Abstract

A well-known thought experiment has us ponder a lottery system that selects one person as the source of transplantable organs for two others. The organs are forcibly harvested and the “donor” dies, whereas the other two patients live. The Survival Lottery is supposed to get at the distinction between killing and letting die, but it is also a challenge to beliefs about moral duties: what are my obligations if my life could be used to save yours and another person's as well? A less extreme version of this thought experiment might have us imagining that officials of the public healthcare system would devise a similar lottery in the aftermath of a large-scale medical emergency. We could imagine that a natural disaster or an attack using biological weapons, for example, has so diminished the ability to provide public health care that in some communities, officials might consider implementing a lottery. To avoid the concerns about outright killing of selectees, officials might offer a wide range of participation in medical practice and research, not just organ allocation. Officials could ensure that no significant risks are involved, and selectees could in various ways be compensated. Would it be possible to ethically justify this “Healthcare Lottery” on the grounds that it was a temporary, yet necessary, infringement on autonomy?