January 30, 2002

5:26 AM

Convict Heart TransplantA 31 year old 2 time felon just got a heart transplant, costing tax payers close to $1 million dollars. With an annual additional cost of $15,000. Right? Wrong? I'm not so sure.
posted by SuzySmith (15 comments total)

The article raises some interesting questions, but the author may not have all the facts about how transplants work. It's entirely possible that the convict wasn't at the top of the transplant list at all, but that he was the only person on the list whose blood and tissue types were compatible with the donor heart. So it may not be as simple as "convict gets transplant instead of law-abiding citizen", it may just be that there was nobody else who matched the heart. If it's a choice between the heart going to waste and someone getting it, then I vote for "someone getting it".
posted by biscotti at 6:29 AM on January 30, 2002

Not to hijack this thread, but I notice the story is by Steve Lopez. I used to enjoy reading Lopez's columns when he wrote for my local Philadelphia Inquirer. His writing is clever, incisive and entertaining, although perhaps this story doesn't show him at his best. He seems intellectually honest, although his politics don't always agree with my own. Here's a piece on his current stint in LA Apparently he hasn't quite found his place on his paper or in the city yet. I hope he does, and I'm pretty sure he will.

I was sorry to see him leave Philly, but our loss is LA's gain.
posted by Slithy_Tove at 6:32 AM on January 30, 2002

It seems like the answer to Mr. Lopez's problem is to have taxpayer's pay for his dad's health care as well.

Oh, sorry, I'm from Canada.
posted by transient at 6:35 AM on January 30, 2002

All of us pay heavily for other people's expensive, heroic medical procedures -- through insurance. That doesn't mean I begrudge anyone their heart transplant. If it has to happen, it has to happen. But many people in the late-terminal stages of their fatal illnesses go through procedures of mind-boggling expense and difficulty for the sake of an extra week or month of life. At what point do the insurance companies and the healthy insured have some authority to say: "No. Can't be covered"?

All these questions involves someone's pain, so they're tough to address.
posted by argybarg at 7:21 AM on January 30, 2002

While a prisoner is in the penal system, the relevant government (city, county, state, or federal) has an obligation to ensure his/her physical and mental well-being. They're essentially wards of the state.

What should have happened in this case? The state should have released the prisoner on the "compassionate release" scheme. That way, the state would no longer have an obligation for the well-being of the man, since he would no longer be a prisoner.

Then, he could have either obtained the transplant by whatever means available, or would have just died.

The main topic under discussion here is the obligation to the prisoner. But another issue lurks: radical procedures and their associated costs. My stance on this is quite firm: if you can't afford the procedure, you can't have the procedure. Choice between $1 million transplant, or death, and you can't afford it? Too bad, you're going to die. Think that's too harsh, too severe, too inhumane? Then support socialized medicine. See, there's the rub: you either support socialized medicine (of some sort), or you accept the consequences of capitalistic, consumerist medicine, which includes letting people die if they cannot afford the costs of treatment.
posted by yesster at 7:34 AM on January 30, 2002

Choice between $1 million transplant, or death, and you can't afford it? Too bad, you're going to die.

Ouch! There's a big debate over here in the UK about the future of the NHS - I don't think anyone would ever consider an outcome where that kind of statment becomes mainstream.

Back to the original point, you've got to look at it from a medical point of view - if he needs it, and it's there, do it. Just because he's a felon doesn't mean he should die - I'm assuming he's not on death row.....
posted by brettski at 7:46 AM on January 30, 2002

I vote with biscotti.... we don't know all the facts.

To quote the artice...

'A lot of factors are taken into account, such as the location of the donor heart, the location of the recipient, the degree of illness, and other compatibility factors'.

Maybe the convict was the only match? Or maybe he was the highest ranking match on the list? Life is life, in all forms - So give 'em the heart.

By the way - this guy was in prison for robbery... would it make a differece if it was white collar crime?
posted by matty at 8:27 AM on January 30, 2002

There are two distinct points to be adressed here, I suppose. The first is about the relative merits of a socialistic based healthcare against insurance based healthcare. The second is about the rights of prisoners and the moral decisions that have to be made in healthcare.

As a Briton, I'm very happy that I can rely on the National Health Service. We hear horror stories all the time - of people being left on trollies in corridors for many hours or even days at a time. Yet, for all it's faults the NHS works for the vast majority of people. I would personally support higher taxes to finance greater spending, but there you go. The failure of the USA to implement anything similar is perhaps it's greatest single failure, in my opinion. In the end, what's more important than your health?
The second part is more thorny. If we deny proper treatment to a prisoner, then when do we stop? Do we deny cancer treatment to smokers? More controversially, the current Bush regime seems keen on promoting Christian family values. Would there be any strings attached to treatments for unmarried mothers or homosexuals, for instance? OK, I accept this is an extreme argument, but I think the logic follows straight on from making moral judgements about who should receive treatment.

