By Alan Regenberg


There has been a flurry of news coverage (and general outcry) in response to news that Kenneth Pike, a convicted rapist who has served 15 years of an 18-to 40-year sentence, was “next in line” and expected to receive a heart transplant. As a prisoner, the estimated $800,000 cost of Pike’s treatment would be paid by the New York State Department of Corrections (i.e., supported by taxpayer funds). The fact that the bill would be footed by taxpayers has fueled the fire of outrage.

 

In the latest twist in this tale, it is now being reported, that Pike has changed his mind and is no longer seeking a transplant. Should we see this as good news? What sort of health care (or things like education, or food, for that matter) should we grant to people who are convicted of crimes and imprisoned? Would it matter if the state was not on the hook for the bill? What if Pike’s crime were something less repugnant; maybe if he committed burglary, or even a more “civilized” crime such as embezzlement?

 

While this case can evoke quick and harsh responses, I think it’s more complicated than it appears. Setting aside understandably passionate reactions, there are some crucial elements to this story that should be considered prior to a leap to judgment.

 

First, it’s inaccurate to frame this as a battle between funding for health care given to prisoners, versus health care for “innocent” patients. The connection between the funds going to health care costs for prisoners and the funds dedicated to providing health care for anyone else through state budgets is ridiculously tenuous. Net savings from denying health care to prisoners (if there were net savings as a result – I suspect it would actually end up being more costly managing a prison population in poorer health) are not going to go directly into a fund labeled “health care for the innocent.”

 

In other words, Pike selecting to forgo a transplant is, unfortunately, NOT going to result in New York State now sending the $800,000 in “rediscovered” funds to an “innocent” patient. An example of such a person might be someone who was turned down by a transplant center as unlikely to be able to pay for the cost of their care, but was otherwise a sound candidate for transplant. There is no direct path between the two.

 

Those horrified by people in prison receiving transplants while “innocents” can’t foot the bill would do better to focus their righteous indignation on the grossly inadequate system in America (but hopefully, soon to improve under the reforms of Obamacare) that leaves tens of millions without access to adequate health care. Again, apart from providing a striking contrast, this bigger picture of health care has very little to do with how we treat our prison populations – health care for prisoners is clearly not the stumbling block for universal access to decent health care for all (non-incarcerated) Americans. Congress has not been overheard saying, “We’d love to pay for universal health care. But, tough-luck, we just spent our last dime on a transplant for a rapist.”

 

The role of guilt, innocence, sinners and saints in medicine presents a challenge for considering Pike’s candidacy as a transplant recipient. Medical professionals are not trained or in any other way particularly well-equipped to filter patients on the basis of saintliness. So, even if it was the case that we should only provide health care to people who meet some minimum standard of “innocence,” I’m not sure whom we would ask to make that evaluation or what criteria they would use – and I don’t see any reason why medical professionals should be the ones tasked with sorting out the saints from the sinners. I don’t really think anybody is equipped to meet this ridiculously complex, probably impossible challenge.

 

Judging Pike on the basis of his actions and labeling him a criminal (i.e., bad) seems relatively uncontroversial. Maybe saints and sinners can be easily identified at the ends of the spectrum, outside of the impenetrable grey area. It’s certainly true that he was convicted of a particularly heinous crime. But, then I wonder about what our point is in filling prisons, and the impact that policy decisions like this will have on achieving our goals. Are we hoping to rehabilitate the prison population? Or are we just seeking to punish people, and hoping this will serve as a deterrent? (The growth of the prison population suggests this isn’t working.)

 

If our goal is the former, rehabilitation, it seems we should get very clear about this and rededicate all related resources towards maximizing success. I don’t see how the goal of rehabilitation can be served by denying adequate health care to the imprisoned. I should note that I know next to nothing about crime and punishment, but I don’t see how treating prisoners harshly is going to encourage them to abandon their prior commitments to lawlessness and adopt commitments more similar to those behind their ill-treatment. Denying someone adequate health care constitutes harsh treatment, and, at least for this claim, I have the Supreme Court on my side.

 

Putting all of this a bit more simply. Crime: bad. Denying health care: also bad.

 

Alan Regenberg, MBe, is the Bioethics Research Manager at the Johns Hopkins Berman Institute of Bioethics. He is currently developing strategies to use social media as a tool for broad public engagement around issues in bioethics. You can follow him using his inside voice @bermaninstitute or @aregenberg.

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One Response to “Op-Ed: Crime and Transplants”

  1. Ishan says:

    I think an important part of this whole debate is that in that physicians don’t (shouldn’t) make moral judgments about the lives of their potential patients. Part of the heavy responsibility that comes with being a doctor is treating anyone who is ill that seeks your assistance-no questions asked. Therefore the onus is not on doctors or healthcare providers, they should treat anyone who needs help. The burden lies on the people to decide if this is the kind of society we want to live in-one where we debate whether or not a prisoner deserves a heart transplant, not whether all humans deserve the ability to get a heart transplant. The truth is we as society like to get excited about unique cases like Pike’s, but im pretty sure no one is writing about all the people who die because they lived good lives but cant afford to pay for their transplants. Ill borrow a quote from Paul Krugman’s recent NYT article: “the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.” Sadly, his words are very apt in relation to the Pike debate.

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