Yes, People Who Do Bad Things Deserve Healthcare

So do people who make bad decisions

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This week saw a tremendous scientific breakthrough: A man in Maryland was the recipient of a successful heart transplant via genetically modified pig. The potential for organ donation is huge, and thousands of lives in the US alone could be saved by this groundbreaking innovation.

But David Bennett, the man who received the transplant, is now under wide scrutiny because of a terrible thing he did more than three decades ago.

In 1988, Bennett stabbed a young man seven times, permanently paralyzing him, after a getting angry with him at a bar. The victim, Edward Shumaker, died at the age of 40 of a stroke, after years of pain and trauma. Bennett was convicted and sentenced to 10 years in prison, of which he served six. Shumaker’s family successfully sued Bennett and were awarded $3.4 million, which the family says Bennett never paid.

Shumaker’s family is, understandably, horrified by the positive attention Bennett is getting for being the recipient of this transplant, and angry that he received the care he did.

Bennett “went on and lived a good life” after the attack, Shumaker’s older sister told the Washington Post. “Now he gets a second chance with a new heart — but I wish, in my opinion, it had gone to a deserving recipient.”

That’s a completely fair reaction, and one the family is justified in having. I question, though, why it merits a story in a major publication, especially when the point of the story seems to be that Bennett is perhaps not deserving of life-saving care because of his past bad acts. Two things can be true at once: That Shumaker’s family is entitled to their feelings of anger and sadness, and that Bennett’s criminal history, for which he served prison time, is irrelevant to this particular story, which is not about a heroic transplant recipient, but about a stunning medical innovation. And it’s also true that in telling stories through this frame — the bad, potentially undeserving recipient of expensive and life-saving medical care — the Post does a major disservice to the public, reinforcing ideas about deserving and undeserving patients and contributing to a generally punitive and retributive culture that is hurting all of us.

There are already common-sense and reasonable rules around who can receive a donor organ. An active alcoholic who refuses or cannot curb his drinking, for example, is not going to be a good candidate for a donor liver in a universe where the number of available donor organs is far lower than the number of patients in need. But doctors rightly don’t exclude very sick people from receiving organs based on prior bad acts, to themselves or to others. A person whose long past poor diet contributed to their heart problems should not be barred from receiving a heart. And a person who committed a terrible crime should not be, and is not, barred from receiving a life-saving transplant.

This issue is coming up at the moment in relation to Covid care. I’m as angry about anti-vaxxers as anyone, and deeply resent being stuck in a never-ending pandemic because of their selfishness. I understand the punitive impulse to say, ok, don’t get vaccinated, but then you don’t get to receive first-priority care in the hospital. The unvaccinated are disproportionately represented in the ranks of those needing serious interventions, including intubation and ICU care, and their decision to remain unvaccinated doesn’t just risk their own lives — it overwhelms hospitals and means that a lot of people who did get vaccinated but face other health problems aren’t able to get care when they need it, or get sub-standard care from overwhelmed institutions and stretched-too-thin staff. A lot of people have died or have had their lives shortened not because of Covid, but because they had the bad luck of needing care for something else in a Covid-overwhelmed health system. I understand the temptation to look at the unvaccinated, many of whom could have prevented their own hospitalizations, and say, fuck ‘em.

But I’m not sure we want to live in a society ruled by vengeance, or make policy based on (even well-earned) resentment. Human beings are fallible creatures. We make mistakes; we make piss-poor decisions and never correct or apologize for them; we act out of selfishness and ignorance and pique far more often than we like to admit. The logic of “you made your bed, now lie in it” is simply too easily applied to situations that you or I find abhorrent — for example, refusing women abortion care because they had sex without adequate protection and need to “take responsibility” for their actions, a common refrain from abortion opponents. Or putting an accident victim last in line for emergency care because she wasn’t wearing a seatbelt.

I suspect that these questions feel particularly acute in the US because of our combination of a punitive justice system and an expensive and predatory health care system. We live in a culture where all around us is the norm of punishing people harshly, and where even a lot of progressive people are quite comfortable with extremely harsh criminal sentences, including capital punishment and life sentences without the possibility of parole, for people whose criminal acts they find particularly egregious. And we live in a country where medical debt routinely bankrupts people, and good health care is a luxury product. I suspect that if we thought of health care as a basic right that everyone was entitled to and everyone had good and affordable access to, we wouldn’t be so upset that a “bad” person got a rare and lifesaving procedure. Because we don’t see it that way — because excellent health care is indeed rationed in the US — a lot of people see receiving a lifesaving heart transplant as something akin to being handed a Porsche: You’d better be deserving of this obscene luxury.

Maybe it’s this attitude that is, in part, keeping us trapped in a country that incarcerates so many and helps so few.

Better attitudes will not by themselves remake the American medical or criminal justice systems. But we’re never going to remake the American medical or criminal justice systems unless attitudes change — unless we shift away from the punitive and miserly and moralizing and toward something more generous, forgiving, and human.

xx Jill

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Photo by National Cancer Institute on Unsplash