Incidently, George Best is currently awaiting a liver transplant. Does he deserve one?
posted by salmacis at 8:28 AM on January 30, 2002

Well, that was certainly an awful article.

Before his transplant, the inmate had applied for a so-called compassionate release because of his condition. He might still get one, because even though he's got a new pump, he may be classified as terminally ill. Taking up a life of crime could be the smartest thing this guy ever did.

"So-called"? Not that I wander around feeling sorry for criminals, but this phrase seems to imply that there is no such thing as justifiable compassion for any prisoner qua prisoner. And suggesting obliquely that being incarcerated is a good strategy for obtaining free health care is pretty fucking stupid.

But should it be the best care available when you and I are the ones paying?

Absolutley not. When it comes to others, I demand substandard care.
posted by Skot at 8:36 AM on January 30, 2002

Funny, salmacis, resisting the lunacy of nationalized health care is something I would hold up as a shining example of one reason why we're generally so much better off than people in the UK...

This aside, I don't think the state has an oligation to provide heroic medical procedures for those who are incarcerated... *unless* it gains the right to take all assets of any prisoner to pay for costs of maintaining the prison system. I think it would be better to let prisoners keep any assets... and let them die when such extreme measures are the only way of preserving life. The humanitarian release idea is not half bad- I don't see an individual in end stages of heart disease as being much of a threat to anyone... let them go to say their goodbyes and make their peace- if he or she can't pay for the operation.
posted by dissent at 8:49 AM on January 30, 2002

"oligation"? Isn't that a birth control procedure? My bad.

Sheesh, dissent, maybe you're not above making the occassional mistale.

(>:->)!
posted by dissent at 8:52 AM on January 30, 2002

Interesting question, but on the limeited information in the column, I've gotta say that yes, they were right to give him the transplant. Not giving it to him would be tantamount to imposing a death sentence for armed robbery, which is obviously a bit over the top. If he was on death row or doing life without for mass murder, it might be a different story, but this guy, from what I know, deserves the same chance at survival as anyone else.
posted by jonmc at 8:59 AM on January 30, 2002

I think the basic question that this raises is does everyone have a right to healthcare? I find it ironic that someone at the street may not be able to get this transplant- yet a prisoner can. My mom works for a hospital and knows all the ins and outs there, yet does not think that that healthcare is a right. Never got into but, but she thinks its something more like a privilage such as a driver's liscence. Are there any other medical personal around here with an opinion on a person's right's to healthcare?
posted by jmd82 at 9:21 AM on January 30, 2002

Interesting article..because it raises more then one question.

The obvious one "do bad people deserve a good heart" has an easy answer: only after law-abiding citizen got their one. Of course if the heart can't be transplanted but to the bad guy because of compatibility problems then let the guy have it, and expenses paid by taxpayers.

But there is one less then obvious question that we can raise: if the bad guy gets a taxpayer paid heart, why shouldn't the good guy get it too, provided that he can't afford to pay for one ?

I'm all for public healthcare system managed in a way that results are maximized (number of patients cured) while trying to minimize costs. What , imho, is happening is that public healthcare is managed with ONLY ONE goal that is minimization of costs, regardless of results.

That because the "competitive market" system is based on competition for bigger profit and customer satisfaction is only a secondary goal ; given that we could say that private healthcare is a monumental scam, what they want is your money not your well being.
posted by elpapacito at 9:36 AM on January 30, 2002

I think the basic question that this raises is does everyone have a right to healthcare?

Unfortuneately I think this question misses the point of public healthcare. No one person is an island in this issue because the cost to the society of allowing a member to fall reverberates through all segments of the society through economic loss as well as intangible (unquatifyable) losses. The second, even more important, reason is that infectious diseases are opportunistic and readily mutate and spread under distressed healthcare conditions. This point is made abundantly clear in Laurie Garret's "Betrayal of Trust" about the consequences of failed, or money starved, public health systems. It is a catastrophic pay-now-or-pay-big-time-later scenario, particularly in Russia now. If any demographic group is systematically denied proper healthcare (for any reason whatsoever) it WILL (not might) become the breeding ground for, and incubator of, diseases that are devastating to all the people of the larger society that contains that group. One recent case in point: Drug resistent TB in the '90's was only controllable in Georgia (the country) when the health of the prison population was stabilized by the use of expensive drugs that the common population couldn't afford.. If you lived in Georgia, would you think this was a waste of money on people who don't deserve it? Or does that question miss the point entirely? You decide...Keep in mind, at the time the money was allocated nobody knew if the plan would work and many believed the prisoners were not the problem.
posted by plaino at 10:06 AM on January 30, 2002