UK: Man, 22, Dies After Liver Transplant Refused

[tigerbob]

The family is crying about how he wasn't given a chance.



He had EIGHT YEARS to change. My question is, why the fuck did the family allow him to binge drink for eight years?

What were they gonna do? Give the guy the liver so he could waste it while someone else on the list who actually deserved it dies?

Back the trolly up one fucking minute. You mean to tell me if we go to Obamacare we're not really go to treat people based on need, we're going to treat them on the basis of who deserves it the most?

no, YOU back up the fucking truth trolly, dude. Do you think we currently give rarely dontated organs like livers to fucking alcoholics? I realize you people have an insatiable urge to cry that the sky is falling but go tell a doctor that you smoke three packs a day after asking for a lung transplant and see how soon you get one.

It shouldn't be up to doctors. That would be unfair.

 

[tigerbob]

Back the trolly up one fucking minute. You mean to tell me if we go to Obamacare we're not really go to treat people based on need, we're going to treat them on the basis of who deserves it the most?

no, YOU back up the fucking truth trolly, dude. Do you think we currently give rarely dontated organs like livers to fucking alcoholics? I realize you people have an insatiable urge to cry that the sky is falling but go tell a doctor that you smoke three packs a day after asking for a lung transplant and see how soon you get one.

It shouldn't be up to doctors. That would be unfair.

Allow me to expand on that as I've just realized it could be taken wrongly. It should not be up to doctors because they have taken a hippocratic oath to help people (First, do no harm). I'm not saying that doctors should have no say or that their opinions are not well informed and valid.

Allocation of organs should be guided by policy. Doctors should follow this policy. Policy should be developed by a body of experts which includes the medical profession.

 

[Shogun]

Back the trolly up one fucking minute. You mean to tell me if we go to Obamacare we're not really go to treat people based on need, we're going to treat them on the basis of who deserves it the most?

no, YOU back up the fucking truth trolly, dude. Do you think we currently give rarely dontated organs like livers to fucking alcoholics? I realize you people have an insatiable urge to cry that the sky is falling but go tell a doctor that you smoke three packs a day after asking for a lung transplant and see how soon you get one.

It shouldn't be up to doctors. That would be unfair.

feel free to go mount a grass root effort to change the way it is NOW.

 

[Diuretic]

Doctors shouldn't be involved in making public policy, that should be left to the elected legislature.

 

[Shogun]

unless it comes to making birth control available? Are you ready to make every doctor and pharmacist abide by what the legislature decides regardless of personal belief? I realize it's easy to toss out rhetorical nonsense but..

 

[ozzmdj]

Doctors shouldn't be involved in making public policy, that should be left to the elected legislature.

Heaven forbid if someone that does it for a living have any input to the know nothing bureaucracy.....that how we got to this point of incompetence on this many thing other than health care.

 

[Diuretic]

Let me clarify. Doctors should be involved in advising on technical issues but the actual responsibility for formulating policy, in legislative form, falls to the legislators who are elected.

 

[toomuchtime_]

Raises the question should smokers be treated if they continue to smoke...? Smokers would probably say they've paid for their treatment via the punitive tax payable for tobacco products. If one view is reasonable, shouldn't it be so for the other as well? Taxes are high on booze as well.

That said, smokers don't get new lungs.

Essex! Hah! Had to be didn't it?

Good point. If we hold drunks responsible for their diseases and deny them health care on that basis, why not smokers or fat people or sedentary people or anyone who eats at McDonald's or drives instead of walking? Perhaps the Brits have hit upon a method of holding down health care costs.

This guy wasn't denied healthcare to hold down costs. Christ, are you really that dumb? He was denied because there aren't enough livers available for everyone that need one and only those who actually take care of themselves and show they are capable of not destroying another liver will get one due to this shortage. It had absolutely nothing to do with cutting costs.

