Demystifying Medicine One Month at a Time

Tag: Mississippi

The Twenty-Two Percent

I live in Oklahoma, a state that ranks near the bottom in many leading health indicators.

mississippi-welcomeThe joke around here that’s often heard is “Thank God for Mississippi,” which is dead last.

Politico Magazine featured a recent photo essay about Mississippi, which is compelling and sad.

Twenty-two percent of Mississippians live in poverty. Despite that, it’s a state that did not expand its Medicaid pool (i.e. declined the federal dollars under Obamacare) so that an opportunity to provide health coverage to more than a hundred thousand people has yet to be realized. After last year’s first-ever Obamacare enrollment, only one state saw its number of uninsured increase: Mississippi.

Click here to take yourself through the photos and educate yourself about a place that odds say you’ve never visited.

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?


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