Drunks, livers, and values. Should social value judgments enter into liver transplant decisions?

The idea that social value judgments should enter into the distribution of scarce resources has been debated for many years. The question of transplanting livers into alcoholic patients, even if they do not constitute a technically worse group than do nonalcoholics, is used to examine this issue. The paper concludes that (a) "social worth," as a criterion for distribution of scarce resources, is morally precluded in allocations directly involving the patient-physician relationship; (b) social worth criteria may be useful in macroallocation decisions prior to resorting to a lottery approach or to a market approach; (c) social worth criteria may be more legitimately applied when it comes to transplanting organs than in the distribution of other resources. Social worth criteria constitute an expression of communal value and are prone to the evolution of communal sensitivities and to growth.