progressivism, individualism, and the public ... - Telmarc Group

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The Telmarc Group PROGRESSIVISM, INDIVIDUALISM, AND THE PUBLIC INTELLECTUAL equality of opportunity, and allows physicians to avoid discontinuing interventions, such as respirators, even when other criteria support moving those interventions to new arrivals,,, Favoring the worst-off : prioritarianism Franklin Roosevelt argued that “the test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little”. Philosophers call this preference for the worst-off prioritarianism… Sickest first: Treating the sickest people first prioritizes those with the worst future prospects if left untreated. The so-called rule of rescue, which claims that “our moral response to the imminence of death demands that we rescue the doomed”, exemplifies this principle. Transplantable livers and hearts, as well as emergency-room care, are allocated to the sickest individuals first… Youngest first: Although not always recognized as such, youngest-first allocation directs resources to those who have had less of something supremely valuable—life-years. Dialysis machines and scarce organs have been allocated to younger recipients first, and proposals for allocation in pandemic influenza prioritize infants and children… Save the most lives: One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccine and responses to bioterrorism. Since each life is valuable, this principle seems to need no special justification. It also avoids comparing individual lives… Prognosis or life-years: Rather than saving the most lives, prognosis allocation aims to save the most life-years. This strategy has been used in disaster triage and penicillin allocation, and motivates the exclusion of people with poor prognoses from organ transplantation waiting lists. Maximizing life-years has intuitive appeal. Living more years is valuable, so saving more years also seems valuable… Instrumental value: Instrumental value allocation prioritizes specific individuals to enable or encourage future usefulness. Guidelines that prioritize workers producing influenza vaccine exemplify instrumental value allocation to save the most lives. Responsibility-based allocation—eg, allocation to people who agree to improve their health and thus use fewer resources—also represents instrumental value allocation... Reciprocity: Reciprocity allocation is backward-looking, rewarding past usefulness or sacrifice. As such, many describe this allocative principle as desert or rectificatory justice, rather than reciprocity… The complete lives system: Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles…: (i) youngest-first, (ii) prognosis, (iii) save the most lives, (iv) lottery, and (v) instrumental value. As such, it prioritizes younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many Page 166
The Telmarc Group PROGRESSIVISM, INDIVIDUALISM, AND THE PUBLIC INTELLECTUAL thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate…." Emanuel et al then state: "As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”; this argument is supported by empirical surveys. , Importantly, the prioritization of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice. " The complete lives system in my opinion reduces to a simple formula. Save anyone say between 15 and 55, and let the rest die. The very young have nothing immediate to contribute and the old have already contributed. The morality of the approach is not the least it considered, it appears to be pure Rawlsian with a flavor of keeping costs down. Thus it seems that with the Emanuel et al system we would let say a Nobel Prize winner who is 66 die and treat a 23 year old crack addict with three counts of murder. The system allows those in teens thru early middle age be treated and then withdraw treatment from the others. This approach seems to take abortion a few more steps beyond the womb. They then conclude: "The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 15 year olds receive priority over 65 year-olds, everyone who is years now was previously years. Treating 65 year olds differently because of stereotypes or falsehoods would be against treating them differently because they have already had more life-years is not." 6.4.4 A Summary of Rawls Amartya Sen is a welfare economists who is also at Harvard a was awarded the Nobel Economics Prize for his work in that area. Sen is a thinker of broad scope and he tends to look at the many sides of the argument and he often consider the "on the one hand and Page 167
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The Telmarc Group and the Progressi
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