The point is, for those who can think, a scarce resource, a liver, was allocated on the basis of a moral judgment about person's behavior, and another scarce resource, money, could by the same reasoning be denied for the treatment of some one who is fat or sedentary or who otherwise does not "take care of themselves". Should we pay for a heart bypass operation for a fat man who eats at McDonalds and not for a liver transplant for a drunk? Both money and livers are scarce resources. Even if the fat man does not change his diet and the drunk does not give up drinking, both will do better for a time because of the treatments, so if the liver is allocated on the basis of where its effects will last the longest, shouldn't the money for a bypass operation, to the extent money for health care is a scarce resource, be allocated on the basis of where its effects will likely be longest lasting, that is, to some one who has already changed his diet and begun exercising, etc.?

Unless, of course, you believe money for health care is not a scarce resource and there is no need to ration it.

 

[Shogun]

Let me clarify. Doctors should be involved in advising on technical issues but the actual responsibility for formulating policy, in legislative form, falls to the legislators who are elected.

which, again, are you ready to FORCE doctors and pharmacists who claim to have a moral disagreement with legislation to comply?

 

[xotoxi]

The point is, for those who can think, a scarce resource, a liver, was allocated on the basis of a moral judgment about person's behavior, and another scarce resource, money, could by the same reasoning be denied for the treatment of some one who is fat or sedentary or who otherwise does not "take care of themselves".

There is no moral judgement, you piece of fucking shit! Clearly you don't have an ounce of logic in you, asswipe.

Would you like an alcoholic - a current alcoholic mind you - to get a brand new healthy liver ahead of your child who has a failing liver due to a congenital liver malformation?

A current alcoholic will take that liver and destroy it.

There is no judgement that is made on HOW the liver failed. There is a judgement made on WILL THE LIVER FAIL AGAIN. An alcoholic that continues to drink will guarantee to pickle that liver. An alcoholic who has not drank for 6 months, will likely not restart drinking, and the liver will do them well.

They also don't give livers to people with liver failure due to metastatic cancer. Do you think that doctors are making a moral judgement on a cancer patient by denying them?

 

[toomuchtime_]

The point is, for those who can think, a scarce resource, a liver, was allocated on the basis of a moral judgment about person's behavior, and another scarce resource, money, could by the same reasoning be denied for the treatment of some one who is fat or sedentary or who otherwise does not "take care of themselves".

There is no moral judgement, you piece of fucking shit! Clearly you don't have an ounce of logic in you, asswipe.

Would you like an alcoholic - a current alcoholic mind you - to get a brand new healthy liver ahead of your child who has a failing liver due to a congenital liver malformation?

A current alcoholic will take that liver and destroy it.

There is no judgement that is made on HOW the liver failed. There is a judgement made on WILL THE LIVER FAIL AGAIN. An alcoholic that continues to drink will guarantee to pickle that liver. An alcoholic who has not drank for 6 months, will likely not restart drinking, and the liver will do them well.

They also don't give livers to people with liver failure due to metastatic cancer. Do you think that doctors are making a moral judgement on a cancer patient by denying them?

Clearly, it would be a waste of money to treat some one of your excitable temperament for high blood pressure or other stress related diseases since you are likely to give yourself a heart attack or stroke regardless of how much money, a scarce resource, the rest of us might spend to try to save you from your own nature. This is not a moral judgment, mind you, just an observation that that money might be better spent trying to save a calmer person.

What is under discussion is how a scarce resource, a liver in this case, should be allocated, what principle should be applied to make that determination. If we assume for a moment that you are not making a moral judgment and that you are not basing your opinion on sentimentality about children, then the argument you are making, whether you are able to understand it or not, is that we should allocate the liver where it will last the longest and in that way return the greatest value to society, in your example, the child since he/she will presumably be able to use the liver longer.

Now let's apply your principle to the allocation of another scarce resource, money for health care. It's pretty much of a given that as our population continues to age in order to keep health care costs down we are going to have to ration health care dollars, and many people are suggesting that they be rationed pretty much as you say livers should be allocated, that is, that to the extent health care dollars have to be rationed, expensive treatments to keep older people alive or improve their quality of life for only a few years should should be stopped to the extent we need the money to keep younger people alive and healthy for many years.

