Who should we prioritize in times of the coronacrisis for scarce hospital resources?

By László Molnárfi, S7HUA, EEB1.

Whereas deontologist principles – the idea that actions are judged on some inherent moral value– are very noble, the world often requires utilitarian principles. Deontologists would say in this case that since all men and women are equal due to their inherent human value, based on Locke’s theories of all humans possessing the faculty to reason or some other principle, hospital beds are to be distributed on a first-come-first-served basis or a random distribution through lottery. 

However, it is precisely this capacity to reason that gives way to another path, based on mathematical formulas that calculate the worth of a life of a sick patient. Surely, it makes no sense to allocate a bed to an at-risk 75-year old with a low survival rate, if another 16-year old has a much higher chance at survival were he to be given help? In other words, it is clear that it is illogical, even immoral, to distribute beds in such a way that minimizes the number of lives saved – a principle of utilitarianism. And in this, a moral dilemma arises, forcing practitioners of the medical profession to play God. Given that deontologism is not the moral way to proceed, how can healthcare professionals apply utilitarianism in the most moral way? 

In a comparison with the famous Trolley problem, it becomes the doctors who pull the lever to divert the train of death from one person to another. But perhaps, in a situation with no truly ethical solution, “absolute” good can be foregone in favour of the “best” good – the one that causes the least pain and most contentment for the individual in question. Thus, one should agree with prioritizing those who have the higher chance of survival, but the calculations thereof should be free from any other bias.  

This means that other more subjective criteria, such as the perceived importance of a person in society must be disregarded, even if this be contrary to the opinion of pure utilitarianists – this solution hereby proposed applies a form of utilitarianism but does not fully adhere to it. Not age, race, class or profession should decide, but a clinical examination that determines with a single result: the percentage of chance of survival. The person who has a higher chance must be prioritized, no matter their age. Otherwise, the moral and mathematical principles of utilitarianism are spoiled with a subjective human-invented criteria, because in the end, utilitarianism means that those working in healthcare do not have to pull the level: the laws of nature, of biology and that of mathematics pulls it for them. 

But then, a new dilemma arises. On the principles of utilitarianism, what happens if a 75-year old is said to have a higher chance than the 16-year old? What if two 16-year olds have the same chance? Who gets to decide then? 

In the former case, utilitarianism can be applied here as well. In the case of an older patient’s life versus a younger patient’s one, the formula devised by Bentham’s hedonistic calculus can be applied. One of its criteria, apart from the survival rate (C – Certainty), would be the length of possible life afterwards, I.e. the length of possible happiness that saving a patient can cause (Duration – D) – thus, the 16-year old is treated. This is also called the “fair innings principle”. In the latter case, however, a simple draw is the most moral way to decide, leaving this life-or-death question to the chance of nature or that of God himself, free from the hands of the medical practitioners. 

In short, the reason why deontologists approaches fail in this case is simply because of the following. While it ensures a morally fair distribution of beds, it disregards other principles, such as the number of people who will survive and thus have the capacity to be happy afterwards – as more people will die if beds are distributed randomly, and so will those who would otherwise most likely live – and the length of possible happiness caused. On the other hand, utilitarianism combines a moral way of distributing scarce hospital resources – leaving it up to chances of biology and mathematics just like deontologists – while at the same time ensuring that the greatest number of people can survive and live happily in a sort of real-world, applied deontology. 

Naturally, it is a question whether our mathematical formulas are precise or how much close they get to the actual mathematical chance of survival –as human methods and ways of gauging this can never match the absolute percentage of survival as it really is in the world – but perhaps that is for another writing. In an imperfect world like ours, we cannot apply any perfect formulas, thus we should settle for the best possible way, and that is a utilitarian-based hedonistic calculation, which can be said to still have traces of deontology, as the contentment caused by using this method is an inherently “good” moral virtue. 

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