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Sunday, March 25, 2012

Cardiologists as Ethicists: On Cheney’s Heart Transplant

The Huffington Post reports that “(f)ormer Vice President Dick Cheney had a heart transplant [on March 24, 2012], after five heart attacks over the past 25 years and countless medical procedures to keep him going. Cheney, 71, waited nearly two years for his new heart, the gift of an unknown donor.” At the time, more than 3,100 Americans were on the states’ waiting list for a heart. Of the roughly 2,300 heart transplants performed in 2011, 332 were over sixty-five. On average, heart failure was killing 57,000 Americans a year at the time, so just a fraction of those who could use a heart get one. One might question, therefore, whether the 332 recipients who were over 65, and Cheney, who was 71, should have been allowed to avail themselves of the relatively short supply of available hearts.

                                   Dick Cheney was noticeably thinner after his 2010 heart attack. 
“The ethicists will get into this case.” Eric Topol, a cardiologist in California, wrote this line in reference to the question of age. Specifically, should someone who could be expected to have ten years left take a heart that could otherwise allow someone else to live twenty or thirty more years?  Over 70% of heart-transplant recipients live at least five years. It could be argued that Cheney had been able to live 71 years so it is not fair for someone who is 50 or 60 to not be able to do likewise for lack of a transplant because someone Cheney’s age has it. On the other hand, Cheney could argue that because people were living into their 80s and even 90s, he could expect to do so as well. In other words, he could look at someone who is 81 and say, “it is not too much to ask to try to live that long.”

To be sure, my primary applications of ethical theory are in business, government, society, and religion. I do not have the background in biology and medicine to be an expert in medical ethics. So this essay can only be cursory. It is odd to me, therefore, when someone who has not even studied ethical theory wades in as a pseudo-ethicist. An undergraduate degree from a medical school (e.g., the M.D.) does not qualify a cardiologist as an ethicist.

Yet William Zoghbi, the incoming president of the American College of Cardiology at the time of Cheney’s transplant, said on that very day concerning Cheney’s age, “It is not too old. Age is really not a factor.” To be sure, he was referring to the medical condition of the patients. However, he went on to overreach, opining “I don’t see any ethical issues here,” given how weak Cheney’s heart had been. Just because a non-ethicist does not think there are any ethical matters involved does not mean that this is so.

From my standpoint as a business ethicist, I believe an ethical issue is indeed involved in hospitals, as businesses, giving hearts to older applicants, especially if they are powerful or wealthy people who can “skip” in line by having a dedicated donor. More generally, using the utilitarian ethical theory of Bentham, it could be argued that giving hearts to older applicants violates the greatest good (in terms of pleasure) for the greatest number. Older recipients tend not to live quite as many years on a new heart, and they have already lived to be a ripe old age while someone with heart disease at 50 has not. Enabling as many people as possible to reach 71 would go a long way in terms of the greatest good for the greatest number.

Admittedly, I must qualify my conclusion due to my lack of medical knowledge. For instance, I do not know how the older recipients fare medically relative to younger ones. Ideally, a doctor of ethics who has an undergraduate degree from a medical school should be decisive here. For a cardiologist without any formal education in ethical theory to venture an ethical conclusion suggests a certain educational immaturity, if not arrogance. I doubt that William Zoghbi had even heard of Bentham’s utilitarian theory and yet the cardiologist presumes that no ethical issues are involved in Cheney’s case.

In a society in which the profession of medicine is valued a lot, people might enable medical practitioners to get away with such an over-reach with impunity. No doubt Dick Cheney really wanted to keep living. This natural urge—the life instinct—can easily succumb to a medical practitioner’s artificial desire to over-reach in terms of what is entitled by the undergraduate degree granted by medical schools.


Kasie Hunt, “Dick Cheney Heart Transplant: Former VicePresident Recovering After Undergoing Surgery,” The Huffington Post, March 24, 2012.