Now let's take it a step further. If we still need to ration health care dollars further and we have to choose whether to spend them on a fat guy who eats at McDonald's and smokes or a slim, active, non smoker who eats lots of vegetables, applying the principle of allocating scarce resources where the benefits will last the longest, shouldn't we tell the fat guy to give up his place in line to the slim guy? And what about people who are discovered to have genetic markers for certain serious and expensive to treat diseases? Should they have to give up their place in line to some one without these markers who has a better long term prognosis? So if the time came when we had to ration health care dollars that severely, would it be reasonable, acceptable, decent of us to send old people, fat people and people with genetic markers for serious, expensive to treat diseases, people who have poor long term prognoses, like the drunk who needed a liver transplant, to the back of the line so we'd have the money to treat younger people with healthy life styles and no genetic markers for serious expensive to treat diseases, people who have better long term prognoses like the child who needed the liver transplant?

Regardless of what the logic of the situation might dictate, I think most people would find this scenario horrifying, but suppose instead of sending old people, fat people and people without genetic markers for diseases to the back of the line, we only sent drunks and junkies back; I think most people would find that less horrifying, but why would this be if we're not making moral judgments about drunks and junkies?

 

[Diuretic]

Let me clarify. Doctors should be involved in advising on technical issues but the actual responsibility for formulating policy, in legislative form, falls to the legislators who are elected.

which, again, are you ready to FORCE doctors and pharmacists who claim to have a moral disagreement with legislation to comply?

This harkens back to the pharmacist refusing to sell some sort of contraceptive, or something similar. If so, then it's a different situation and not related to this topic. But if you want a response okay. Doctors have obligations both under their ethical code and under the law. If they feel unable to comply with their ethical code and the law then they're free to quit (but they're more likely to get their powerful union to lobby to get the law changed). The same for pharmacists. Just what the law should be though, is up to the legislators who are elected and thus represent the collective will of the electorate.

 

[xotoxi]

Obviously, you don't really have a firm grasp on the topic which is being discussed.

Clearly, it would be a waste of money to treat some one of your excitable temperament for high blood pressure or other stress related diseases since you are likely to give yourself a heart attack or stroke regardless of how much money, a scarce resource, the rest of us might spend to try to save you from your own nature. This is not a moral judgment, mind you, just an observation that that money might be better spent trying to save a calmer person.

Are you implying that high blood pressure medications, or the cost of high blood pressure medications, are as scarce as livers for donation?

I think you are...which is rather proposterous.

What is under discussion is how a scarce resource, a liver in this case, should be allocated, what principle should be applied to make that determination. If we assume for a moment that you are not making a moral judgment and that you are not basing your opinion on sentimentality about children, then the argument you are making, whether you are able to understand it or not, is that we should allocate the liver where it will last the longest and in that way return the greatest value to society, in your example, the child since he/she will presumably be able to use the liver longer.

This you seem to understand. Give the liver to the individual in whom it has the greatest chance of succeeding. Give it to a teenager over a 65 year old alcoholic. Give it to a 65 year old non-alcoholic over a 25 year old alcoholic. Give it to someone who has liver failure due to tylenol overdose over someone with metastatic disease.

There are principles that are applied. There are rules that are followed. The determination is not just made willy-nilly.

Now let's apply your principle to the allocation of another scarce resource, money for health care. It's pretty much of a given that as our population continues to age in order to keep health care costs down we are going to have to ration health care dollars, and many people are suggesting that they be rationed pretty much as you say livers should be allocated, that is, that to the extent health care dollars have to be rationed, expensive treatments to keep older people alive or improve their quality of life for only a few years should should be stopped to the extent we need the money to keep younger people alive and healthy for many years.

