Some protocols for rationing limited health care resources focus on the relative need of patients and their relative chances for getting better. Others focus on things like age, cognitive ability, and physical capacity. What sorts of ethical considerations should guide hospitals, medical groups, and other institutions who are trying to decide how they will distribute their limited medical resources?
At the core or foundation of the answer to just about every important ethical question is the principle of the profound, inherent, and equal dignity of each and every member of the human family. In making decisions — including hard, even tragic, decisions about distributing limited medical resources — it is critical that we treat every person as equal in inherent worth and dignity to every other person.
We must avoid the temptation to treat some as superior (and others as inferior) because, for example, they are young and strong (rather than old and frail) or able-bodied (rather than physically disabled or cognitively impaired). The temptation to discriminate invidiously will present itself — about that I’ll give you a money-back guarantee.
Some people will want to throw over the radical egalitarianism (all human beings are “created in the image and likeness of God”; “all men are created equal”) of the sanctity of life ethic and replace it with a “quality of life” ethic that is amenable to decision-making by utilitarian calculation. We must be firm in our resistance to anything of the sort.
If some institutions decide to ration health based purely on age or disability, might they face lawsuits for violations US civil rights law?
Yes, our federal civil rights laws (as well as many state statutes) forbid discrimination based on age or disability. To its credit, the U.S. Department of Health and Human Services’s Office of Civil Rights, under Roger Severino, has already spoken forcefully about the applicability of these laws when it comes to the care of patients and the allocation of health care resources. I’m glad they are getting out ahead on these issues, because, as I noted, the temptation to discriminate invidiously will come.
Some people will say, “why should that Down Syndrome person be given a ventilator when it could be given to someone who’s not ‘retarded’ and who can contribute more to society?” A fully sufficient answer should be: “because in fundamental worth and dignity, the Down Syndrome person is every bit the equal of any other person.”
But for some people, that will cut no ice. But here is an answer that will: “Because federal law forbids discrimination based on disability and you or your institution will be sued or prosecuted if you engage in such discrimination.”