Medical Ethics
Michael Green
Manuel Vargas
phone, office information

11 May. Numbers don't count.
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: 13 May. Aggregation and Kamm.

So much to say and so little time. Sigh.

What we did and didn't show

At most, we gave an argument for the view that the world is worse if more people die than it would be if fewer die. That's simply worse, not worse from any particular person's perspective. That's what Kamm will have shown if she's completely successful.

But Taurek still has an argument: it's unfair to the smaller number of people to always choose to save the greater number of people. We should give each person an equal chance of living instead. He can still stick to this even if he loses the argument that the world can't better or worse from no particular person's perspective.

Looking ahead

There's a general point here: what rules should we follow in rationing care? Should we allocate our health care resources so that they save the greatest number of lives? Should we allocate our health care resources so that everyone has an equal chance of having his or her life saved?

What's coming up next is a version of this debate. Some (Singer, McKie, et. al. believe that we should allocate health care resources to produce the greatest number of Quality Adjusted Life Years (QALYs, for short). Maximizing QALYs would mean maximizing the number of lives saved but with extra weight given to higher quality lives over lower quality lives: those who could only live on in a hospital bed score lower in terms of their quality of life than those who could move about normally. Harris, on the other hand, thinks that this would be unfair. His basic position is much like Taurek's.

Read over what Taurek says about the boat and the volcano: it's about how he thinks public resources (the boat and coast guard captain) should be distributed.

Here's a quick summary. There's an island about to be destroyed by a volcano. The island's coast guard boat can save the many people on the north end of the island or the few at the south end. You might think that a publicly financed coast guard should always save the greatest number. But why is that fair to the people on the southern tip of the island?

But what if the public policy had been settled in a fair way, such that everyone agreed that the coast guard should save the greatest number of people in an emergency? Then Taurek would have no objection: no one could object that the policy is unfair since everyone had agreed that that's what the coast guard should do.

There are good reasons why they'd make this choice. If I don't know where I will be when the volcano erupts, I'd choose the policy of saving the greatest number: that maximizes my chances of being saved.

But if I know that I'll be at the southern end, I wouldn't choose the policy of saving the greatest number and I'd be sure to object that my tax dollars were going to finance a boat that will do nothing for me.

Of course, not all rationing questions involve public resources (the case of David and the drug was a rationing question). But many of them do.

Of course, we don't have to look too far ahead. Jean beat me to the punch today -- she saw right through to the big issues in rationing health care.


We didn't get to talk about Glover's argument in class today and, given the schedule, we probably won't get to it. Still, you can look at what I would have said.

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This page was originally posted on 5/27/98; 12:08:17 PM and was last built on 6/3/98; 2:43:53 PM with BBEdit and Frontier 5 on a Macintosh running System 8.1.