As the Assistant Controller, you have struggled to balance the books at the hospital where you work. Your employer is a tax-exempt, nonprofit hospital that has a superb emergency room and offers free preventative health care to the low-income community it serves. However, by caring for a large number of uninsured patients, the hospital finds it very difficult to generate sufficient fees to cover its costs. Nurses already work for 20% less pay than they could earn at nearby hospitals, and the hospital can barely afford a badly needed paint job for its hall- ways.
To help remedy this problem, you have pre- pared the following proposal for the upcoming Board of Directors’ meeting:
PLAN NUMBER 1: The hospital will hire a top kidney transplant surgeon and begin performing kidney transplants. To ensure that the hospital has an adequate supply of kidneys, the hospital will pay donors up to $8,000 for a kidney. According to your budget, the hospital will be able to charge wealthy patients over $100,000 per kidney, plus also bill at premium rates for its medical staff and facilities. Based on your research, your hospital will be the only one in the area that allocates kidneys based on a patient’s ability to pay rather than based on a waiting list or the severity of a patient’s medical needs.
PLAN NUMBER 2: The hospital will set up a website that will allow potential kidney donors to directly auction their kidney to the highest bidder. The hospital will simply charge a 10% service fee. An Internet company that resells tickets to sporting events online already has “auction software” that can be readily adapted to sales of human organs and is willing to provide technical advice for this endeavor at a nominal fee.
PLAN NUMBER 3: As a condition of providing free emergency room care, uninsured patients will be required to sign an organ donor card. According to the hospital’s outside lawyers, this card will create an enforceable promise that will result in uninsured patients donating their organs to the hospital when they one day die. In defense of this plan, you note that most patients are cremated, which results in their organs going unused by others who could have benefited from their trans- plantation.
PLAN NUMBER 4: Organs harvested from deceased patients will be offered at no charge to wealthy contributors to the hospital’s charitable foundation. Although the hospital will not directly charge for the organs, you forecast that many wealthy individuals in the community will be enticed to become charitable benefactors to gain priority access to this donor waiting list.
a. How would a utilitarian evaluate these proposals?
b. How would a deontologist evaluate these proposals?