As the prison population in America grows in numbers and increases in age, questions and debates about the allocation of medical resources to prisoners will grow in urgency. One issue which arises every so often is whether convicted felons, especially those who are awaiting capital punishment, should receive the same level of medical care as others in society – including scarce donor organs for the purpose of transplantation. As is often the case, the debate over whether a death row inmate should receive an organ transplant is not a single controversy, but rather several rolled into one.
Being able to address the larger question requires disentangling the smaller questions and examining each in turn. What role, if any, should a person’s social and moral worth play in the allocation of medical resources? Are prisoners still members of society, deserving of the same medical considerations as others? An important consideration which must be explained before any such questions can be answered is the distinction between medical justice and social justice.
The sphere of medical justice involves the decisions doctors must make about providing medical care to those in need, while the sphere of social justice involves the allocation of resources by society those those in need. For doctors, medical justice makes answering the above questions relatively straightforward: they are obligated to provide medical care to those in need regardless of moral worth, dollar costs, or social status. Thus, doctors are ideally obligated by medical justice to provide the same level of medical care to other human beings regardless of any non-medical considerations.
Social justice, however, requires different conclusions because society is required to make decisions that do include non-medical considerations. This means that while medical justice may require a question be answered one way, the larger sphere of social justice could lead to a different answer entirely. Should a person’s social and moral worth play a role when it comes to allocation of medical resources? This tends to be one of the most contentious issues in the debate over the provision of expensive medical care to prisoners.
Those who object rely heavily upon the visceral argument that these prisoners have committed heinous acts and therefore no longer deserve to get the sort of medical care which is unavailable to poor, law-abiding citizens. From a purely medical perspective, however, this is not a valid argument. Doctors are committed to providing the best possible medical care to all human beings, regardless of any personal opinions about their patients’ moral and social worth.
Doctors in the military, for example, are obligated to provide the same treatment to captured prisoners who may have been responsible for the wounds on less seriously injured soldiers who are comrades of the doctors and who are still waiting their turn for medical attention. Any other standard of care would be dangerous. We certainly wouldn’t want doctors to start using their personal prejudices as the criteria by which they decide what sort of medical treatment will be received by whom. Who wants their doctor to start deciding that this or that patient has less moral or social “worth” and hence deserves less than her best efforts at care?
But can society at large make decisions about who can receive what sort of medical treatments based upon judgments of their moral or social worth? Society certainly needs to be able to decide how to allocate scarce resources and differences in “worth” are perhaps as valid as any other criteria. On the other hand, decisions about the “worth” of other human beings is still a difficult ground to tread safely. Most societies have, at best, a mediocre track record when it comes to evaluating the worth of minorities, for example.
Closely related to the question of prisoners’ social and moral worth is their status as citizens of the community and of the nation. Whereas the previous question focused upon prisoners’ moral status and whether they deserve the same moral and ethical considerations, this one changes matters slightly to focus instead upon their legal status and whether they deserve the same legal rights and considerations. This represents an important shift because it eliminates many of the potential problems and dangers inherent in assessing the social and moral worth of other human beings.
There is a long-recognized legal principle that while people who are not members of a community may deserve certain basic rights and privileges, they do not necessarily deserve all of the rights and privileges accorded to members. Thus, non-members have rights to life, liberty, free speech, etc. , but they do not have the right to vote. There is very little debate over whether this principle is valid in general, but there is quite a bit of debate over just what qualifies as basic, minimum rights and privileges which everyone should have, regardless of their membership or citizenship status.
This is especially true when it comes to health care because there is such a wide range of possible treatments available to people. Should prisoners receive only the very minimum necessary to keep them comfortable? Should expensive diagnostic and treatment options be made available to them? Where exactly should the line be drawn? If a prisoner does receive a lower standard of medical treatment and is later found to be innocent, what sort of responsibility do the state and society bear if he now leaves prison sicker than when he entered?
Most people would balk at providing no more than the absolute bare minimum, but they would also balk at providing access to the absolute latest and best which remain unavailable to the nation’s poor. One of the most popular arguments against providing extensive medical care to prisoners involves cost: they have already taken away so much from society through their crimes, so why should we continue to aid them by spending huge amounts of money on expensive medical care that even poor people who obey the law cannot receive?
This is a very appealing argument, especially in economically troubled times. It is also, however, often a bad argument. For one thing, while it may sound reasonable to object to prisoners receiving better medical care in prison than so many receive on the outside, it doesn’t necessarily follow that prisoners’ access to medical care should therefore be restricted. Instead, it can just as easily serve as a reason to expand others’ access to medical care so that it is at least as good if not better.
Another problem with this argument is that it is so often very short sighted. For example, when the possibility of a prisoner receiving an organ transplant is brought up, detractors are quick to point out the high costs associated with such a procedure. What they fail to note, however, is that continued treatment without the procedure often costs even more. If money is the only issue, then an organ transplant is often the best option we have. An important issue which has only been hinted at so far involves how medical resources should be allocated in the first place.
Some medical resources are plentiful while others are relatively scarce, and it would be reasonable to insist on different standards depending on just how scarce something really is. When it comes to medical treatments which are based primarily upon the actions of doctors – like basic surgeries – we are not talking about “scarce” resources. There is a great deal of available “doctor time” and there is no reason to institute strict standards as to who is allowed to see doctors and who is not.
On the other hand, expensive medical treatments may be considered “scarce” because they use up a finite amount of money. Even more justifiably labeled “scarce” would be donor organs – many people die every year while waiting for one of the few precious organs that are donated. Doctors should have a say in who should receive what resources based upon medical criteria, but doctors alone cannot make these decisions. Medical resources are supposed to be there for everyone; as a consequence, society as a whole must be prepared to make difficult decisions with regards to how the resources are used.
This is where medical justice becomes modified by social justice: although medical justice might be inclined to favor decisions made upon nothing more than medical concerns, social justice can dictate that resources be allocated based upon entirely different criteria. So, should prisoners receive organ transplants at public expense, even as law-abiding citizens go without and possibly die while waiting for scarce donor organs? Although the above helps to explain the ethical and legal terrain of this issue, it doesn’t allow us to make any easy and obvious decisions.
The arguments against providing quality medical care to prisoners may have a great deal of emotional appeal, but their logical and social basis are generally very poor. This is especially true because the health and welfare of prisoners are the responsibility of the state in a way unlike that of any other human beings – and a state presuming to keep people locked up as a matter of justice must also show justice towards them by meeting that responsibility adequately.
On the other hand, there are very scarce medical resources which cannot be made available to absolutely everyone in society. Even when we eliminate those who cannot be eligible for medical reasons (and that would generally include those on death row, considering their shortened life expectancy), there still isn’t enough to go around – with donor organs probably being the biggest example. Therefore, non-medical standards have to be taken into account when allocating these treatments. Perhaps being an incarcerated felon is a valid reason to be moved further down the list of candidates.