Medical Ethics
Michael Green
Manuel Vargas
phone, office information

13 May. Aggregation and Kamm.
13 May. Glover
15 May. How to measure quality in a QALY
15 May. QALYs and fairness
18 May. The veil of ignorance argument
22 May. QALYs in macro and micro contexts
27 May. Rakowski and Post on preferring the younger.
29 May. How great a loss is death?
3 June. Consent as a way out?

Medical Ethics: 11 May. Numbers don't count.

An ambiguous point

I said that Taurek equivocates between agent-relative and agent-neutral values in his friendship and ownership arguments. The important point was clear enough: in the first premise of both arguments, the thing that is morally valuable is valuable to a particular agent, in the second, what's relevant is the value of the thing to just anyone.

But I wasn't terribly clear about what the valued thing is. Oops. It's David's life.

In the first premise, the argument holds that David's life is specially valuable to the agent (the person who has the drug). In the second, the argument holds that David's life has no special value; here, the value of David's life is considered from an agent-neutral perspective, not from the perspective of any particular agent.

Taurek had argued that if we grant the first assumption, we're forced to accept the conclusion (point 3) in both arguments. But once we see that he's equivocating about the point of view from which David's life is (or isn't) especially valuable, we can see that the argument doesn't go through. Specifically, we can grant the first point, which is about what a particular agent is permitted to do, without accepting Taurek's conclusion about what anyone is permitted to do.

Chantal's question

What about someone who owns the drug? Does that person have to use a random decision procedure to figure out who uses it?

The friendship and ownership arguments suggest this isn't what Taurek thinks that person has to do. But the equality arguments that come later suggest that it is.

Note: I've changed my mind a little here

Having looked at it again, here's what I think. Taurek would say that you don't have to use a random decision procedure if you want to use the drug for a friend or yourself, even if there are five others who need it. That's the best way of understanding pp. 305-6.

But I think that Chantal's right to suppose there are some difficult questions about whether Taurek is being consistent here. Why is it that I'm allowed to do that? Isn't that a failure to treat the other five as equals? Why are we allowed to give them a less than equal chance of living?

It may be that there's a serious objection in this. I suspect that this is another manifestation of the schizophrenia of this argument: on the one hand, he appeals to agent-relative values -- the value of my friend's life/my own life to me -- on the other hand, he appeals to agent-neutral values -- we're all equal to one another, etc.

On the other hand, perhaps it just shows that his positive proposal for making decisions like these isn't worked out in much detail. Perhaps he could have provided us with a simple rationale for departing from equal/random decision procedures in these cases. This is something we'll have to think about: could he have done that?

In any event, it's an excellent, challenging question. Chantal scored twice today.

Megan's point

I know I said this in class, but I wanted to mention it again: Megan did exactly the right thing.

After we'd pressed Chantal's point, suggesting that Taurek was appealing to inconsistent premises, Megan argued that he had to appeal to inconsistent premises in order for his argument to (appear to) make headway against the intuitive view that numbers count.

If we can make good on Megan's point (as I think we can), we'll have a much stronger position against Taurek. Plus, we would have been scrupulously fair to Taurek: we would have been sure that we hadn't just caught a minor slip, but that there was a serious difficulty with the whole line of argument.

Lorie's point

Lorie wasn't impressed by the friendship or ownership arguments (really, they're the same argument form, just with different fillings). But she thought the one about how there's no point of view from which the world is worse if more people die is a good one.

That's extremely convenient. We'll discuss this second argument on Wednesday: both Glover and Kamm disagree, albeit in different ways.

Minor notes about Wednesday's readings

Glover criticizes an argument made by Elizabeth Anscombe which is similar to Taurek's.

The Kamm reading is fairly difficult. One way of handling it is to skip to the last section ("IV: The Aggregation Argument", pp. 83-5) in order to see where she's going. Then read through the preceding sections to see how she got there.

Another really nice part of the Kamm article is the way she lays out Taurek's claims at the beginning (pp. 75-6).

Is rationing just for meanies?

It can seem that the main reason for rationing health care is to save money ... for the wealthy owners of an HMO or hospital. That may well be a perfectly legitimate reason to ration health care, but it isn't inspiring, especially if you have leftish political inclinations.

If so, you should know that many who support rationing plans do so because they believe that the saved money can be used to help the poor. More generally, all socialized medical systems employ rationing: they have to since the budgets are public.

Previous | Next

This page was originally posted on 5/27/98; 12:08:11 PM and was last built on 6/3/98; 2:43:47 PM with BBEdit and Frontier 5 on a Macintosh running System 8.1.