3/06/2010

Ezekiel Emmanuel on how health care should be rationed



Here is Emmanuel's explanation for the probability that people should receive medical treatment.

Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value. As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.” Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.

Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants (figure). Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life. As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”; this argument is supported by empirical surveys. Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice.


Human capital investments are important except where Emmanuel and friends don't think that they matter. There is one thing that is obviously left out: what the patients think their lives are worth.

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2 Comments:

Blogger Angela said...

Yes, that's far more ethical than rationing it on an ability to pay. And only providing health care to those least likely to need it makes absolute economic sense! Without demand to drive up prices, we won't have to worry about increasing efficiencies nearly as much. /sarc

3/06/2010 10:41 AM  
Blogger ged said...

I always find it depressingly ironic when self-anointed medical ethicists attempt to decide the most moral and socially just way to spend resources that they've taken involuntarily from others by the use and/or threat of force. Then again, it's hardly surprising in the context of deciding the best way for Congress to go about doing something for which it has absolutely no Constitutional authority. I'm at a loss as to whether I should be singing "Союз нерушимый республик свободных ..." or "Die Fahne hoch! Die Reihen fest geschlossen! ...".

3/06/2010 8:23 PM  

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