Medical Ethics
Michael Green
Manuel Vargas
phone, office information

11 May. Numbers don't count.
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?

Medical Ethics: 3 June. Consent as a way out?

The meaning of life

I meant to add one thing. Often, "the meaning of life" seems like a silly thing to talk about because people expect a kind of answer that is too specific. They think that a philosophical discussion of the meaning of life will tell them what to do with their lives, who to marry, what job to take, and so on. That's probably not going to happen (or, if it did, it's not advice that you'd want to accept: beware of gurus).

But we can still say sensible things about the meaning and value of life; we just have to restrict ourselves to saying something more abstract than that. It all depends on the level of description that you employ. (Of course, since it's so abstract, it's hard to see if what we said was true. But that's a different problem).


That last piece about consent went by rather quickly, so here are my notes.

1. Why consent is attractive

a) helps to make questionable, difficult value judgments: if we're unsure about the relative value of life as an older person vs. the quality of life as a younger person, we should let affected people decide instead of trying to make a decision ourselves.

b) it legitimizes otherwise questionable decisions: those who lose in rationing decisions can't object to losing if they previously agreed to abide by the rationing rules.

2. versions of consent

a) actual consent: what you did agree to

b) hypothetical consent: what you would have agreed to

3. problems with actual consent

a) generally can't be obtained for many questions: e.g. value of life -- the best we can do is survey some people and extrapolate the results to the population at large.

b) when someone expresses consent about complex health care or rationing issues, it's not clear that the person is fully informed. But expressions of consent in ignorance are not really consent.

c) fairness: patients with a known problem may form a smallish minority, such that the majority won't agree to put their problem high on the priority list. If we rely on actual consent, we may magnify other social or economic inequalities in ways that seem unfair.

d) by contrast, hypothetical consent seems better.

i) we can imagine what people would agree to if they were fully informed.

ii) or what people would agree to if they weren't biased by knowledge of their own situation (that's one version of the "veil of ignorance" strategy, as Shannon shrewdly pointed out; note that Singer, McKie, et. al. put no weight on any ideas about consent -- they thought their veil of ignorance argument showed that the use of QALYs is fair, not that it is justified on grounds of consent.).

4. problems with hypothetical consent

a) information is even less reliable: are we sure that's what people really would have decided on?

b) It's not clear that it does all the moral work that it's supposed to do:

i) I would have bet $20 if I had stayed in the poker game; but that doesn't mean I'm required to put $20 in.

ii) nor does the fact that I would have agreed to a certain insurance plan when I was not ill mean that I have waived my rights to complain when you seek to deny me coverage.

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This page was originally posted on 6/14/98; 10:35:36 AM and was last built on 6/14/98; 10:35:45 AM with BBEdit and Frontier 5 on a Macintosh running System 8.1.