Personal Choices and Future Medical Need

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Editor’s Note:[1]

This column presents a problematic medical-surgical case that may pose a medical-ethical dilemma for patients, families, and healthcare professionals. As these cases are based on a real medical situations, identifying features and facts have been altered to preserve anonymity and to conform with professional medical standards. In this case, the healthcare team needs to decide if a medical procedure is warranted in the face of past problematic personal behavioral choices.

Question: Should this man with alcoholism be considered for liver transplantation?

Story:

Everett is a 62-year-old business executive with a 40-year history of constant moderate alcohol use. He has no history of violence, blackouts, or legal or work problems because of his drinking. It is reported that his wife has also been a problem drinker all during this time, and his two adult daughters are moderate to heavy drinkers.

Rather suddenly nine months ago, he suffered liver decompensation.[2] He was stabilized (reluctantly), stopped drinking, and was referred to our liver transplant program. Part of the pre-listing evaluation for patients with liver failure secondary to substance abuse involves a one-week stay on the in-patient psychiatric unit. The purpose of this evaluation is to see if there are any psychiatric, psychological, or characterological problems which would make the patient a poor candidate. This evaluation was completed two months ago, and it was the consensus of the evaluation team that, although he did not exhibit those problems, he was not then a good candidate because of continued denial of his alcoholism and an attitude that he had a liver problem, not a drinking problem. Because he was stable at that time, it was recommended that both he and his wife enroll in an alcohol recovery program and that he be re-evaluated upon completion.

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