The Delilah Saunders liver transplant case

The story of Delilah Saunders has been in the news lately. Ms. Saunders is seeking a liver transplant, but cannot get on the waiting list due to a "six-month clean" policy which Ms. Saunders is apparently not compliant with from the news reports.

Saunders supporters are expressing frustration with the policy. Some might think the six-month clean policy is unfair. The liver transplant policy is based on objective criteria, and it applies equally to all. Thus the policy is certainly fair.

Some supporters believe that the six-month clean rule is wrong. Well health care is the provinces responsibility under the constitution. It's for the Minister of Health to establish a liver transplant waiting list policy, and review or revise the policy as he sees fit. Thus the policy as it exists is right per the authority of the Minister of Health.

It would be unethical for the policy to be changed at this point in order to favour one individual, Ms. Saunders, and necessarily bump someone else further down, or effectively off the list (if they die before getting a live transplant). The thing is, erasing the six-month clean rule wouldn't particularly help Saunders. After all everyone else currently shut out of the liver transplant program under six-month clean, however many dozens or hundreds or whatever, would then immediately have precedence over Saunders. These other excludeds have been "waiting" outside the program earlier, perhaps attempting to comply with six-months clean, to become eligible to be on the transplant list.

So the only way waiving six-month clean would help Saunders would be if it was waived for Saunders only, telling the others currently on the outside to go home and get sober for six months while Saunders gets on the list now without having to meet the sobriety requirement. Is that fair or ethical?

One point made in the media by Saunders supporters is the "multiple traumas she has suffered in her life". So yes Saunders has a sympathetic hard-luck story. I will confidently believe that everyone on the liver transplant list, or around the list in six-months clean limbo, can tell a hard-luck story in addition to facing liver failure. So we don't know who, like Saunders, has the most hard-luck story to tell. There seems no obvious way to objectively measure it or use it to prioritize the waiting list.

Basically what Saunders supporters are seeking is for the policy to be set aside in this one case in order to favour a specific individual. Let's follow that through to its logical conclusion. Suppose the policy as it exists is struck entirely and there is no specific policy to get on the liver transplant list, or to move up or down in priority once on the list. What would happen is the list would become based on

• political connections
• money
• bribes and corruption
• access to mass media (Delilah Saunders)
• ability to present a hard-luck story in the press, while ignoring other hard-luck stories (Saunders)
• supporters being able to mobilize campaigns in social media, and public demonstrations (Saunders)