Again, you slip into delusion...that money for health care is "scarce". It is no where near as scarce as a liver for transplant. True, there are very expensive treatments that SHOULD be looked at.

For example, Erbitux is used to treat lung cancer. 18-weeks treatment - $80,000. The mean increase in survival is 1.2 months. (Lilly Erbitux Cancer Drug Not Worth Price, U.S. Scientists Say - Bloomberg.com)

Should insurance companies or government based insurance pay for this? Should we as a society allow this? No. We need to draw a line in the sand in situations like this and say that the cost/benefit does not work for our health system. On the otherhand, there are many other treatments that are expensive, but give people great chances of survival...these should be continued.

Now let's take it a step further. If we still need to ration health care dollars further and we have to choose whether to spend them on a fat guy who eats at McDonald's and smokes or a slim, active, non smoker who eats lots of vegetables, applying the principle of allocating scarce resources where the benefits will last the longest, shouldn't we tell the fat guy to give up his place in line to the slim guy? And what about people who are discovered to have genetic markers for certain serious and expensive to treat diseases? Should they have to give up their place in line to some one without these markers who has a better long term prognosis? So if the time came when we had to ration health care dollars that severely, would it be reasonable, acceptable, decent of us to send old people, fat people and people with genetic markers for serious, expensive to treat diseases, people who have poor long term prognoses, like the drunk who needed a liver transplant, to the back of the line so we'd have the money to treat younger people with healthy life styles and no genetic markers for serious expensive to treat diseases, people who have better long term prognoses like the child who needed the liver transplant?

Now...by talking about the "back of the line"...what exactly are you talking about? Are you talking about treatment for blood pressure and diabetes? Or are you talking about treatments are are truly limited in resource, such as organs for transplant? They are two entirely different subjects.

Health care dollars should go into trying to prevent the diseases that a fat smoker will face. Education, screening, early treatment, lifestyle modifications. Those are where the focus should be, in order to prevent heart attacks, hospitalizations, strokes, amputations, etc. I fail to see where judgement and rationing comes in.

Regardless of what the logic of the situation might dictate, I think most people would find this scenario horrifying, but suppose instead of sending old people, fat people and people without genetic markers for diseases to the back of the line, we only sent drunks and junkies back; I think most people would find that less horrifying, but why would this be if we're not making moral judgments about drunks and junkies?

Again...no moral judgement. There are many drunks who have liver failure, who receive a liver transplant after they have been sober for 6 months. That is the requirement. If you are sober, you go on the list. That's not a moral judgement - I don't understand why you don't get it. It's just a fact - an current alcoholic who is drinking at the time of transplant will have a far higher incidence of continuing to drink after transplant, then would a former alcoholic who had been sober for 6 months.

And finally, I apologize for my rudeness at the beginning of my last post. It was uncalled for.

 

[L.K.Eder]

The OP has failed,

signed Larry Hagman's liver

 

[Coyote]

The point is, for those who can think, a scarce resource, a liver, was allocated on the basis of a moral judgment about person's behavior, and another scarce resource, money, could by the same reasoning be denied for the treatment of some one who is fat or sedentary or who otherwise does not "take care of themselves".

There is no moral judgement, you piece of fucking shit! Clearly you don't have an ounce of logic in you, asswipe.

Would you like an alcoholic - a current alcoholic mind you - to get a brand new healthy liver ahead of your child who has a failing liver due to a congenital liver malformation?

A current alcoholic will take that liver and destroy it.

There is no judgement that is made on HOW the liver failed. There is a judgement made on WILL THE LIVER FAIL AGAIN. An alcoholic that continues to drink will guarantee to pickle that liver. An alcoholic who has not drank for 6 months, will likely not restart drinking, and the liver will do them well.

They also don't give livers to people with liver failure due to metastatic cancer. Do you think that doctors are making a moral judgement on a cancer patient by denying them?

