Individuals with alcohol-related end-stage liver disease should be given lower priority for liver transplants compared to those who develop end-stage liver disease from other factors (congenital biliary disease, congenital polycystic liver disease).
The selection process of prospective cancer patients for the transplant should be based on the parameters of disease chronicity and not over the social preferences, gender, race, sexual orientation or ethnicity preference.
Description of the ethical issue
Two conflicting ethical principle that comes under consideration in this case is beneficence and non-malfeasance (Mikesell, Bromley & Khodyakov, 2013). The principal of beneficence (doing good) stands for the proposition that it is the duty of the healthcare professionals to do good for their patients. This is regarded as the foundational principle of medical science which finds its roots in Hippocrates. The act of beneficence is often co-related with the term non-malfeasance which relates with the Hippocratic duty of “do not harm”. The dichotomy in between these two ethical principles leads to the foundation of the benefit/risk analysis (Bastable, 2003). In this case individuals with alcohol related end stage liver disease may remain at a high risk of fatal threat as he or she might indulge in alcohol consumption even after the liver transplant thus making the entire strenuous liver transplant process futile (Lucey, 2014; Addolorato et al., 2013). In order to make good use of the liver, it is better to transplant the same to the end-stage liver disease patients with congenital polycystic liver disease or congenital biliary disease. However, this negligence of the alcohol intoxicated patients in terms potential selection for liver transplant goes against the ethical rule of non-malfeasance which vouch for “do not harm”. Because giving preference of congenital end stage liver cancer patients over alcohol intoxicated patients in liver transplant may in turn harm the alcohol intoxicated end stage liver cancer patients (Mikesell, Bromley & Khodyakov, 2013).
Importance of Ethical Issues
The ethical issue is important both from the perspectives of a healthcare professionals and the patients. From the perspective of the health care professionals it can be said that the concept of non-malfeasance is the ethical fabric or legal determinants the covers both negligence and malpractice. Any form of negligence is characterised as lack of observance of the professional code of conduct (Bastable, 2003). From the perspective of the patients it can be said that it is the duty of the healthcare professionals to do justice while procuring healthcare (Bastable, 2003). Here justice means equal distribution of healthcare services. So it is the ethical right of both the alcohol-related end stage patients and congenital biliary related end-stage patient to receive equal level of quality care when it comes for liver transplant.
Race, gender, sexual orientation etc and their relevance on ethical issue
Provision in quality care is the prime focus in the health care practise that deals with equality in healthcare, thus going with the ethical duty of “justice”. Thus during the process of liver transplant among the end stage cancer patient, the selection process should be based on the parameter of disease chronicity and not over the social preferences, gender, race, sexual orientation or ethnicity preference. In majority of the cases, the alcoholic patients are looked down upon or are socially excluded and hence giving rise to the stigma of discrimination. However, this goes both against the ethical principle of egalitarianism/ justice for all and professional code of conduct for Canadian nurses that supports fairness in health care approach (Canadian Nursing Association, 2017).
Addressing the Issue
The end stage liver cancer patients should be given preference in terms of liver transplant based on the mortality and morbidity chances. Moreover, according to the reports published by Addolorato et al., (2013), presence of Alcohol Addiction Unit (AAU), inside the liver transplant centre helps in the reduction of the threat of the alcohol recidivism after the process of liver transplant.
Addolorato, G., Mirijello, A., Leggio, L., Ferrulli, A., D'angelo, C., Vassallo, G., ... & Gasbarrini, A. (2013). Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcoholism: Clinical and Experimental Research, 37(9), 1601-1608.
Bastable, S. B. (2003). Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.
Code of Ethics For Registered Nurses. (2017). Cna-aiic.ca. Retrieved 26 February 2018, from
Lucey, M. R. (2014). Liver transplantation for alcoholic liver disease. Nature Reviews Gastroenterology and Hepatology, 11(5), 300.
Mikesell, L., Bromley, E., & Khodyakov, D. (2013). Ethical community-engaged research: a literature review. American journal of public health, 103(12), e7-e14.