The first in a series of things I’ve been meaning to write about: when one ethical value comes into conflict with another.

We have a bioethics class where we discuss autonomy , nonmaleficence , beneficence , and scarce resources , but I’m not particularly a fan. We can argue this hypothetical case studies presented in class, and see different perspectives, but in the end, the answer always seems to be “it depends on the situation.” It always seems like a cop-out.

In the last week of classes, however, we had a patient come speak to us about his experience as a smoker and lung transplant. The surgeon presented the patient’s history, and told us that there are significantly more people waiting for donor lungs than there are donors available. The patient told us he ended up smoking something like 120 pack years , and was supplemental oxygen for at least 5 years, and *still* kept smoking. The patient eventually stopped, and had one lung transplant. It was a bad pair of lungs–they failed within months–and so he was put back on the transplant list, and received a second set of lungs. (Nothing up to here really gets to me.)

The surgeon presenting the case told us the patient was on immunosuppressive drugs , to prevent the body from rejecting the foreign lungs, and then reminded us that, as a consequence, the body is much more likely to develop cancers and tumors when it is immune suppressed. The patient then told us how he knows he’s at higher risk for skin cancers, that his doctor has warned him, but he doesn’t listen–he just got back from a week in Cancun tanning all day long. Most of my classmates laughed; the surgeon did too. “What a silly, fun-loving, risk-taking patient! Ha ha!”

Maybe I was just in a peevish mood, but it totally rubbed me the wrong way. I mean, here we are, talking about lack of resources for other lung transplants–or hell, lack of resources in general–and we’re encouraging destructive behavior by laughing at it.

I *know* we can’t just tell patients what to do, how to behave, or what to eat. Maybe it’s my lack of experience with non-adherence by patients, but it just seems like totally ignoring the “justice” or “limited resources” ethical value.

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