Case 4: Organ Transplantation in Patient with Severe Depression

Case 4: Organ Transplantation in Patient with Severe Depression

Case 4: Organ Transplantation in Patient with Severe Depression

Mrs. White is a patient who has been detained in a psychiatric hospital on account of a severe depression which amounts to a mental illness. She also has failing kidneys and will die imminently in the absence of a transplant. Not surprisingly perhaps, Mrs. White won’t give her consent to the transplantation and she has also expressed the view that transplants are morally unacceptable. If a person has a severe depression, the decision he or she makes about life-saving treatment may not be a true decision but one that results from the illness. It could be that Mrs. White has not weighed factors that she would consider if mentally well, and so the balancing act that would normally be followed by a person weighing the risks and potential benefits of a transplant has been infected by the depressive illness. The doctor is unsure whether the decision to accept or reject a transplant belongs to Mrs. White and whether she is entitled to consider that the risks of the process do not outweigh the potential benefits.

Please discuss the alternatives and justify your answer. How would you approach the ethical questions?

1. Mrs. White should be given a life-saving transplant because there is a duty of care arising from the need to treat the depressive illness – if the refusal to accept the transplant is a symptom or consequence of the depressive illness, then the transplant may be seen as directly linked with the treatment for the mental illness given the importance of the issues involved (death if there is no transplant despite the intrusive nature of the operation).

2. As it is most important that there is a solid decision making procedure that allows the patient’s viewpoint to be represented, a court will be involved to make a final decision.

3. The refusal of Mrs. White is accepted because, even if the patient may not approach the matter by carrying out a cost-benefit analysis, she holds the view that transplants are wrong on moral grounds. If it is the patient’s lot to die, that is something the doctor should accept. The fact that the patient is mentally ill at the time he or she has to make the decision does not alter the starting point, namely the presumption that the person can make his or her own decision and that this decision should be accepted.