Some years ago my father had a coronary bypass operation for heart disease. The first question the surgeon asked when assessing him was, "How old is your youngest child?" The unstated message was that patients with young families to care for would get priority. My father, who then had a nine-year-old daughter, got his operation in four weeks although he had been told the waiting list was four months.
That seemed to me then - in1981 - and seems to me now a humane way to proceed. Of course I am biased. For all I know someone else on the waiting list died because the surgeon, the most eminent in his field at the time, helped my father to jump the queue.
Michelle Paul, the 15-year-old Aberdeen girl who suffered liver failure after taking half an Ecstasy tablet, was denied a liver transplant because someone else was judged to be in greater need. Yesterday, Aberdeen's Sheriff's court ruled that the decision was made on medical, not moral, grounds. The transplant surgeon, Dr Hilary Sanfey, and her colleagues at Edinburgh Royal Infirmary had told the court that Michelle had suffered irreversible brain damage. But Dr Sanfey admitted that social problems such as drug taking had to be taken into account when considering which patients were suitable for transplant. Success is not achieved when the transplanted patient, with newly inserted organ, is discharged from hospital. There follows a strict lifelong regime of drugs and medical tests that must be followed rigorously if the organ is to last. Doctors have to make a judgement about whether the patient is capable of following such a regime. Is that a medical or a moral decision? There is intense debate about these matters within transplant units - and beyond them. Sir David Carter, the chief medical officer of Scotland and former director of the liver unit at Edinburgh Royal Infirmary to which Michelle Paul was admitted, said last year that a background of drug or alcohol abuse in a patient "coloured the thinking" of surgeons assessing them. Alcoholics would be required to stop drinking for at least six months before their case for a transplant would be considered, he said. Sir David was asked if this did not amount to playing God. His response was instructive: "I think that's inevitable if you practise medicine. We are making clinical decisions that affect life and death all the time. Part of the calculation of risks and benefits involves the setting to which the patient returns and the ability they have to cope medically and socially with the pressures." Few doctors are prepared to speak as frankly as Sir David but all know that social judgements frequently intrude into medical decisions. …