Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list

Abstract

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed.

Transplantation for Alcoholic Hepatitis: Are We Achieving Justice and Utility?

“…“Luck egalitarianism” is a recent philosophical concept that attempts to define what many of us do unconsciously: namely, defining a role for personal responsibility in distributive justice in which equality is valued but not paramount. Albertsen, in his adaptation of this concept to organ allocation for patients with alcohol use disorders, explains that it “assesses distributions as just if, and only if, people’s relative positions reflect their exercises of responsibility.” Hence, luck egalitarianism recognizes individual behavior matters but appreciates that some are born or happen into “luckier” circumstances than others, and therefore behavior must be judged in a social context. Finally, we note that although the term “fairness” is sometimes equated to justice, it lacks precision.…”

Transplante de fígado e alocação dos órgãos no Brasil: entre Rawls e o utilitarismo

“…Pode se estar utilizando a aplicação do princípio de "dar a cada um conforme seus méritos", priorizando conforme a responsabilidade pessoal pelo autocuidado, priorizando doentes que "não contribuíram" para a sua doença. O critério da responsabilização pelo autocuidado é altamente discutível para utilização na saúde 37 , embora Albertsen 38 , por exemplo, considere que a responsabilização individual, no caso do consumo de álcool por hepatopatas, pode ser harmonizada com a justiça distributiva. Dessa forma, indivíduos com consumo ativo de álcool perderiam pontos frente a outros candidatos, uma teoria conhecida como luck egalitarianism 38 .…”

“…O critério da responsabilização pelo autocuidado é altamente discutível para utilização na saúde 37 , embora Albertsen 38 , por exemplo, considere que a responsabilização individual, no caso do consumo de álcool por hepatopatas, pode ser harmonizada com a justiça distributiva. Dessa forma, indivíduos com consumo ativo de álcool perderiam pontos frente a outros candidatos, uma teoria conhecida como luck egalitarianism 38 . Cabe ressaltar que, mesmo na ausência de uma discussão filosófica mais ampla, isso já ocorre, pois somente indivíduos abstêmios por três a seis meses são habitualmente listados para transplante hepático.…”

How Should Lungs Be Allocated for Transplant?

“…The ethical dilemma relates to the role of personal responsibility in distributive justice. 51 Should duration of abstinence factor into allocating scarce organs for transplant? Few programs would offer a lung transplant to a current smoker.…”