David L. Perry, Ph.D.
On January 3, 2002, a convicted felon was given a new heart at Stanford Medical Center. The cost of the transplant and years of post-operative care may reach $1 million, courtesy of California taxpayers.
Most people would no doubt find it troubling that a criminal would get a major organ transplant while hundreds of law-abiding citizens who desperately need that organ are made to wait. Imagine watching a loved one die for lack of a heart, then reading in the paper the story about our fortunate felon.
But according to Russ Heimerich of the Dept. of Corrections, as quoted by Steve Wiegand of the Sacramento Bee (25 January 2002), "The courts have told us that inmates have a constitutional right to health care. The judge did not sentence this guy to death. And who knows, he may get out and become a productive citizen."
Wiegand went on to explain, "In 1976 the U.S. Supreme Court held that ‘deliberate indifference’ to a prison inmate’s health problems constituted cruel and unusual punishment and thus violated the Eighth Amendment to the Constitution. Since then, hundreds of subsequent cases have established that inmates have a right to medical care equal to that of the public in general."
Now, I can imagine situations where denying basic medical care to a prisoner would indeed be cruel and unjust. We may not keep antibiotics or painkillers from prisoners and still call ourselves a compassionate, civilized society.
But I’m not persuaded that the Supreme Court intended to give violent criminals a claim equal to that of the rest of us on highly scarce medical resources like hearts, livers, lungs and kidneys, especially when the decision to save one person’s life with an organ transplant almost inevitably means that someone else will die. The unprecedented decision of the California Dept. of Corrections to give the convict a heart transplant evinced questionable legal judgment.
Moreover, that prisoner had been [twice] convicted of robbery. While not a capital crime, robbery implies at least the threat of injury or death to its victims if they don’t comply with the robber’s demands. In my view, those who deliberately threaten the lives of innocent persons thereby forfeit whatever moral claim they otherwise might have had to an organ transplant.
The question here is not whether the convict might one day become a "productive citizen," though we might certainly hope that his "change of heart" would be more than merely physical. It would be morally repugnant for society to allocate organs based on estimates of persons’ "social worth."
Further, we need to reform our justice system to minimize the chance of an innocent person being wrongly convicted of a violent crime and thus being denied an organ transplant.
In general, organs should be distributed according to 1) degree of need and 2) probability that the transplant will be successful. But unlike most other medical treatment decisions, those regarding organ transplants ought also to take into account 3) a history of violent crime. I think we can agree that if we knowingly commit such crimes and thus violate others’ basic rights not to be harmed or killed, we lose the right to an organ transplant when it could save the life of an innocent person.
Finally, we can help alleviate the dire scarcity of organs in concrete ways: increasing their supply by becoming organ donors and informing our families of that; and decreasing our demand for organs by living healthier lives—e.g., exercising, not smoking, and not drinking excessively. Let’s save organ transplants for nonviolent citizens who need them through no fault of their own.
This op-ed was published in the San Jose Mercury News on 31 January 2002 under the title, "Criminals Should Be Far Down on the Heart Transplant List."
David Perry was Director of Ethics Programs at the Markkula Center for Applied Ethics and Lecturer in Religious Studies, Santa Clara University. None of his views should be construed necessarily to reflect those of the Ethics Center or SCU.