HEARTS OF THE CITY: Exploring attitudes and issues behind the news.

A rotating panel of experts from the worlds of philosophy, psychology and religion offer their perspectives on the dilemmas that come with living in Southern California.

Today’s question: Given the shortage of donor organs, is it ethical to give a transplant to an individual whose organ was destroyed by his or her behavior--such as alcoholic cirrhosis--or to the very elderly?

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Rabbi Elliott N. Dorff

Rector and professor of philosophy at the University of Judaism

“Moral decisions about distribution assume scarcity; if there were an unlimited supply of ‘x,’ everyone could get one. The severe shortage of organs, though, forces us to make hard decisions about who should get the ones available. For Judaism, those who can most benefit medically from a procedure should be the first to receive it, and then all others should be treated on a first-come, first-served basis. Since the chances of success for the transplantation itself and for sustained use of the organ are greater in young people and in those who have not abused their own organs, it is appropriate to prefer such recipients in the order of triage.”

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Dr. Hassan Hathout

Physician and author of books on biomedical and social ethics from an Islamic viewpoint

“Treatment is the right of all, but when there is a shortage, competition is inevitable and some priorities should be set. In this respect perhaps the easiest to exclude is the patient whose illness was caused by his/her own indulgences and lifestyle. It is fair that individuals should bear the consequences of their own actions, and it would be unethical to allow them to displace the others. As for the age factor, there is room to consider other aspects, including the prognosis. As a generalization, however, it is a better utilization of a donated organ to be used to save an expectedly longer life than a shorter one.”

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Sharon Presley

Executive director of Resources for Independent Thinking, a nonpartisan, nonprofit educational organization in Oakland

“Physicians have always made difficult choices. Should we also demand that their choices be based on judgments about whether a person’s behavior is ‘acceptable’ rather than on what is medically possible? Should we discount someone’s life simply because they are old? Are these choices more ethical? And who is to decide whose lives are most important? The state? This strikes me as a potential path to Big Brother. Let’s focus on finding ways to increase the number of organ donors rather than on proscribing who may be recipients.”

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Compiled by LARRY B. STAMMER / Los Angeles Times