Resource Allocation - Age

Rationing according to age.

Doesn't always mean favouring the young and restricting access to old.

It's usually about life prolonging treatments. It's not usually about nursing care, or palliative care.

Consequentialist

For: QALYs

Saving the life of a 20yr old vs an 80yr old with same condition will generate more QALYs.

Same is a treatment that improves the quality of life of an 80 yrs

This isn't so much about the age, as it is the expected remaining life span. So it would also deprioritise those with life limiting illnesses even if young.

For: Societal Benefit

Younger people more likely to be economically 'useful'. Not saving them will have worse overall consequences for society

The problem here, is that age and 'societal benefit' isn't always the strongest advocate. It also means that young children are a low priority. It also implies that you should favour those with dependents (children) as losing them would have worse consequences.

Against: Anti Ageist - John Harris

All of us who wish to go on living have something that each of us values equally although for each of us it is different in character… This thing is of course ‘the rest of our lives’… So as long as we each fervently wish to live out the rest of our lives, however long that turns out to be, then… we each suffer the same injustice if our wishes are deliberately frustrated and we are cut off prematurely. (Harris 1985, p.89)

So he implies that both young and old who die lose the same thing. Or something that they value equally.

Even if it is something we individually value equally, it doesn't mean it actually is equally valuable.

Harris argues that what is a value of a life, is the values the individual gives it. But what if the person doing the valuing is wrong, or has been limited by things outside their control, or values things we wouldn't approve of. Do we still value their life in the same way they do?

Deontology

For: Harris

Harris goes for the "fair innings" argument. Putting that it's fair, because everyone has the same situation where when they are young they are favoured, and when they are older it becomes someone elses turn to be favoured.

Harris picks a threshold age of 70. It's more a tragedy to die before that threshold, than after.

But then a difficulty becomes, where should you place that threshold? And why should that age matter only at the threshold? Once age matters at one age, surely it matters at all ages?

For: Callahan - Natural Lifespan

Callahan talks about the difference between a premature death and a tolerable death. Callahan uses a communitarian view, rather than of individuals and fairness between individuals.

A tolerable death is:

At that stage in a lifespan when (a) one’s life possibilities have on the whole been accomplished; (b) one’s moral obligations to those for whom one has responsibility have been discharged; and (c) one’s death will not seem to others an offense to sensibility, or tempt others to despair or rage at the finitude of human existence. (Callahan 1987, p. 66)

So he feels it should be based on a communal consensus on the place of old age in the life cycle. Older people should have different priorities than when they were younger. They have completed the major phases of life, and should now use their experience in the service of future generations.

The goal of medicine should be to acheive a natural lifespan for all, and then after that there should be no entitlement to life-prolonging care once a "normal" lifespan is reached

What do older people think of this? What does this consensus amount to?

It seems unlikely that people will actually reach this consensus. It also seems likely that older people will have multiple different views on their priorities

This has the same issues as Harris'. It's just you've removed Age and replaced it with Completing Life Goals

For: Veatch - Prioritising worst off over life

What Veatch does is take Rawl's idea of maximin that "justice requires identifying the worst-off individuals and allocating resources so as to give those persons an opportunity to be as well off as others"

He says you should apply this to "slice of time" and "over a lifetime" perspectives

Veatch argues that a 40 yr old vs a 60 yr old has had much less opportunity for wellbeing. (My thoughts, why can't you flip that and say the 60yr old has less remaining time left for wellbeing?)

This isn't just about prolonging life, but also quality of life

So then the issue is whether you should use the slice of time perspective or the over a lifetime perspective?

McKerlie argues that it's about acheiving equality between simultaneous stages of different lives. And so we're comparing 40yr old today vs 60yr old today, not taking on their past.

Against

What if age-based rationing is a discriminatory and injust practice?

Discrimination is when a group are treated differently based on a difference that either doesn't exist or is insufficient to justify the difference in treatment.

So with the consequentialist arguments are based on the differences in "remaining lifespan" or "usefullness", then are these differences sufficient enough? Also why are we not going directly for these categories rather than using age as a proxy measure>

Danils - Prudential Lifespan Account

We should allocate resources based on lifestages through which we all pass, rather than person vs person.

As we aren't good enough at preparing for ill health ourselves, society should do that, and use the threshold of planning for what a "prudent" person would choose.

To work out what a prudent person whould use, we should use Rawls' "veil of ignorance"