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PubMed1990

Health care as a right, fairness and medical resources.

Our intention in the following is to use the WHO declaration as a basis for considering the allocation of resources in health care. We shall first argue that most of the criteria suggested as grounds for fair allocation of scarce medical resources have their difficulties if one tries to apply them one by one to medical practices. We shall then go on to claim that, if we take the right of all human beings to health or health care even moderately seriously, increasing the resources would in most cases be more ethical than attempting to allocate them 'fairly'.

Altruism↗
PubMed1992

QALYs, age and fairness.

... We can therefore conclude that either we should go for equality; and in that case QALYs are unfair because they haven't got enough of an ageist bias. Or we should accept consequentialism; and in that case QALYs have just the right sort of ageist bias. No plausible case can, however, be made for the claim that QALYs have an unfair bias against old people. Other things being equal we ought when distributing resources essential for survival favour the young. This ethical claim can be supported both by reference to equality (the life-time-view) and by reference to consequentialism (and the premises that resources generally will be more useful when given to young people).

Adult↗
PubMed1993

Rationing fairly: programmatic considerations.

CONCLUSION: I conclude with a plea against provincialism. The four problems I illustrated have their analogues in the rationing of goods other than health care. To flesh out a principle that says "people are equal before the law" will involve decisions about how to allocate legal services among all people who can make plausible claims to need them by citing that principle. Similarly, to give content to a principle that assures equal educational opportunity will involve decisions about resource allocation very much like those involved in rationing health care. Being provincial about health care rationing will prevent us from seeing the relationships among these rationing problems. Conversely, a rationing theory will have greater force if it derives from consideration of common types of problems that are independent of the kinds of goods whose distribution is in question. I am suggesting that exploring a theory of rationing in this way is a prolegomenon to serious work in "applied ethics."

Civil Rights↗
PubMed1994

Does justice require that we be ageist?

This paper restates some of the principal arguments against an automatic preference for the young as advocated by Kappel and Sandøe, arguments many of which have been extant for over a decade but which Kappel and Sandøe largely ignore. It then goes on to demonstrate that Kappel and Sandøe's "indifference test" fails to do the work required of it because it can be met by unacceptable conceptions of justice. The paper develops a number of new arguments against what I have called "ageist" preferences for the young or for those with long life expectancy. Finally I show that Kappel and Sandøe must believe that murdering older people is less morally wrong than murdering the young and that people relying on arguments such as theirs will have to accept the moral respectability of killing the innocent in order to maximise units of lifetime.

Adult↗
PubMed1994

Saving the young before the old -- a reply to John Harris.

For a distribution of health care resources to be fair, it should consider the consequences for the whole lives of the affected persons and not just how badly off they are at the present moment. Since, other things being equal, a person is worse off if he dies young than if he dies old, it is fair to give scarce vital health care resources to young rather than to old persons. In the paper this ageist view is restated and defended against a number of objections raised by John Harris. According to Harris' so-called anti-ageist argument the only relevant consideration in the distribution of vital health care resources is people's desire to go on living. On reflection, this is highly counterintuitive. Instead, it is argued that both present desires to go on living and possible future happiness should weigh together with considerations of fairness. Both fairness and possible future happiness will in most cases speak in favour of saving the young before the old. A number of other problems for the ageist view are discussed, and solutions are suggested.

Adult↗
PubMed2004

Adequate conscious life and age-related need: F.M. Kamm's approach to patient selection.

Kamm's approach to patient selection qualifies the notion that fairness makes need for scarce, transplantable organs inversely proportional to age. She defines need as how much adequate conscious life a person will have had before death. Length of adequate conscious life correlates highly with age. If so, then younger persons are usually needier than older ones. Since Kamm allows for past periods of non-adequate conscious life, I argue that this correlation may be neither as close, nor as easy to apply, as she wants it to be. Fairness should require assessment of experiential content in determining how long one's life has been adequately conscious. I argue that such assessments involve some of the goods of experience and quality of life judgements that Kamm thinks a reliance on adequate conscious life will avoid.

Age Factors↗
PubMed2006

Organ sales and moral distress.

The possibility that organ sales by living adults might be made legal is morally distressing to many of us. However, powerful arguments have been provided recently supporting legalisation (I consider two of those arguments: the Consequentialist Argument and the Autonomy Argument). Is our instinctive reaction against a market of organs irrational then? The aim of this paper is not to prove that legalization would be immoral, all things considered, but rather to show, first, that there are some kinds of arguments, offered in favour of legalisation, that are, in an important sense, illegitimate, and second, that even if legalisation might not be wrong all things considered, there are good reasons for our negative moral intuitions. Moreover, identifying these reasons will help highlight some features of moral decisions in non-ideal situations, which in turn might be relevant to some other moral or policy choices.

Commerce↗
PubMed2006

Health care need: three interpretations.

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation.

Health Policy↗
PubMed1986

How children can be respected as 'ends' yet still be used as subjects in non-therapeutic research.

The question of whether or not children may be used as subjects in non-therapeutic research projects has generated a great deal of debate and received answers varying from 'no, never' to 'yes, if societal interests are served'. It has been claimed that a Kantian, deontological ethics would necessarily rule out such research, since valid consent would be impossible. The present paper gives a deontological argument for allowing children to be subjects in certain types of research.

Child↗