You are transplant nurse coordinator, thinking about two patients who are being evaluated for placement on the kidney transplant waiting list. One patient is a 40-yr-old African American schoolteacher. She is married and has two children. The other patient is a 22-yr-old unemployed white man. He misses three or four dialysis treatments per month and does not take his antihypertensive medications consistently.

Points to consider:

• The foundation of this conflict resides in the Constitution, in which the founders made education a free public resource and ignored health care as a right. Health care then became a privilege, a resource to be obtained by persons with the funds to pay for it.

• It took almost 200 years for health entitlement programs to be developed. Medicare is a federally administrated program. Individuals covered by Medicare are protected by Constitutional laws prohibiting discrimination based on race, gender, religion, and ethnic background.

• Medicaid is a federally sponsored program jointly administered by the various states. The states have the right to set coverage eligibility and limits but may not violate an individual’s constitutionally protected rights against discrimination.

• It is highly unlikely that the standard prohibitions against discrimination will change, but it is possible that definitions of unhealthy behavior such as substance abuse, alcoholism, smoking, and obesity may be used to screen out candidates.

• Nurses are concerned about social justice because of their health advocacy role. Today the situation is immensely more complex because of the cost and availability of care.

Address the questions below:

Which ethical principles and values apply to this case; which ethical principles are in conflict?
What which of the patients should receive the next available kidney transplant? Defend your answer using the steps of the decision-making model. Address each level of the decision-making model. Identify other information that might help you make a decision.