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Demystifying Medicine One Month at a Time

Category: charity (page 2 of 2)

Mississippi Learning

Governor Haley Barbour of Mississippi recently suspended the life sentences of sisters Gladys and Jamie Scott on the condition that Gladys donate a kidney to her older sister Jamie, who has end-stage kidney failure and is dependent on dialysis treatment three times per week.

Gladys (36) and Jamie (38) Scott (photo: Guardian, UK)

The sisters served sixteen years of their life sentences, and had become a cause celebre in social justice circles (both the NAACP and the ACLU were involved in their petitions to overturn the sentences) for the harshness of their punishments. Their crime?

In 1994 they were convicted of being accomplices to an armed robbery that netted the main bandits $11 in cash, according to press reports.

Barbour is on record stating that he no longer felt the sisters were a danger to society. That and Jamie’s dialysis is costing the state prison system on the order of $200k per year.

In her petition for pardon, younger sister Gladys came up with the idea to donate one of her kidneys to her big sister. She was quoted as saying that she made the decision herself and would go through with it, pardon or no pardon. [The sisters were pointedly not pardoned; they merely had their sentences suspended. Their petition to seek pardons continues, with or without a transplant.]

The conditional release set off a furor in parts of the medical community, particularly the transplant and medical ethics sectors. The President of the American Society of Transplantation wrote a letter to Governor Barbour “respectfully requesting” him to de-link the kidney donation from the suspension of their sentences. The linkage gives the impression of a quid-pro-quo: “You donate your kidney, we’ll let you out of jail.” Such coercive tactics are not morally, ethically, or legally permitted in the United States, where the law of the land (NOTA, 1984) forbids commerce (or even ‘objects of value’) in exchange for organs.

I’ve thought about this story a lot; I concluded it would be fun and interesting to break down the plot and its meanings from all of the players’ perspectives:

Jamie Scott: I’m sick: Sick of being in jail for a pretty small crime, and sick from kidney disease. Did I mention sick of dialysis treatments? Verdict: Win-win: out of jail, and possibly a kidney which will be better treatment.

Gladys Scott: I’m happy to help my sister, jail or no jail. Governor wants me to donate as a condition of getting out, then so be it. I’d do it anyway. Verdict: win-win, doing a mitzvah, getting out of jail. Potential cost: donor surgery. Also, potential for re-incarceration if she doesn’t wind up donating, though pundits think that’s unlikely.

Governor Barbour: I’m letting these sisters out, which seems like the right thing. But I’m extracting the promise that one sister will donate to the other. This pleases my conservative constituencies. Verdict: win-win, he gets to placate both sides by his actions, and look fiscally prudent as well (the state will save the estimated $200k per year). The sisters promptly moved to Florida after their release, which will invoke federal and Florida money for their future health care needs.

Other patients awaiting kidney transplants: There’s hope that one day our country will increase the likelihood of someone donating to me by offering incentives to do so. Verdict: hung jury.

Other potential kidney donors: This lady got something in return for her kidney (her freedom). What will I get other than gratitude? Surely my kidney must have some market value? Maybe at least if I go through with this I could get my health care for life paid for? Verdict: double jeopardy.

The hospital where the proposed transplant may happen in the future: We’ll benefit from the media attention; we must be careful not to look like we condone the Governor’s quid-pro-quo appearing deal, and say the ‘right’ things. Verdict: win, with some downside potential.

Medical ethicists: This trade defies our current norms; there is a lot of debate in our community about compensating donors; most stakeholders remain resolutely opposed to compensating donors, though there seems to be a rising chorus of critics interested in changing these norms. Verdict: lose-lose, looking like sticks in the mud (implying that for principle Gladys should stay in jail), and having our values trampled by political (and medical/economic) opportunism.

What are your opinions on this story?

GlassHospital

Whither Charity Care?

The Illinois Supreme Court issued a fascinating ruling last week, upholding a decision to strip a downstate non-profit hospital chain of its tax-exempt status for failing to provide sufficient charity care to its patients.

Provena Covenant Medical Center is a chain of six Catholic hospitals. Provena will now in effect owe millions of dollars in property taxes having lost said tax-exempt status. USA Today ran both a story and an editorial on the decision. From the story:

The justices found that Provena Covenant is not a charitable organization because the vast bulk of its income comes from charging for medical services, not from charitable donations; because it didn’t dispense charity care to all who needed and applied for it; and because it placed obstacles in the way of those seeking charity by not advertising its charity program while aggressively pursuing unpaid bills.

The justices also found the hospital’s campus was not used for charitable purposes because both the number of patients and the dollar value of the free care those patients received were minuscule compared to the hospital’s revenues and patient population.

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Peace In

So, I haven’t used this blog to shill products. Me, my writing, my ideas–sure.

Here’s an idea that’s so good I can’t resist passing it on:

Peace Care.

Remember the Peace Corps?  Started by JFK and now in its 50th year, thousands of Americans have volunteered for stints of two to three years in 139 different countries.

Arguably, there has been no greater dissemination of American know-how and values to the world than from our Peace Corps volunteers.  In an era of rampant anti-Americanism in the Muslim world, Peace Care is an idea that makes sense no matter where you find yourself on the political spectrum.

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An Uncomfortable Question

Like most people, I’ve found the news and images coming from Haiti in the aftermath of the January ’10 earthquake appalling and upsetting.

The sheer amount of devastation and orders of magnitude loss of life make the story compelling by itself.  Coupled on top of Haiti’s ignominious history, the situation touches us for its Job-like quality:  “How much misery can one people withstand?”

I’ve been pleased at the outpouring of support for Haiti.  Part of me feared a sense of ‘crisis fatigue’ after the pacific tsunami and Hurricane Katrina, in addition to the fact that our economy is so weak.  And, let’s be honest–Haitians are very much ‘others’–darker skinned, with a French-sounding language that likely doesn’t play well in more conservative/isolationist quarters of the U.S.

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