Exactly, it isn't a "moral" judgement. Alcoholism is a disease - by the time it reaches the stage of liver failure, the person has usually been suffering a host of problems for quite some time and knows full well he is an alcoholic. If he can't or won't treat the underlying disease then a new liver will not do him any good but it might do someone else some good.

If you refused an alcoholic who had shown he was able to overcome it and stay clean a new liver then you might be guilty of a "moral judgement".

To refuse a new liver to an ongoing alcoholic is no different then to refuse it to a person with metastic liver cancer - it's a cost/benefit analysis for a scarce resource, not a moral judgement.

 

[Coyote]

Clearly, it would be a waste of money to treat some one of your excitable temperament for high blood pressure or other stress related diseases since you are likely to give yourself a heart attack or stroke regardless of how much money, a scarce resource, the rest of us might spend to try to save you from your own nature. This is not a moral judgment, mind you, just an observation that that money might be better spent trying to save a calmer person.

There is a direct correlation between untreated alcoholism and liver damage.

The correlation between temperment and heart attacks, strokes or stress related disease is far less clear and influenced by multiple other factors such as genetics, inflammation of the arteries, lifestyle choices. And, as Xo pointed out: treatment for those diseases is not a scarce resource nor is "money" as scarce a resource as organs for transplant.

What is under discussion is how a scarce resource, a liver in this case, should be allocated, what principle should be applied to make that determination. If we assume for a moment that you are not making a moral judgment and that you are not basing your opinion on sentimentality about children, then the argument you are making, whether you are able to understand it or not, is that we should allocate the liver where it will last the longest and in that way return the greatest value to society, in your example, the child since he/she will presumably be able to use the liver longer.

You're the one making the moral judgement here...we "should". But is that how it is actually done?

According to the OPTN/UNOS donated livers are prioritized with candidates at greatest short-term risk of dying without a transplant at the top (Status 1A and 1B) who have a life expectancy of seven days or less without a transplant. At any given moment there are usually fewer than 10 of these candidates nationwide.

Status 1A candidates are adults or children who either have fulminant liver failure (a rapid, life-threatening loss of liver function) or have recently received a liver transplant that failed shortly afterward. Status 1B candidates are children who have chronic liver disease with severe and life-threatening complications.

Both adults and children are rated equally with need and short term survival being prioritized. However, patients that are too sick to survive a transplant (as was also the case with the UK man) are not likely to receive one for obvious reasons. That is not a "moral" judgement.

Now let's apply your principle to the allocation of another scarce resource, money for health care. It's pretty much of a given that as our population continues to age in order to keep health care costs down we are going to have to ration health care dollars, and many people are suggesting that they be rationed pretty much as you say livers should be allocated, that is, that to the extent health care dollars have to be rationed, expensive treatments to keep older people alive or improve their quality of life for only a few years should should be stopped to the extent we need the money to keep younger people alive and healthy for many years.

That might occur but for one thing: a person who can afford it, can always go outside their chosen system to get treatment. Those who would be affected by "rationing" are those already affected by the current "rationing system" - whether through a private plan or a public one. If you choose to use public moneys for your healthcare then some rationing is inevitable. If you choose to use a private plan for healthcare then some rationing is inevitable whether it's in choices of treatment covered or ceilings on cost.

Who are these "many people" suggesting healthcare be rationed like transplant organs?

Now let's take it a step further. If we still need to ration health care dollars further and we have to choose whether to spend them on a fat guy who eats at McDonald's and smokes or a slim, active, non smoker who eats lots of vegetables, applying the principle of allocating scarce resources where the benefits will last the longest, shouldn't we tell the fat guy to give up his place in line to the slim guy?

And what about people who are discovered to have genetic markers for certain serious and expensive to treat diseases? Should they have to give up their place in line to some one without these markers who has a better long term prognosis? So if the time came when we had to ration health care dollars that severely, would it be reasonable, acceptable, decent of us to send old people, fat people and people with genetic markers for serious, expensive to treat diseases, people who have poor long term prognoses, like the drunk who needed a liver transplant, to the back of the line so we'd have the money to treat younger people with healthy life styles and no genetic markers for serious expensive to treat diseases, people who have better long term prognoses like the child who needed the liver transplant?

