HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Martin F. McKneally Robert M. Sade Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McKneally, M. F. Articles by Sade, R. M. Search for Related Content PubMed PubMed Citation Articles by McKneally, M. F. Articles by Sade, R. M. Related Collections Transplantation - heart Professional affairs

J Thorac Cardiovasc Surg 2003;125:451-453
© 2003 The American Association for Thoracic Surgery

Editorials

The prisoner dilemma: Should convicted felons have the same access to heart transplantation as ordinary citizens? Opposing views

From the Department of Surgery and Joint Centre for Bioethics University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada,^a and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC.^b

Received for publication March 26, 2002. Accepted for publication April 1, 2002. Address for correspondence: Martin F. McKneally, MD, 77 Forest Grove Dr, Toronto, Ontario Canada M2K 1Z4 (E-mail: sader@musc.edu).

The first 300 words of the full text of this article appear below.

	Introduction

 
Case: In January 2002, a 31-year-old resident of a California prison, twice-convicted for armed robbery, was hospitalized at Stanford University Medical Center for heart failure, constantly attended by two armed guards. He became the first prisoner to receive a heart transplant. Because of the shortage of hearts for transplantation, someone else will die for lack of a heart. The cost of aftercare is estimated to be approximately $1 million. A storm of protest blew across the country in response to moral questions about allocating this scarce resource to a felon, rather than a law-abiding citizen, and to fiscal questions about the cost of his care. ¹ Should prisoners receive heart transplants?

Editor Craig Miller asked for an opinion about this intuitively disturbing case. Here are two opposing opinions, with their supporting arguments. A dilemma is a situation in which there are strong arguments for adopting each of two contradictory alternatives. As we will see, persuasive arguments can be advanced on both sides. Let us know what you think about this challenging problem.

	Prisoners deserve a chance to have a change of heart

 
Martin F. McKneally, MD
The intuitive responses of aghast, law-abiding citizens can be grouped into three clusters. 1. Prisoners have violated the rules of civil society, so they should be punished rather than awarded society's most precious goods. 2. Providing the highest level of medical care to prisoners may encourage criminality. 3. The fact that 40 million law-abiding US citizens have no insurance to pay for health care intensifies the injustice of awarding the highest level of care to a felon at public expense.

Intuitions are conclusions that we jump to, unmediated by thoughtful analysis. The first generalization, that prisoners should be ranked lower on the recipient list than law-abiding citizens because they are morally inferior or less socially useful, assumes that we can know the internal moral state of another person and . . . [Full Text of this Article]

This article has been cited by other articles:

				R. Jagsi, T. F. DeLaney, K. Donelan, and N. J. Tarbell Real-Time Rationing of Scarce Resources: The Northeast Proton Therapy Center Experience J. Clin. Oncol., June 1, 2004; 22(11): 2246 - 2250. [Full Text] [PDF]

				A. Sampath Kumar Medical resources and capital punishment J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2107 - 2108. [Full Text] [PDF]