Convicted rapist Kenneth Pike of Auburn, N.Y., has reportedly turned down a lifesaving heart transplant that would have cost New York taxpayers up to $800,000.
Pike's sister, Sharon Cardinal of Auburn, said Pike changed his mind about the transplant after news reports sparked controversy about inmates receiving big-ticket health services arguably at the expense of others, according to The Associated Press.
Pike, 55, is serving an 18- to 40-year sentence for raping a 12-year-old female relative in 1996.
Another relative said Pike recently underwent a triple bypass and would likely die without a transplant, according to The Associated Press.
The issue has been the talk of the small suburban New York town: Should taxpayers shell out for convicted criminals to receive services that some payers could probably never afford themselves?
"We do think that prisoners are treated much better than those on the outside," said Carol Speach, a media sales professional in Auburn, who also suggested that Pike and his family should foot a larger portion of the bill.
"Everyone else is expected to pay for some of their health care," she said.
And the question of whether prisoners should receive equal, if not better, health care than everyone else has been the heart of a decades-long debate among medical ethicists.
Transplant centers have the right to turn patients away, but physicians are required to care for every patient they see, according to Arthur Caplan, director of the Center for Bioethics and the Sydney D. Caplan professor of bioethics at the University of Pennsylvania.
In 1976, the U.S. Supreme Court ruled that prisoners were entitled to the same medical and dental treatment as everyone else in their communitities. Prisons that withhold necessary care from inmates can be held liable for violating constitutional bans against cruel and unusual punishment.
Prison facilities often pay a negotiated reduced fee with contracted hospitals across the state, according to Peter Cutler, spokesman for the New York State Department of Corrections and Community Supervision. But Strong Memorial Hospital in Rochester, where Pike is reported to have been transferred, is not one of them.
"We are constitutionally obligated to provide health care services to any inmate," said Cutler, citing the Eighth Amendment of the Constutition. "We're a state agency doing our job."
Many transplant centers undergo what Caplan called a "wallet biopsy" as one of their first steps to add a patient on the transplant list.
"Before you're even put on the list, you need to show a way that you can pay," Caplan said.
That may put some prisoners, whose medical bills are covered by the state, at a competitive advantage, he said. But other factors, such as medical necessity and geographic location, also play a role.
But many transplant centers offer ways to help patients pay for transplants, said Dr. Andrew Cameron, surgical director of liver transplantation at Johns Hopkins Medical Center. Medical necessity is the overwhelming factor that knocks a patient off the list, he said.
"The triage is made only on medical grounds and is not based on other values," he said.
Critics argue that efforts to ensure prisoner rights have compromised the lives of law-abiding taxpayers who are paying inmates' medical bills.
"Constitutionally, you didn't sentence a guy to death, you just sentenced him to prison," Caplan said. "If the public is so turned off by prisoners to get transplants, their goal should be to legislate to change the standard of care."
Prisoner health care has posed less of a dilemma for physicians who are ethically bound to help all patients.
"No part of your punishment for a crime is forfeiting the standard of medical care," said Cameron. "It's not a contraindication to transplant."
While transplant lists do not outline a patient's criminal history, or whether the recipient is currently in prison, Caplan said there haven't been too many cases of prisoners approved for organ donations.
"In general, the ethics of medicine is not to sort out sinners and saints," he said.