Bioethicists, moral philosophers and social policy analysts have
long debated about how we should decide who shall be saved with
scarce, lifesaving resources when not all can be saved. It is often
claimed that it is fairer to save younger persons and that age is
an ethically relevant consideration in such tragic decisions.
Medical benefit should be maximized and final selection should aim
to minimize the contaminating influence of chance. These claims are
challenged by Duff R. Waring in Medical Benefit and the Human
Lottery, one of the few books that attempts a sustained defence of
random patient selection.
This book combines ethics and political philosophy in its novel
and strict egalitarian approach to patient selection for
transplantable organs. Waring addresses the question of whether we
should choose between lives on the basis of fair chances or best
outcomes. He argues that final selection criteria should be based
on fair chances that equalize opportunity as opposed to best
outcomes. His defence of "hardy" egalitarianism aims to show that
random selection by lottery can affirm both a common humanity and
the equal value of lives. The notion of patient selection by
lottery has not fared well in bioethics and has been regarded by
some as a moral affront. Waring argues that a human selection
lottery may be neither as crude nor as ethically anomalous as some
have supposed. Indeed, it can reflect a familiar conception of
equality as a political and moral ideal. This conception abstracts
from many undeniable differences between patients and claims that
scarce resources should be allocated on the principled assumption
that each of their lives is equally worth saving. The book isalso
notable for its critiques of some recent utilitarian notions of
medical benefit which can have an age-biased impact on elderly
patients. Waring then argues against the leading, contemporary
age-based approaches to patient selection. He explores the way
random selection by lottery can affirm his egalitarian ethos in
cases where eligible transplant candidates have each passed a
threshold level of prospective medical benefit that has been set by
democratic deliberation. Taming chance with a human lottery is
defended as the most lucid means of ensuring equal opportunity. In
so doing, Waring argues that we give the principle of equal concern
and respect a radical expression: above a noncomparative threshold
of medical benefit, each candidate can have an equal claim to
Springer-Verlag New York
|Country of origin:
||International Library of Ethics, Law, and the New Medicine, 22
Duff R Waring
||297 x 210 x 14mm (L x W x T)
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