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It is not ethical to deny a person an organ transplant if they are a current smoker. The risks do not outweigh the benefits. Although available organs for transplant are scarce, a person who smokes should not be denied a life-saving procedure. The intent of this paper is to provide ethical reasoning, which is in favor of providing organ transplants for people who smoke. According to Butts and Rich (2020), An ethical dilemma is a situation in which an individual is compelled to choose between two actions that will affect the welfare of a sentient being and both actions are reasonably justified as being good, or the goodness of the actions is uncertain. One action must be chosen, thereby generating a quandary for the person or group who is burdened with the choice (p. 46).
Transplant teams are often left having to deny people in need of an organ transplant due to their smoking addiction. Denying care based on addiction is an unethical outcome, which affects a patients quality of life. Beauchamp and Childress (2019) share a set of actions, which are the basis for an autonomous decision by the patient. It involves a patient who acts intentionally, with understanding, and without any outside influence. When considering an organ transplant for a smoker, the physician must provide education on smoking cessation and the possible outcome of the transplant for a patient who fails to quit smoking. This provides the patient with the knowledge needed to decide on this procedure. Although a patient may fail to stop smoking, it is still the responsibility of the physician to provide a way for the patient to obtain an organ transplant. The American Medical Association (2003) states a physician must commit to relieving suffering and prolonging life. If the rights and duties of the physician and the patient conflict, a patients interests should take precedence. A patient in need of an organ transplant should be the priority of the physician, regardless of the patients lifestyle choices. When a patient decides to continue their smoking habit, the physician is obligated to respect their wishes and provide any treatment necessary to enhance their quality of life.
When a physician discriminates against a patient who smokes, they demonstrate a lack of respect for the patients autonomy. According to Senderovich (2016) What many do not realize is that physicians are not legally allowed to pose ultimatums for their patients who do not refrain from smoking, since their patient has the human right to autonomy (p.5). Denying a patient an organ transplant directly violates a patients right to autonomy. Discrimination based on addiction has no place in health care. It penalizes a patient based on a social characteristic, which is against a physicians code of ethics. According to Springer (2013) The World Health Organization states: donated organs should be made available to patients on the basis of need and not on the basis of financial or other considerations Thus discrimination based on behavior is not considered a factor of allocation (p. 6). When a health care organization chooses not to hold a smoking addiction against a patient, it allows the patient to receive a high standard of care. If a patient wishes to be an organ recipient, this decision should be respected based on nonmaleficence.
Beauchamp and Childress (2013) state Nonmaleficence requires intentional avoidance of actions that cause harm (p. 152). When a physician denies an organ transplant because of smoking history, they are intentionally causing harm to a patient. For example, a person in need of a lung transplant experiences many symptoms which decrease their quality of life. They would experience respiratory or ventilatory failure, which may lead to hypercarbia, hypoventilation, and hypoxemia. High levels of carbon dioxide cause acidemia, and acidemia leads to lethargy, drowsiness, coma, and death. These symptoms of a patients disease significantly inhibit a patient from having a decent quality of life. If a physician makes the decision to withhold an organ transplant to a patient in a circumstance such as this, they are failing to display nonmaleficence and harming their patient. Nonmaleficence is critical for a physician to display in their character. In order to display nonmaleficence, a physician must be willing to do no harm to their patient.
The outcome of smoking before a surgical procedure differs between patients. According to a study regarding thoracic surgery by Barrera et al. (2005), there is no difference in pulmonary complications between patients who are currently smoking and those who recently quit smoking cigarettes leading up to a surgical procedure. Due to a lack of differences between current and past smokers, it is unethical to deny a patient an organ transplant based on their smoking history. It is the right of the patient for autonomy regarding their medical decisions; therefore, if it is the patients desire to be a transplant recipient, they should receive one.
There are several people in this situation who could be directly affected by the outcome. Patients who continue smoking are most at risk to face a smoking-related complication post-transplant surgery. According to Bottorff, Seaton, and Lamont (2015), there is an increased risk of infection, delayed healing, prolonged intubations, and morbidity. It is the responsibility of the physician to disclose and discuss any possible outcomes following an organ transplant, but it is not their responsibility to decide whether they are worthy of receiving an organ due to their addiction to nicotine. For this reason, the medical institution and its staff are also stakeholders. This includes physicians, nurses, therapists, social workers, and case managers.
According to the Mayo Clinic Staff (2019), one of the factors that affect a persons ability to be an organ transplant recipient is if they can not stop smoking. This is an issue because if a person can not stop smoking, they may not be able to keep their donated organ healthy. The policies vary, but in general, most patients must abstain from smoking for at least 6 months leading up to an organ transplant.
If a patient is competent and of legal age, it is always their right to receive the type of medical care they desire. It is an ethical dilemma when a physician starts to deny medical treatment based on an addiction to nicotine. Denial of an organ transplant to current and former smokers is discrimination. This type of discrimination has no place in health care. A person in need of an organ transplant is on the list because they will die without one. When a physician decides a person doesnt deserve to live because of a specific behavioral characteristic, it goes against the belief that a physician should do no harm.
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