Dear Friends, Family, Neighbors, and Those of You I Don’t Yet Know —
Welcome! Tonight’s issue of Odd Company is about moral decisions. What are they? How do they differ from other types of decisions? How do we make them? And why the heck has this been on my mind?
Let’s take the last question first. About a month from now, the Organ Procurement & Transplantation Network (OPTN) will be changing the guidelines they use to determine who gets a new lung and who doesn’t. In case you’re new to Odd Company and don’t know about this yet, my husband has been on the list for a lung transplant for about the past year. It’s hard to believe now, but in the spring of 2021, he was a very healthy guy who swam a mile after lunch most days, regularly rode his bike 40 or 50 miles, and worked out with a trainer three times a week. He had a mild lung condition called hyperallergic pneumonitis — basically a major allergy to feathers — which had been stable for years. That summer, the lung problem began to progress. No one knows why for certain, but it was very sudden, and it started after his second dose of mRNA COVID vaccine. After his third dose, it took off like a rocket. By February of 2022, he was down to 20% lung capacity, on oxygen 24-7, and his doctor started the process of getting him qualified for a transplant. By March, he was officially on the list. The lung team told us the average wait time was six months.
Out of an abundance of caution, he decided not to get any further COVID boosters. Again, maybe it was a coincidence, but by last fall (when a year had passed since his last mRNA dose), the lung condition had stopped progressing, as suddenly as it started. So that’s the situation. He’s tethered to his oxygen concentrator machines or a tank, sleeps with a canula, can’t do much in the way of aerobic exercise, and can’t travel. But he’s alive, not hospitalized, not getting any worse, and could go on this way without a transplant for the rest of his natural life. At this point, he’s been on the transplant list for about ten months.
As I understand it, early in the history of organ transplants, it was more like waiting in line at the bank or the grocery store. There was a list, and when your name got to the top, you got the next suitable organ that came up. But this meant a lot of people died before they got to the front of the line. So “severity scores” were invented, so patients in imminent danger of dying could be moved up faster than those who could afford to wait longer. Which certainly makes sense.
But there must have been a lingering sense that the process still wasn’t as fair as it could be. To that end, OPTN has created a rating system that gives each patient a number — the Lung Composite Allocation Score, or LCAS. The patient’s score (or rating) takes nine different variables into account, including obvious things like how likely they are to live for a year if they don’t get a transplant, how likely they are to survive for five years if they do get a transplant, their blood type and HLA antibody sensitivity, and their height (which determines the lung size they need). It also includes four attributes I hadn’t thought about before. Is the patient a child? Has the patient ever donated an organ in the past? How much will it cost to transport the lung to the patient? And how many miles will the lung have to be transported. OPTN has published a 33-page document detailing how patient scores are determined, complete with graphs, bar charts, and formulas. Time spent on the wait list is not considered. The bottom line is that, under this new system, and assuming his condition remains stable, there’s a good chance that John will never get a lung, even though he very much needs one. Is the system fair? Yes. But even in the fairest system, there are winners and losers.
This seems like a good spot for our musical interlude. Looking for something soothing and inspirational, I landed on the eight-member English a capella group VOCES8. This piece is more of a collaboration than is usual for this group. The lyrics are about love and hope. “Let it go/ In love we find our way/ With trust, hope remains/ I’ll be here/ Stay right here/ Don’t you see/ (Oh don’t fear)/ In love we find our way/ Through the night/ In love we find the way/ Your love leads the way.” This piece was written by the unclassifiable singer/songwriters Kelly Lee Owens and Sebastian Plano, who, as far as I can tell, don’t usually collaborate. The piece was arranged for VOCES8 by vocals arranger James Clement, known for his rich harmonies, especially in the tradition of sacred music. Though it takes some focused listening, you might be able to discern the low hum of a cello in the background — celebrity cellist Gabriella Swallow, using her instrument to lend extra warmth to the human voices. The overall effect makes me glad I’m alive to hear it.
The main issue with the lungs is that there aren’t enough to go around. When there isn’t enough of something to go around, how do we decide who gets it and who doesn’t? It’s hard enough even if it’s just an inconvenience. The water situation with the Colorado River is a good example. Not enough water for everyone to have as much as they’d like, so we have to figure out a way to share it. When it’s a matter of life and death, as it is with transplant organs, things get way more complicated. It becomes a moral decision.
We tend to think of moral behaviors as so basic that they are universal. Surely, we all agree that slavery, murder, and cruelty to animals are immoral behaviors, right? Not so fast! There have been times and places throughout history when otherwise good and upstanding people owned slaves. There are places in the world where the same people who would give you the shirts off their backs eat dogs and horses. We send soldiers into battle with permission to murder our enemies, and we sometimes murder criminals in retribution for their crimes. The truth is that morals vary from culture to culture and from one historical period to another. We may think that moral behaviors are gut instincts, but in fact, we learn them just like other behaviors. Oscar Wilde, that master of cynical wit, once quipped, “Morality is simply the attitude we adopt towards people whom we personally dislike.”
OPTN’s struggle to reduce each patient’s situation to a handy number illustrates how hard it is to justify moral decisions. Often, our moral judgments are automatic, based on experiences that other people in our lives have reinforced over and over. In the best scenarios, we decide which actions are good or bad through a combination of rational thought and intuition. But when we make a decision that affects the happiness of many people, we’d better be able to explain ourselves. Thus, all those bar charts and graphs and formulas to justify decisions that, in the end, will always be based at least in part on emotions and intuitions that are very hard to explain.
As is so often the case, the remedy is willingness to consider the viewpoints of others as they struggle to make the right decisions, often in situations where “right” can barely be defined at all. There are some behaviors that make it easier for us to live with our fellow human beings, and others that make life difficult for everyone. It’s easy to see what we should do or not do in those cases. But much of the time, all we can do is try our best, apologize or forgive if we must, and hope everything comes out all right.
Next time, some thoughts about saying “sorry”! And what I’ll be planting in the garden this spring. Till then, happy End of January…and how.
I am so sorry to hear about your husband's health. There is always wisdom in your messages. I feel fortunate that Kristine Erving told me about your writing. I have been an avid fan of Voces8 for nearly 3 years. We have streamed their concerts Live from London. On Feb 25 I will fly to SF for their concert at The Bing performing Lost Birds. The composer, Christofer Tin, graduated from Stanford. (I am Class of 64) and he will conduct I think. The music moves me to tears. CD's are available. Thanks for your writing and hope for your husband, Carolyn Gabrielson
I finally have plowed through my email to reach this precious news, and yes, the question of morality is not black & white. Excellent he is doing better, sucks not good enough to resume his fabulously active life! Thank you for sharing this wonderful music and much appreciated lyrics.
Let it go
In love we find our way...