Thursday, April 2, 2020

Utilitarian Response

            With the shortage of hospital beds, respirators and other vital medical supplies, health providers are being forced to make difficult decisions about who is to receive these life-saving services and who is not. Who is to live, and who is to die? I thought the decision-makers might be enlightened by my discussion of the matter.

            It has been suggested that we might have to go to a utilitarian criterion: Treat the person who is most likely to create the greatest happiness, or greatest benefit (there is some disagreement here among phiiosophers), for the greatest number of people?

            There are, of course, some ethical problems. Do you give priority to a rich guy who promises to donate money to build a hospital if you treat him first? That would certainly provide the greatest benefit for a lot of people – unless you have a big subtraction for how pissed off people are at the privileged guy who cut in line. Or, using similar logic, do you give priority to health care workers because they are also in short supply and are more essential than hospital beds and other supplies? This is not as easy to reject as the wealthy donator, except it may be these same health care workers who are making decisions to treat themselves.

            And teachers, of course, need to be treated first, for obvious reasons. I’m still trying to come up with a rationale for treating retired English teachers.

            But some questions remain. Here are some hypotheticals:

·      In order to increase the average level of human happiness on the planet, per capita, do you deny treatment to unhappy people?

·      Do you give priority to sick people with large families because saving them would make more family members happy? But of course, in some families the math does not work that way . . ..

·      Do you deny treatment to politicians who, if elected, in your judgment would create widespread unhappiness and would not benefit people?

·      Choose one seriously ill teenager to treat:
o   poor, a high-school dropout, no job
o   wealthy, accepted at Harvard, plans on pre-med
o   very bright but arrogant and selfish

            Perhaps it’s best to sidestep the utilitarian quicksand and go straight to triage, a method of deciding that goes back to the ancient Egyptians but is best known from its application in World War I. Triage, according to Wikipedia, divides the sick and wounded into three categories:

·       Those who are likely to live, regardless of what care they receive;
·       Those who are unlikely to live, regardless of what care they receive;
·       Those for whom immediate care might make a positive difference in outcome.
Easy, right, given enough medical knowledge? Forget trying to create the greatest benefit or the greatest happiness for the greatest number. Forget privilege.
            But how about this: You have two sick patients and one respirator. The one who gets the respirator has an 80% chance of surviving. The one who does not get it has a 20% chance. But if you come up with a way to have the two of them share a single respirator, each has a 50% chance. Who gets it? Does your decision change if the shared respirator gives each a 40% chance of survival?
            You may feel that this essay is flippant and in bad taste, given this very real suffering caused by our pandemic. Believe me, I am writing from the heart. Decisions similar to the ones I present are being made daily, and what are the chances that a person in her 70s with stage 4 cancer would make the cut?
            When Kim read this, she said that she would give up her respirator to a young person, “but it wouldn’t be easy.”

1 comment:

  1. Dear David - thank you for this thoughtful post. As meaningful as it is to think this through as a citizen of the world, there are literally doctors DOING THIS right now. In Italy, and in New York? What a responsibility and burden on these already overworked people. No solution will be perfect or "fair" in my opinion. I think someone with authority just needs to make a judgement (based on the best thinking possible) and create a process health workers can follow. Take this burden off of the overworked doctors and other medical staff so they can do their job! Much love and stay safe, Kirstin