27 Jun 2013


Not surprisingly, AL and K passed the College examination with flying colors. Shortly before the examination, they asked GW and me to conduct a mock examination for them. Personally I think such kind of exercise is quite useless. But as Prof RK said, when many useless things add up together, they may turn out useful. To go along this line, I asked a useless question that would never appear in the examination.

“A 38-year old man learned from the news that a rich man in town is dying from liver failure. He offers to donate part of his liver to him, but demands a compensation of $500,000 in return, which the family for sure is willing to pay. He argues that he owns his body and should have autonomy over its use. Besides, he believes that his request is reasonable given the sacrifice he is going to make. As a doctor, do you agree with his points?”

After thinking for a while, the candidate replied, “This is certainly not acceptable. Above all, doing no harm is the fundamental standard of medicine. We cannot risk his life to save a richer person.”

“Wait a second,” I interrupted. “Do you mean you are against living donor organ transplantation?”

Seeing it could not be right, the candidate changed strategy, “Not really. We also need to see if the patient had problems with alcohol and the reason for liver failure.”

“He does not drink alcohol. He had decompensated hepatitis B-related cirrhosis.”

“We should see whether the patient really requires liver transplantation and is fit for the procedure. Besides, we shouldn’t let someone jump the queue just because he can pay.”

“All right,” I said. “In other words, if the patient is at the top of the waiting list but a cadaveric liver is not available yet, you would find the proposal acceptable. In fact, you may argue that such a move would even shorten the waiting list for other patients.”

“No, no, no. Organ trading is illegal in Hong Kong.”

“That is true,” I said, “but what is the ethical basis of the policy?”

“I give up.”

At least we learned one thing that afternoon. Principles are not subject to conditions. There is no if or when. You cannot say the government should not run students over with tanks if they are protesting peacefully. They just shouldn’t.

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