Meeting needs and respecting persons : An ethical framework for the allocation of lifesaving healthcare interventions

This thesis considers how we should allocate scarce, lifesaving healthcare interventions among persons in need. In some situations, clinicians must choose how to allocate scarce lifesaving interventions among their patients, and public health administrators must choose how to allocate scarce prophylaxis among population groups. Not everyone’s needs can be met. It is apposite to consider, therefore, how the State should adjudicate between the competing claims that people make on healthcare resources.

In discussing this issue, I take as my point of departure the bioethical principle of respect for persons. Respect for persons is understood by many to be synonymous with the need to obtain informed consent from persons who receive medical treatment or participate in biomedical research. This thesis, however, advances an alternative account of respect based on an ethic of mutual accountability and a concern to take moral claims seriously (Darwall 2006). This conception of respect is used to develop a framework for rationing according to which we should base our decisions on the individual claims of need that candidates make on a resource, and allocate the resource to the person or group with the most serious and urgent health needs. I respond to several recent proposals arguing for the rationing of resources on the basis of age (Kamm 1998; Persad, Emanuel and Wertheimer 2008), utility (Miller 2008; Stein 2012), or desert (Segall 2011; Albertsen 2016). I argue that these approaches fail to take seriously the moral claim that other persons have on our assistance. We fail to respect persons if we fail to give appropriate consideration to their claims of need. This thesis concludes by providing general principles for the allocation of vital organs under conditions of scarcity, and the allocation of vaccines and treatment in a pandemic scenario.