Question

Consider the following case: Blocking Transplant for an HMO Patient with Liver Cancer [Taken from Veatch, et. al. 2015. Case Studies in Biomedical Ethics. Oxford University Press, pages 78-79.] Rafael Villanueva was a 38-year-old venture capitalist with a serious liver problem. He had been diagnosed with a primary tumor of the liver at the health maintenance organization (HMO) where he was a member. Mr. Villanueva had been asymptomatic during the early stages of the tumor's development. When he was diagnosed the tumor had grown to 5 cm in diameter, which meant it had developed to the point that it was beginning to pose a serious risk of metastasis or, in other words, spreading throughout his body. He was informed by his HMO hepatologist, Dr. Edwards, that the only possible therapy was a liver transplant, but given the size of the tumor it was not medically appropriate. Dr. Edwards had researched the options. He discovered that the liver transplant center with which the HMO had a contract would not accept patients once the tumor size had reached 5 cm. They reasoned that the chances of metastatic disease were sufficiently great that the transplant was unlikely to succeed. On that basis, Dr. Edwards had told his patient that the transplant was not medically indicated. Mr. Villanueva gradually realized that this was a death sentence. The liver cancer would continue to develop until it took his life. He began researching the treatment options. He had amassed a sizable estate and traveled internationally reviewing start-up enterprises in which he could invest. He discovered that there was general agreement in the transplant world that liver grafts should not be attempted once the tumor had reached this size but that two centers in the United States and one in Sweden were performing transplants on an experimental basis. On the basis of this discovery Mr. Villanueva returned to his HMO and asked if he could once again be considered, given the fact that death was the certain alternative. he expressed concern that his wife and small child would be left without a father and income provider, should he die. When Dr. Edwards again refused to recommend him for transplant, Mr. Villanueva discovered that he could appeal his clinician's decision. The case was appealed to the medical director, the final HMO authority in such cases. The medical director, Dr. Florence Cunningham, received Mr. Villanueva's appeal. After a week to investigate the facts, she again denied his request, citing both the clinical judgment that the transplant was not medically appropriate and the fact that one-year cancer-free survival following transplant in the programs doing experimental grafts for primary liver tumors was only 5-15 percent. If the tumor has not metastasized, the transplant will remove the cancer, but in most cases cancer cells will already have migrated beyond the liver. She also noted that livers for transplant were very scarce, life-saving resources and should not be used for patients who have such a small chance of successful transplant. Q: Would a utilitarian agree with Dr. Edwards and Dr. Cunningham? Explain your answer.

Answer 1

I think his family members will agree with Dr.Edwards and Dr Cunningham knowing the fact that cancer had already expanded to other parts of the body too. Even the liver transplantation can not save Villanueva from this case study. Physicians will have to consider all the factors before the final decision. This is what  Dr.Edwards and Dr Cunningham had done exactly. They would have recommended the liver transplantation if the tumor was in the primary stage. Since the livers for transplantation are very difficult to get, they will not advise the transplantation why because it can be useful for another patient who has more chances to survive.