The Code of Ethics for Nurses, revised and approved in 2001 at the American Nurses Association Convention in 2001, puts forth in its first provision that nurses treat all members of society the same. It says, “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”

Recently on my blog, donorcycle, a commenter was affronted that a prisoner was getting a transplant. He would never donate now, he said, if there was a chance that his organs would go to a less than desirable candidate. Never mind that the other 7 organs might go to nuns, or school children or the next American Idol. Many people are upset at the thought of drug addicts or alcoholics getting an organ. (I don’t know why this prisoner needed an organ). Criticism was raised when Mickey Mantle received his second liver in a short period of time, prompting concerns that he had jumped the list, despite all evidence to the contrary.

This isn’t limited to transplantation. At times it seems like there is an unwritten hierarchy of patients, with pediatrics and oncology at the top, then L&D, working your way down to drug addicts, alcoholics and the mentally ill. Don’t agree with me? Look where your hospital spends its money. Five dollars says the women and children’s pavilion looks much nicer than the psych ward. Yes, I know that money is also spent where it’s going to get a good return, like L&D, because patients shop around, but I think it’s easy, for patients and healthcare workers alike, to internalize the message that you get what you deserve.

Take drug seekers, for example. Yes, they absolutely exist. Patients who cruise the local ER’s, trying to find who is the most likely to give out narcs. Like kids at Halloween, I’m sure they even tell their friends who’s giving out the biggest candy bars on the block. They have a list of medication allergies as long as my arm. They come in all shapes and sizes. The little old lady who was put on percocet 6 years ago for back pain can be just as addicted as a the malodorous street person. I’m not suggesting that we enable anyone’s addiction, but there is this pervasive attitude that if the drug seeker somehow gets past our radar and receives a dose, they have somehow gotten one over on us. Taking the cynical approach and prejudging people who fit the stereotype not only does nothing to help their addiction, it puts patients who may appropriately need medicating at risk. Regardless of whether the drug seeker gets his fix, the chance that you’re going to make or break their addiction in the ER is slim. I’ve yet to meet an addict who says, “Hey, they didn’t give me my demerol. Maybe I should seek help for my problem.”

Methadone, marijuana, Michelob or Marlboro’s, many people have health problems of their own devising. Passing judgment on the drug addict or alcoholic is as ridiculous as judging someone having an MI because they ate too many cheeseburgers. If you think it’s wrong for a prisoner to receive a liver transplant, where do you draw the line. Should he get chemo if he has cancer? Antibiotics for an infection? Stitches for a cut? If we put certain people into a category of “they got what they deserved”, that leaves only the innocent victims and if we only treat the innocent victims, the line at the door to the ER is going to be very, very short.