equation. The only 'injecting' of personal values comes into play with the 'everyone should be treated equally' assumption at the base of the process, but it is eliminated *everywhere else*;

Exactly. You eliminate personal values by injecting personal values. Do you seriously expect people to just go along with that theory? How do you feel about "We had to destroy the village in order to save it."?

Why on earth would anybody decide to go with your values over his own merely on account of yours being put in at the base of the process instead of being put in somewhere in the "*everywhere else*" you've eliminated them from? What makes the beginning any better than the middle as a place to inject personal values? And even if that were a good idea, why on earth would anybody decide to go with your values over his own when setting up the base of the process? It's not as though there's anything stopping us from picking "expected number of years of life gained" as the base of the process, and thereafter treating everyone by that same standard with no further personal values injected.

"He lives, you die." is not an egalitarian distribution. "But that third party got an organ, and she's the same "kind" of person as you, so that's practically the same as you getting one." doesn't make it egalitarian.

Once again, you don't seem to understand the basic concept of egalitarianism. We're talking about a limited resource. So long as it remains a limited resource, someone *must* lose out. You can't divide a heart two ways and still make it work. So long as that is the case, it is egalitarian to ensure that everyone is treated the same when determining who ultimately winds up with the heart.

See? I do understand egalitarianism. It's exactly what I said it is. "Treating everyone the same is impossible; therefore do it my way and we'll call that treating everyone the same." Don't pee on my friend and tell her it's raining.