Expecting Doctors to Do It All
 

An acquaintance of mine has pretty much destroyed his liver at the age of only 26 and will die unless he gets a liver transplant. Meanwhile he's said to be taking a medication that costs around $10,000 a month (could this be anywhere near a proper figure?) and which he will have to continue taking for the rest of his "life" unless he gets a liver transplant. I am concerned that he is said not to have developed any plan to achieve sobriety nor has he tried AA. If so he may be expecting the doctors to do it all. If this is accurate it raises serious ethical problems, particularly since the cost of treatment is coming out of "medicaid" public funds.

W.

Your friend can not and will not receive a transplant if he continues to drink. I'm unsure of his mind-frame or commitment to sobriety, but his doctors will know if he continues. I will tell you that from a Healthcare perspective liver failure is not easy or pretty to watch someone go through. Try to be there for him as much as you can, do not be surprised if he doesn't seem able to grasp the complete scope of his problems because when your liver starts to fail you have more and more toxins in your blood which confuses the patient, irritates the patient and can at times cause them to become violent.
There is no ethical problem here, we as a nation take care of these people and could have possible helped him sooner if we had a better mental heath system. Hope this helps and best of luck to your friend.
PS. He may not need AA for recovery. The threat of death may be all the motivation he needs.

I don't think the hospital can do a transplant unless they have proof positive that he is no longer drinking and abstains for at least 6 months. For those who have severe cirrhosis or other liver damage, there is very little chance of surviving six months from being diagnosed as requiring a transplant. Of those who do receive a transplant, the prognosis is very good.

It is very controversial. The recipient has to also be healthy enough to withstand the transplant (heart, lungs etc) and go through lifestyle changes, psych exams etc.

The others are right if he keeps drinking the doctors will not give him a new liver to damage while others who are not drinking continue to wait. I have a bad liver, but not to that extent, but I continued to drink for years after doctors warnings, because I thought oh well the damage is done. It is a hard mind set to get out of, but maybe if you and others he loved sat down with him, and explained that he is killing himself and ruining his chance for a better life you could change his mind. Best of luck to both of you.

Unfortunately he's the only one who can change the situation. No matter what, if he keeps drinking he is a burden socially, financially and physically to those around him. And unfortunately addiction really doesn't care about ethics or the cost of treatment.

I'd try to help him if I could but he lives in a distant state and is the son of a woman whom I used to know years ago. I have only met him once. I am unsure that a liver transplant would be justified merely because a person has not "continued to drink" (i.e. is not currently drinking). If a person does not have a plan or would not consider AA (a real option although not necessarily a "must"- I doubt it proper to rule it out) then to me at least this casts doubt on the propriety of using public funds to medicate or otherwise treat a patient. Without a plan or a firm commitment, there is a high probability of relapse and the future is uncertain. The ethical issue is to me at least a real one.

W.

I'm sorry for your friend wpainterw

D

The title of the thread is telling. We in the West expect medical miracles on demand, and some would say we're happy to offload personal responsibility for our health onto them. Except in rare cases (often emergency medicine) we have more say in our health than doctors. We're capable of doing far more damage to ourselves than any doctor could ever hope to fix.

I hope your friend will change his ways. It's sad to see someone so young dying of self inflicted wounds, especially when they don't really understand what they're doing.