David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Ethical Perspectives 6 (2):115-125 (1999)
Due to the increasing cost of health care and the diminishing resources available, priority of health care resources has become a most important political and ethical issue. What principles should guide the decisions of priorities? The Swedish Commission of Priorities in Health Care proposed in 1995 that priorities in health care should be based on a Principle of Human Dignity . Later, the recommendations of the commission were implemented in Swedish law.The question I will try to answer in this article is whether a principle of human dignity is helpful when establishing priorities in health care. What implications, if any, will it have for the decisions on how to make priorities?It is often said that human life has intrinsic value and that human beings are inviolable. When applied to normative ethics, these views are the bases for a Sanctity of Life Principle and a Principle of Human Dignity , ethical standards that have a long history in the western tradition. The principles stating the intrinsic value of human life have been interpreted in different ways and there are a large number of definitions of concepts like `sanctity of life' and `human dignity' . The concept `sanctity of life' is often used by authors in a religious tradition, while `human dignity' is usually used by secular authors. Immanuel Kant, using the concept `dignity' is one example of the latter.To establish a priority is to make a choice to do one thing before something else. In health care it means in practice in some cases a choice to treat one patient first. It seems that if human life is of intrinsic value and inviolable, one should always give priority to life-saving treatment and critical care. Thus, a duty always to save human lives would follow from the PHD and saving human life would be primary in an ordering of priorities. As a consequence, one could question an allocation of health care resources to other ends than saving human lives.One objection against this application is that it leaves out of account the distinction between direct and indirect ways of saving human lives. Some minor illnesses may in the long run become grave, if they are not treated when they are just minor. Thus, to treat them at an early stage is an indirect way of saving the life of the patient. And it may also be a more cost-efficient way. The treatment at an early stage may be much easier and cheaper than at a late stage in the development of the illness.On the other hand, the objection based on the distinction between direct and indirect ways of saving human lives applies only to some of the minor illnesses. There are others, among them fractures, which in the long run do not threaten the life of the patient if not treated.The PHD has been under forceful attack in recent discussions in medical ethics. It is said to imply indefensible consequences and stands accused of being a remnant of a moral tradition no longer relevant. Does the PHD imply that saving human life is primary in an ordering of priorities? Is the principle relevant for the discussion on priorities in health care? In order to answer these questions I will examine some different views of the PHD and ways of applying the principle to decisions on priorities. I will start with the report from the Swedish Commission on Priorities in Health Care that claimed that the PHD should be the most basic principle for priorities. Than, I will examine some theological and philosophical views in support of, or questioning, the PHD. I will relate the application of these views to the moral aspects of establishing priorities in health care. Finally, I will answer the question whether the PHD really has any relevance for decisions on priorities in health care
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