Inmate's heart underscores the value of every life

This article appeared on the Opinion Page of USA Today on February 12, 2002. Learn more about Mike Miraglia, the patient mentioned in this article, by following the link. He eventually recieved a heart transplant, and is apparently doing well. He runs a well known catering business in the San Francisco area.

On January 3 of this year, a 31 year-old California man received a heart transplant at Stanford Medical Center. He recovered quickly and was discharged home after an uneventful hospital stay. Cost: about $200,000. Just another medical success story? It might have been, except that "home" in this case was the Vacaville Correctional Center near San Francisco. As it turns out, the protagonist of this story was diagnosed with severe heart failure while serving the fifth of a fourteen-year sentence for robbery. And because his arrest occurred while on parole for an earlier burglary conviction, he will not be up for parole again until 2008. By then, taxpayers will have picked up a medical tab estimated at $1 million.

Criticism of the decision to transplant a two-time felon was surprisingly strong. Los Angeles Times columnist Steve Lopez wrote, "You have to wonder if a law-abiding, tax-paying citizen drew one last breath while Jailhouse Joe was getting a second wind." As it turns out, the convict had indeed cut in line, delaying Mike Miraglia's transplant by a week or so. But the "law-abiding, tax-paying citizen" most affected by the inmate's transplant could be counted among the few who did not seem to mind too much. Through his family Miraglia affirmed "the fact that a heart went to a prisoner was never an issue". It was a medical decision.

Unfortunately, some in California have chosen to make it an issue, despite the fact that when all is said and done every man, woman and child there will have to chip in a grand total of 3 cents to pay for the convict's medical care over the next six years. At first blush, it might seem unfair to make society pay for the extraordinary medical care of someone who has repeatedly shown disregard for the social order. But perhaps we should focus more on the great deal we stand to gain by providing health care to convicted criminals, rather than the little we stand to lose.

The U.S. Constitution guarantees persons convicted of crimes access to the same health care as everyone else. When these statutes have been challenged, the courts have consistently ruled in favor of the inmate, compelling the penal bureaucracy to live up to a high ethical standard. And in matters of human rights, it is much better to aim high than to settle for a minimum. To provide necessary medical care to criminals is to aim high. Neglecting their care is the moral equivalent of "tit-for-tat". Imprisonment becomes retaliation rather than rehabilitation, and society loses when a subtle vindictiveness becomes the motivation for negligence.

If the prisoner from Vacaville had been convicted in some other country, he might well have become an organ donor rather than the recipient of our reluctant largesse. There is little doubt, for example, that Chinese death row prisoners are used involuntarily as organ donors, and that executions -- often for offenses such as robbery -- occur on schedules coordinated with transplant surgery. So compelling is the evidence for this that Congress is currently preparing legislation to prohibit U.S. medical centers from training visiting Chinese physicians as transplant surgeons.

Clearly, the networks of people engaged in the harvesting of human organs are enticed by the impressive profits of a sellers market. And this is a market driven not just by the Third World's wealthy sick. Three years ago, the FBI indicted two Chinese nationals in New York for attempting to sell human organs there. The United Network for Organ Sharing estimates that 200 to 300 Americans each year are buying organs from sources that either pay or coerce donors or their survivors. The actual figure may be much higher.

We should not assume that our own medical establishment is immune from the same economic forces driving organ harvesting. The American Medical Association has recently proposed paying organ donors or their families for their donation. Without a doubt, the AMA is moved by a desire to meet the needs of the sick in a professional and ethical manner. But offering financial rewards as incentive for organ donation may only serve to confuse families, who might read less than noble motives into the solicitations. Perhaps solutions may be found elsewhere. Transplant centers in Philadelphia, Milwaukee and Los Angeles consistently report donation rates of 80% or better, suggesting that physicians, too rushed to carefully explain organ donation to grieving families, bear considerable responsibility for the donor dearth. Perfecting the pitch rather than offering payment may be the most respectful approach.

For the same reason that the cost of medical care for criminals should be borne by the society they offended, organ transplantation should remain a gift from the donor to the sick. They are occasions we have to express solidarity with the weak and the sick, with those who have little to offer in return. If we have difficulty recognizing the value of these gestures, it is because we have not grasped the unique worth of every human life and the importance of promoting this view in our conflicted times.

1 comment:

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