Who should receive life support when not all can?

A respiratory epidemic has occurred. People are rushing to hospitals and only the mechanical help of respirators could keep them alive. There are of course not enough respirators for everyone. Who should have priorities?

This is the scenario presented by Dr. Douglas White in his seminar at University of California, San Francisco. This is a problem of how to allocate limited resources with a giant red tag for violation of personal and medical ethics. In these situations, there are only losses. All we could hope for is to maximize what could be retained. Which criteria should be used to rank these patients?

Under the egalitarian principles, everyone is viewed to have the same worth. Determining who should be treated is simple. Either a lottery based system or a first come first served approach would suffice. Critics of the egalitarian approach argue that the random selection does not ensure the best results. Resources could be wasted on lost costs. Rebuilding/recovering normal society is not ensured. It is when the utilitarian approach is adopted, however, that ethics would most likely be breached.

Yes, the greatest goods for the greatest number of people sound fantastic. Except for those left with out of those benefits.

If people do not have the same worth, who should receive treatment:

A. 35yrs old mother of 3 children with breast cancer. 50% chance of survival.
B. 85yrs old pastor. 80% chance of survival.
C. 16yrs old boy. 20% chance of survival.
D. 20yrs old ex-convict. 70% chance of survival.

These are just simple representations of the factors that are at play when a person’s worth is calculated. Humans are creatures of foresight, but we use our past to help us predict our future. These predictions might or might not be accurate. What are the chances of the 16yrs old turning criminal or the ex-convict turning a new leaf (both examples could be seen with single example of Frank Abagnale Jr. - popularized by his life story adapted to the movie “Catch Me If You Can”)? What are the chances that the mother would recover from her cancer? These are the probabilities we simply do not know, especially with the occurrence of a significant event. A person’s narrow social value - the function the person could provide to help society get out of the crisis - has not even been discussed. Dr. White advocated for an integration many different criteria instead of single criterion of social values, the number of lives saved, or the number of years saved…

The most provoking part of this seminar for me is during questions and discussions. The example used is a shortage of respirators. People with pulmonary failures do have personal respirators at home. As a matter of fact, those patients often have two: main and back-up. These patients also have poor prognosis. The question is would we cease those respirators to treat those affected by the epidemic with better prognosis. I would say the collection of the back-up respirator is reasonable. Yes, there is an intrusion of personal rights but I think this violation is minimal if those respirators could keep many alive. The collection of the main respirator, however, would be utterly unacceptable. The oath to do no harm would be completely violated. When we are robbing life from the weak even with the intentions to help many others, we are taking away what is worth more than a live. We are taking away our humanity. That would be too great of a loss.