Some of those are serious considerations but are you sure you aren't committing a "slippery slope" fallacy?

Regardless of what the logic of the situation might dictate, I think most people would find this scenario horrifying, but suppose instead of sending old people, fat people and people without genetic markers for diseases to the back of the line, we only sent drunks and junkies back; I think most people would find that less horrifying, but why would this be if we're not making moral judgments about drunks and junkies?

I don't think it's a "moral judgement" - if you have a scarce resource, and transplant organs are undeniably scarce - giving it to someone who has shown he will not treat his disease over someone who will is a no-brainer.

 

[toomuchtime_]

Obviously, you don't really have a firm grasp on the topic which is being discussed.

Clearly, it would be a waste of money to treat some one of your excitable temperament for high blood pressure or other stress related diseases since you are likely to give yourself a heart attack or stroke regardless of how much money, a scarce resource, the rest of us might spend to try to save you from your own nature. This is not a moral judgment, mind you, just an observation that that money might be better spent trying to save a calmer person.

Are you implying that high blood pressure medications, or the cost of high blood pressure medications, are as scarce as livers for donation?

I think you are...which is rather proposterous.

What is under discussion is how a scarce resource, a liver in this case, should be allocated, what principle should be applied to make that determination. If we assume for a moment that you are not making a moral judgment and that you are not basing your opinion on sentimentality about children, then the argument you are making, whether you are able to understand it or not, is that we should allocate the liver where it will last the longest and in that way return the greatest value to society, in your example, the child since he/she will presumably be able to use the liver longer.

This you seem to understand. Give the liver to the individual in whom it has the greatest chance of succeeding. Give it to a teenager over a 65 year old alcoholic. Give it to a 65 year old non-alcoholic over a 25 year old alcoholic. Give it to someone who has liver failure due to tylenol overdose over someone with metastatic disease.

There are principles that are applied. There are rules that are followed. The determination is not just made willy-nilly.




Again, you slip into delusion...that money for health care is "scarce". It is no where near as scarce as a liver for transplant. True, there are very expensive treatments that SHOULD be looked at.

For example, Erbitux is used to treat lung cancer. 18-weeks treatment - $80,000. The mean increase in survival is 1.2 months. (Lilly Erbitux Cancer Drug Not Worth Price, U.S. Scientists Say - Bloomberg.com)

Should insurance companies or government based insurance pay for this? Should we as a society allow this? No. We need to draw a line in the sand in situations like this and say that the cost/benefit does not work for our health system. On the otherhand, there are many other treatments that are expensive, but give people great chances of survival...these should be continued.

Now let's take it a step further. If we still need to ration health care dollars further and we have to choose whether to spend them on a fat guy who eats at McDonald's and smokes or a slim, active, non smoker who eats lots of vegetables, applying the principle of allocating scarce resources where the benefits will last the longest, shouldn't we tell the fat guy to give up his place in line to the slim guy? And what about people who are discovered to have genetic markers for certain serious and expensive to treat diseases? Should they have to give up their place in line to some one without these markers who has a better long term prognosis? So if the time came when we had to ration health care dollars that severely, would it be reasonable, acceptable, decent of us to send old people, fat people and people with genetic markers for serious, expensive to treat diseases, people who have poor long term prognoses, like the drunk who needed a liver transplant, to the back of the line so we'd have the money to treat younger people with healthy life styles and no genetic markers for serious expensive to treat diseases, people who have better long term prognoses like the child who needed the liver transplant?

Now...by talking about the "back of the line"...what exactly are you talking about? Are you talking about treatment for blood pressure and diabetes? Or are you talking about treatments are are truly limited in resource, such as organs for transplant? They are two entirely different subjects.

