The Price of Personal Choice: An Ethical Dilemma

Published on February 5, 2024

We all make choices, some small, some life-altering.
That extra slice of cake. The late-night cigarette. The soda instead of water. The skip in exercise. The silence when we should have spoken up.

Most of us live with the quiet consequences. But what happens when those choices lead to something irreversible? When a liver fails. When a heart gives out. When a lung can no longer breathe?

And then… there’s an organ waiting. One that could save a life.

But should that life be yours, if you helped break it?

This is the haunting question at the center of Glenda Cooper’s 1997 essay, “Should those who abuse their bodies pay the price?” It’s not just about medicine. It’s about justice. About fairness. About what we owe each other, and what we owe ourselves.

The Weight of Responsibility

Cooper doesn’t ask whether people should take care of themselves. We all know they should.

She asks something far harder:

If someone knowingly harms their body through persistent, preventable behavior, should they be denied care when they finally need it most?

Imagine two patients needing a liver transplant:

Patient A: A lifelong non-smoker, active, balanced diet, never drank excessively.
Patient B: Diagnosed with cirrhosis after 20 years of heavy drinking, despite multiple warnings from doctors.

Both are dying. Only one liver is available.

Who gets it?

Our instinct might be to choose Patient A. They didn’t cause their own suffering. They’ve been responsible. They deserve it.

But here’s the twist:
What if Patient B has tried to quit? What if they’re now sober? What if their regret is heavier than any guilt we could assign them?

Is fairness about who deserves it most… or about who needs it most?

Ethics vs. Morality: A Crucial Divide

Cooper makes a thoughtful distinction between morality and ethics, one I wish more of us remembered.

Morality is society’s rulebook: You shouldn’t smoke. You should exercise. You must take care of your body.
Ethics is the deeper question: How do we treat people who fall short of the rules?

The danger comes when we confuse the two.

It’s easy to judge.
It’s harder to hold compassion alongside accountability.

When we say, “They brought this on themselves,” we risk turning healthcare into a meritocracy, where worthiness replaces need. Where dignity becomes conditional.

And yet…
Healthcare resources are finite. A single transplant costs hundreds of thousands. There are waiting lists. Families crying in corridors. Doctors making impossible calls every day.

So where do we draw the line?

The Flawed Analogies That Undermine the Argument

Cooper tries to strengthen her case with comparisons, but some land awkwardly.

She compares children eating candy to adults choosing alcohol. But children don’t have full autonomy. Adults do. That’s not negligence, it’s agency.

Then she draws a parallel between doctors allocating organs and Nazis selecting victims.

This is deeply problematic.

One is about saving lives under scarcity.
The other is about exterminating them.

Equating the two doesn’t sharpen the argument, it shatters its moral credibility.

We don’t need shock value to make this point. The truth is painful enough without sensationalism.

The Real Question Isn’t About Blame, It’s About Hope

Perhaps the most uncomfortable truth is this:

We already make these decisions.

Hospitals screen for sobriety before listing for transplants.
Insurance companies deny coverage for complications tied to smoking.
Waitlists prioritize those who show commitment to change.

We aren’t denying care because someone was “bad.”
We’re prioritizing care for those who still have a chance to heal.

It’s not punishment. It’s pragmatism.

But here’s what we must never forget:

People don’t become addicted because they’re weak.
They become addicted because pain, trauma, isolation, or despair led them to find relief in something destructive.

And recovery? It’s rarely linear.

So when we ask, “Do they deserve it?”
Maybe we should also ask:

Can they still become worthy of hope?

A Better Path Forward

I don’t believe anyone should be denied care simply because they made mistakes.

But I also believe we owe it to our systems, and to each other, to design care that encourages responsibility, not shame.

What if, instead of denying treatment, we offered it with conditions?

A year of sobriety before transplant eligibility.
Counseling paired with medical intervention.
Community support, not judgment, as part of the healing process.

This isn’t about withholding compassion.
It’s about extending it in a way that works.

Because medicine isn’t just about fixing bodies.
It’s about restoring dignity.

Final Thoughts: Compassion Without Cynicism

We live in a world that loves to punish failure.
But healing? Healing requires grace.

Let’s not pretend that personal choice exists in a vacuum.
Poverty, mental health, addiction, trauma, they shape our decisions more than we admit.

Yet let’s also not ignore the reality of limited resources.
We cannot pretend we have infinite time, money, or organs.

So what’s the answer?

Not “punish” or “reward.”
Not “they deserve it” or “they don’t.”

But:

How can we help people reclaim their health, without abandoning our duty to use what we have wisely?

Maybe the most ethical thing we can do isn’t to decide who lives or dies.
It’s to create a system where fewer people ever reach that breaking point.

Until then, we sit in the gray.
With trembling hands.
And open hearts.

Thank you for sitting here with me in it.

🫶