How do we choose which life to save? Equality of access or a fair go?

Abstract 

This paper examines the ethics of distributing limited resources when demand exceeds supply. I examine two ethical theories, egalitarianism and utilitarianism, applied to an example of allocating hearts to children who have cardiac failure. I examine the strengths and weaknesses of these approaches. I argue that we must include some concern for equality of access (equal treatment for equal need). But this should occur within a context of first evaluating the impact of a medical intervention on how long an individual will live, his or her quality of life and the probability of the intervention succeeding. I propose a third more plausible approach: ‘a fair go’. I also examine whether the cost of treatment, the existence of dependants and responsibility for illness should play a part in the allocation of limited resources. Finally, I briefly discuss the role of patients and their family in making these decisions.

Keywords: ethics, social justice, healthcare rationing, human rights, patient selection, economics (medical), cost–benefit analysis, healthcare costs, economic value of life, state medicine, prejudice

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• f1 Correspondence to: JS. Tel.: 613 8341 6311; Fax: 613 9348 1391; E-mail: savulesj@cryptic.rch.unimelb.edu.au