Health care dollars should go into trying to prevent the diseases that a fat smoker will face. Education, screening, early treatment, lifestyle modifications. Those are where the focus should be, in order to prevent heart attacks, hospitalizations, strokes, amputations, etc. I fail to see where judgement and rationing comes in.

Regardless of what the logic of the situation might dictate, I think most people would find this scenario horrifying, but suppose instead of sending old people, fat people and people without genetic markers for diseases to the back of the line, we only sent drunks and junkies back; I think most people would find that less horrifying, but why would this be if we're not making moral judgments about drunks and junkies?

Again...no moral judgement. There are many drunks who have liver failure, who receive a liver transplant after they have been sober for 6 months. That is the requirement. If you are sober, you go on the list. That's not a moral judgement - I don't understand why you don't get it. It's just a fact - an current alcoholic who is drinking at the time of transplant will have a far higher incidence of continuing to drink after transplant, then would a former alcoholic who had been sober for 6 months.

And finally, I apologize for my rudeness at the beginning of my last post. It was uncalled for.

First, your assumption about alcoholics destroying a new liver are without a basis in fact. No studies I found report no greater incidence of serious liver disease after a liver transplant among alcoholics than among non alcoholics. On the contrary, survival rates among both groups at 1 year, 5 years and 7 years are the same, and while survival rates are significantly lower for alcoholics at 10 years, The causes of death had nothing to do with liver disease but were things like certain cancers and cardiovascular disease for which alcoholism is considered a risk factor but not a direct cause, most probably because alcoholics tend to make poor life style choices, such as smoking, poor nutrition, lack of exercise, etc., more ofter than non alcoholics do.

Alcohol relapse adversely affects 10-year liver transplant survival

This suggests that if alcoholics are not being denied liver transplants because of moral judgments then others who have statistically similar risk factors for these cancers or cardiovascular disease should also be denied liver transplants even if they don't drink. So people who are fat, smoke, have poor nutrition, exercise little, have family histories of cancer or cardiovascular disease would also be denied liver transplants until all people with lower risk factor for these diseases had gotten their livers, and we all know that would never. Moreover, one study found that the amount of alcohol consumed daily is a better predictor of recidivism that the length of time the patient was sober before the transplant. If this is true, then the doctors in the UK could have simply asked him how much he drank daily to determine how likely he was to continue drinking after surgery instead of letting this young man die because there wasn't enough time left for him to be sober for six months.

Relapse was predicted by daily ethanol consumption (P =0.0314), but not by duration of pretransplant sobriety or explant histology.

Liver Transplantation for Alcoholic Cirrhosis: Long Term Fol... : Transplantation

Since there is no basis in fact for believing that continued alcoholism will lead to serious liver disease after surgery and since there is no reason to believe six months sobriety before surgery is a good indicator of continued sobriety after surgery, why shouldn't non alcoholics who have statistically similar risk profiles for cardiovascular disease or cancer to an alcoholic's be denied liver transplants unless a moral judgment about alcoholism is the basis for requiring six months sobriety before getting a liver transplant?

Moreover, since poverty, living in a high crime rate area also have implications for survival, it might be that an older alcoholic living in a pleasant suburb whose whose family history showed no cancer or heart disease would have a better risk profile for 10 year survival than a young black man, who was otherwise healthy, a non drinker, but who lived in a high crime inner city area - homicide being the leading cause of death among young black men - and whose family history showed cancer, heart disease, diabetes, high blood pressure, etc. Then we'd have reason to assume the older, richer alcoholic would be able to use the liver longer, but who wouldn't cringe at assigning the liver because of factors associated with race and economic class? Yet we would have far fewer qualms about giving it to the young black man despite the fact his 10 year survival was less likely than the alcoholic's. How can this not be the result of moral judgments about alcoholism, race and economic class?

The rationing of health care dollars goes on in every health system, but not as seriously or severely as in the UK.

The NHS cannot, and never has been able to, offer every treatment to everyone who needs it.
The NHS is funded from taxes, and it spends more than £42bn every year - £779 for every person in the UK. But it is not a bottomless pit of funds and some treatments have to be restricted.

