Should people who engage in health damaging choices like smoking, drinking, drug abuse, overeating be denied organ transplants if their organs where to fail as a result of their actions?

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I don't see why. If there is reason to think that these bad choices would continue in such a way as to make the transplant likely to fail, then I can see having them be a factor. But if a patient needs a transplant, then it does not seem to me to be up to the medical profession to deny that transplant on some moralistic ground.

Consider two cases, where both need a kidney transplant. In one case (A), we have good reason to believe that the patient needs the transplant because of drug abuse earlier in their lives. (Let's not complicate the issue further by going into how likely we think it is that the person might return to drug abuse if the transplant is done successfully.) In the other case (B), we see no such evidence, but we also do know that B has been guilty several times in his life of physically or sexually abusing members of his family in numerous ways. Imagine finally that only A and B could be plausible candidates for this transplant--the kidney will spoil and be useless to anyone if the transplant is not made in the next day. Should it be a medical decision to withhold the transplant from A or B because of what we know about them?

The reason I give this case is because I think that there may be any number of factors that might incline us to favor one over another candidate for a transplant. Maybe A is also a really funny person who is charming to be with and B is a total grouch liked by very few people. Should that matter? I can sympathize with those who feel the pull of such considerations, but I really think it would be a very bad idea to have doctors or medical staff making medical decisions based on such factors.

Medical teams do have criteria they apply to these decisions, and perhaps the sself-inflicted nature of some medical conditions should count as a kind of "tie-breaker" in otherwise similar cases. But bringing in more such considerations seems to me to be an extremely risky business, and judgments about these are not appropriately made by medical professionals.

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