The US Health and Human Services Advisory Committee on Organ Transplantation is in the process of revising their current policies. Recognizing your prominence in field of bioethics, the Committee has requested your assistance with ranking groups of people for potential kidney, liver or lung transplants. The groups under consideration are Alcoholics, lifetime smokers, prisoners (outside of death row inmates) and illegal immigrants.

As you begin thinking of how you'll rank the groups consider these points:

Any alternatives that may be available and the relevant cost factors that might be associated with the fair allocation, under the bioethics principle of justice.

If you do not believe in ranking the individuals, consider what method you would find more agreeable for allocating the organs.
You must support your opinion with ethical justifications using any of the relevant principles of bioethics and any appropriate theories:

Utilitarianism - Ethical actions are right to the degree they promote overall happiness or pleasure (this is a metaphor for a good outcome). Utilitarians are concerned about the aggregate happiness (good outcomes or greatest amount of benefit) of all. John Stuart Mill was a 19th century proponent. This is a consequentialist theory - one makes ethical decisions based on the expected outcome.

Duty-based Ethics (Deontology) - Relies heavily on the work of Immanuel Kant and stresses doing one's duty and following rules. Deontologists stress adherence to principles rather than outcomes or consequences when determining the rightness of an ethical choice. W.D. Ross, another early deontologist, developed a version of deontology somewhat less absolutistic than Kant's. But, Ross felt that ethical decisions cannot be based on what is useful; they must be based on what is right. (Munson)

Virtue-based Ethics - Focuses on the goodness or badness of people's character rather than the rightness or wrongness of their actions. Aristotle felt we cannot achieve true happiness unless we use the capacity that distinguishes us from plants or animals. This capacity is the human ability to reason. Compliance alone is not enough; only continual striving to be a good human as well as a skilled professional is acceptable.

Natural Law-based Ethics - Law is the highest reason, implanted by nature, which commands what ought to be done and forbids the opposite (Munson). Nature (God) has hard wired us to live, to procreate, to love, to know and so forth. People defy nature when they choose death over life, childlessness over procreation, ignorance over knowledge, etc.

Rights-based Theories - All persons, it is assumed, have individual rights. According to George Annas, rights "..help people prevent people from being treated as interchangeable, inanimate objects...." Rights may be negative, rights to noninterference, like the right to refuse unwanted medical treatment. Positive rights might include the right to receive certain goods and/or services.

Care-based or Feminist Approaches to Ethics - Includes approaching ethics using values such as compassion, empathy, nurturance and kindness. Whether a health care professional is a man or a woman, they should not only be encouraged to act in a caring way, but also be respected for so acting (Tong).

There are, according to Beauchamp and Childress, four co-equal principles that govern health care ethics. These principles are non-maleficence, beneficience, autonomy and justice. They point out that non-malificence finds voice in the Hippocratic Oath, "at least do no harm.'

Principle of Non-maleficence - Also known as the Standard of Due Care - treating patients attentively and vigilantly so as to avoid mistakes - do no harm.

Principle of Beneficience - Patients want more than not to be harmed, they want to be benefitted. Paternalism can come into play here. "To act beneficently is to do for the patient the good the patient desires; to act paternalistically is to do for the patient the good the health care professional thinks the patient should desire." (Tong)

Principle of Autonomy - Munson tells us that we act autonomously when our actions are the outcome of our deliberations and choices. This includes the right to be informed about treatment options and the right to refuse treatments.

Principle of Justice - W e believe it is unjust to treat one person better or worse than another in similar circumstances (Tong). Rawls states that "rational persons want to live in just, rather than unjust societies. To allocate scarce medical resources to patients on the basis of social worth for example...... rather than on the basis of medical condition is more often than not wrong."

These short excerpts on theories and principles are taken from a number of sources including the following:

Beauchamp and Childress, Principles of Biomedical Ethics (sixth ed), New York: Oxford University Press.

Munson, R. Intervention and Reflection: Basic Issues in Bioethics (9th ed). New York: Wadsworth Concierge Learning.

Tong, R (2007), New Perspectives in Healthcare Ethics. Upper Saddle River, NJ: Pearson Education Inc.

250 word min.