Raising taxes to pay for every possible need is politically unthinkable, as it would require a massive increase in income tax to raise enough revenue to make a significant difference to spending.

This means some treatments have to be restricted, or rationed.

In a January 1999 survey of GPs, conducted by Doctor magazine, one in five said they knew patients who had suffered harm as a result of rationing.

More than 5% of the 3,000 surveyed also said they knew of patients who had died as a result of being denied treatment on the NHS.

Expensive treatments

One of the most controversial rows over rationing concerns beta interferon, a treatment for multiple sclerosis.

The full effectiveness of the drug has yet to be established, and because it is very costly - approximately £10,000 per patient per year - some health authorities are reluctant to allow doctors to prescribe it.

Another example is a drug used in the treatment of ovarian cancer, Taxol, which has been licensed for use in the UK since mid-1998.

It costs £1,500 per injection and the average course requires six of these.

There are two studies that show the drug extends a patient's life by a year, but this is not enough evidence to justify prescribing it for everyone with ovarian cancer.

Marilyn Bush had the disease but was able to get the treatment because her private health care insurance agreed to pay for it.

She said: "Could you imagine how you would feel if you knew you could not possibly find the money for a drug you needed?"

Dr Gordon Rustin, who treated Ms Bush, is familiar with the implications of local priority setting.

"Some health authorities have made special funding available just for patients who fit into certain clinical trials and some health authorities have said they will not provide any extra funding for Taxol."

Dr Rustin said that before he sees a patient he has to check their postcode to see which health authority pays for their treatment. He says he can only then prescribe the drug if he knows the authority will fund it.

He said authorities have to make a crude calculation.

"They want to show that we can improve duration of life with a new drug and they then try to calculate the extra duration of life," he said.

"If you get an extra year of life for less than £10,000 then it is generally considered that that is a reasonable buy."

BBC NEWS | Health | Rationing care from limited funds

The article is ten years old, but other than the numbers changing because of inflation, I have not found any articles to suggest the situation has changed much.

£10,000 is equivalent to $16,500, so the article is saying that if you have cancer in the UK and the treatment costs more than $16,500 to keep you alive for another year, then you will either have to be able to pay for it yourself, have private insurance that will pay for it or die. That's pretty serious rationing, and the reason health care is rationed so much more severely in the UK than in the US or in other European nations is that the UK decided it was more important to keep the cost down than to keep people alive as long as possible.

As our populations continue to age, all developed nations will have to devise ways of rationing health care. We all do already, but in different ways. In the US we ration care by not insuring some people. In Canada they ration care by low capital investments in newer technologies and waiting times that Canadian doctors call "clinically unreasonable" meaning potentially dangerous. In the UK they ration care by putting a cap on what they will pay individually on a treatment even if denying it will cause death and by putting a cap on the collective cost of some treatments. Even France, thought by many to have the best health care system in the world, is changing its very complex system so that primary doctors will begin to act as gatekeepers to limit access to tests and specialists because of increasing budget deficits, much as HMO's do here in the US and as the "health homes" Obama's people want to use to reduce health care costs here.

Obama said in one of his speeches that if his grandmother were dying of cancer and broke her hip, he wouldn't want her to have to go without a hip replacement and lie in bed for the last year of her life, but in the UK today, she might well have to do that, unless she had a wealthy grandson, and as our health care costs continue to rise because of our aging population, she might well have to suffer here in the US tomorrow regardless of what kind of reforms we adopt.

So it makes sense to ask what principle we should adopt to ration increasingly scarce health care dollars. Should we limit what we spend on people whose health problems are the result of their behaviors, such as alcoholics, smokers, fat people, people who have poor eating or exercising habits? Should we limit what we spend on people who have poor risk profiles for long term survival, such as those above as well as people with high risk family histories and poor socioeconomic circumstances? Or should we choose some other way?