A distinguishing characteristic of being human is the ability—and necessity—to put yourself in another’s place. Empathy is the psychological basis of the key ethical commandment found, in various forms, throughout the world: Do unto others as you would have them do unto you.

Empathy makes possible the ability to know what another is feeling and therefore act accordingly. Without empathy, all is lost. It is the very foundation upon which we build social groups and it is the groundwork of morality and ethical precepts.

While empathy is a good and necessary thing, it isn’t everything and sometimes stands in the way of doing the right thing. Empathy has an underside. For one thing, it can lead us to give an unfair advantage to those with whom we identify while we remain indifferent to strangers whose needs may be greater.

We are biased in favor of those we are close to and we are inclined to favor those we can see. Relatives and friends move us, as do pictures of those who suffer. Reading about someone we don’t know and don’t see but who is in need often fails to move us to action. We simply don’t identify as strongly with nameless people.

While empathy is good at regulating intimate relations, it is weak when dealing those who aren’t directly connected to us. At the societal level we need to be fair and just, concepts grounded in reason more than empathy. In fact, empathy can stand in the way of fairness, as was starkly revealed by news reports that 10-year-old Sarah Murnaghan didn’t qualify for an immediate liver transplant, even though she is given only a short while to live.

Many were outraged that Sarah Murnaghan—whose photo was in newspaper, on TV, all over the Internet and social media—was denied a liver transplant because she was low on priority list. Many accused bureaucrats of mindlessly adhering to rules and letting a little girl die. As a result of the widespread bad publicity, a judge ordered the Organ Procurement and Transplantation Network to add her to the list for adult lungs. And she received a lung transplant this week.

The reality is that as Sarah gets bumped up to the top of the list, someone else gets pushed down. But we don’t see the person who was displaced and who now may die because they continue to wait. Sarah received such well-wishes because the public saw her as a real person; the other whose place she has taken is only an abstraction.

There is a system in place to allocate organs because there is mismatch between supply and demand—more people need them than there are organs available. Under the current system, run by the Organ Procurement and Transplantation Network in conjunction with the United Network for Organ Sharing, there are two lists for lung transplants recipients, one for adults and one for children. The reason for dual approach is that children are poor candidates for adult lungs. Far more benefit comes from adults receiving lungs from adults and children from children.

The policy was determined a number of years, attempting to provide the greatest good for the greatest number, a policy based on then-current medical knowledge. The policy is meant to reflect both need and efficacy.

The problem with the moral outrage over Sarah Murnaghan’s situation is that it substitutes compassion for medical realities and undermines a fair allocation. Should Sarah Murnaghan be given priority because of the publicity she received? Doesn’t this open the door to transplants going to the person with the best public relations campaign or to people who can buy airtime to plead their cause?

Sarah Murnaghan’s case moved to the courts and was debated on the Internet and cable TV. But as ethicist Arthur Caplan says in a USA Today interview, “The best place to make medical decisions is not in a courtroom, it’s not in Congress, it’s not on television. It’s with doctors and people with expertise in transplants making the decision based on how well the transplant will work and who is likely to live. Those aren’t facts that judges, senators, or bureaucrats have.”

The judge ruled and Sarah received her transplant. The Organ Procurement and Transplantation Network is now reviewing its procedures. Transplants have come far since the policy was adopted. While compassion shouldn’t overturn rational and fair procedures, it does seem that compassion has moved enough people to take a look at whether the present policies remain fair. In this regard, compassion has done its work. Without it, we wouldn’t even be concerned about creating a fair policy in the first place.

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