Revisiting Macklin's arguments against the complete lives principle

Authors

  • Federico Abal IIF - SADAF - CONICET

DOI:

https://doi.org/10.5007/1677-2954.2023.e93527

Keywords:

Ageism, Triage, Allocation, Resources

Abstract

In June 2020, Ruth Macklin published a critical essay against a guideline from the General Health Council (Consejo de Salubridad General) of México that recommended using age as a tie-breaking criterion to allocate scarce therapeutic resources. The guideline based this recommendation on the complete-lives principle. In this paper, I reconstruct and reject the three arguments presented by Macklin against the complete-lives principle. Subsequently, I formulate three objections of my own to the complete-lives principle.

References

BIDADANURE, J. Discrimination and Age. In: LIPPERT-RASMUSSEN, K. (Ed.) The Routledge Handbook of the Ethics of Discrimination. London: Routledge, 2017.

BOGNAR, G. Fair Innings. Bioethics, V. 29, N. 4, p. 251-261, 2015. DOI: https://doi.org/10.1111/bioe.12101

CSG - Consejo de Salubridad General de México. Proyecto Guía de Triaje para la Asignación de Recursos de Medicina Crítica, 2020. Link: https://laurieximenez.files.wordpress.com/2020/04/3-guia_bioetica_15abril2020_v3.pdf

DANIELS, N. Am I My Parents Keeper? An Essay on Justice between the Young and the Old. New York: Oxford University Press, 1988.

EMANUEL, E. J., PERSAD, G., UPSHUR, R., THOME, B., PARKER, M., GLICKMAN, A., ZHANG, C., BOYLE, C., SMITH, M. & PHILLIPS, J. P. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine, V. 382, N. 21, p. 2049-2055, 2020. DOI: 10.1056/NEJMsb2005114

FISHER, A. Fair Innings? Against Healthcare Rationing in Favour of the Young over the Elderly. Studies in Christian Ethics, V. 26, N. 4, p. 431-450, 2013. DOI: 10.1177/0953946813492918

GAMLUND, E. What is so important about completing lives? A critique of the modified youngest first principle of scarce resource allocation. Theoretical Medicine and Bioethics, V. 37, N. 2, p. 113-128, 2016. DOI: 10.1007/s11017-016-9358-8

GOSSERIES, A. Euthanasie des mineurs, pourquoi un critère d'âge?. La Revue Nouvelle, N. 68, p. 74-84, 2013. Link: https://revuenouvelle.be/Euthanasie-des-mineurs-pourquoi-un-critere-d-age

GULLETTE, M. M. Avoiding Ageist Bias and Tragedy in Triage. Tikkun, April 14, 2020. Link: https://www.tikkun.org/avoiding-bias-and-tragedy-in-triage/

INOUYE, S. K. Creating an anti-ageist healthcare system to improve care for our current and future selves. Nature Aging, 1, p. 150-152, 2021. DOI: https://doi.org/10.1038/s43587-020-00004-4

JECKER, N. Too old to save? Covid?19 and age?based allocation of lifesaving medical care. Bioethics, V. 36, N. 7, p. 1-7, 2022. DOI: 10.1111/bioe.13041

KERSTEIN, S. & BOGNAR, G. Complete Lives in the Balance. The American Journal of Bioethics, V. 10, N. 4, p. 37-45, 2010 DOI: 10.1080/15265160903581718

MACKLIN, R. Allocating medical resources fairly: the CSG bioethics guide. Salud Pública de México, V. 62, N. 5, p. 590-592, 2020 DOI: https://doi.org/10.21149/11486

MILLER, F. G. Why I Support Age-Related Rationing of Ventilators for Covid-19 Patients. The Hastings Center, April 9, 2020. Link: https://www.thehastingscenter.org/why-i-support-age-related-rationing-of-ventilators-for-covid-19-patients/

NIELSEN, L. Pandemic Prioritarianism. Journal of Medical Ethics, V. 48, N. 4, p. 236-239, 2022. DOI: 10.1136/medethics-2020-106910

OBD – Observatori de Bioética i Dret, Universitat de Barcelona. Recomendaciones para la toma de decisiones éticas sobre el acceso de pacientes a unidades de cuidados especiales en situaciones de pandemia, 2020. Link: http://www.bioeticayderecho.ub.edu/es/recomendaciones-toma-decisiones-eticas-sobre-acceso-pacientes-unidades-cuidado

PERSAD, G., WERTHEIMER, A. & EMANUEL, E. J. Principles for allocation of scarce medical interventions. The Lancet, V. 373, N. 9661, p. 423-431, 2009. DOI: https://doi.org/10.1016/S0140-6736(09)60137-9

PERSAD, G., WERTHEIMER, A. & EMANUEL, E. J. Standing by our principles: meaningful guidance, moral foundations, and multi-principle methodology in medical scarcity. The American Journal of Bioethics, V. 10, N. 4, p. 46-48, 2010. DOI: 10.1080/15265161003650528

RIVERA LÓPEZ, E., ABAL, F., REKERS, R., HOLZER, F., MELAMED, I., SALMÚN, D., BELLI, L., TERLIZZI, S., ALEGRE, M., BIANCHINI, A. & MASTROLEO, I. Propuesta para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Revista de Bioética y Derecho, V. 50, p. 37-61, 2020. DOI: https://doi.org/10.1344/rbd2020.50.31816

RIVLIN, M. Why the fair innings argument is not persuasive. BMC Med Ethics, V. 1, N. 1, 2000. DOI: https://doi.org/10.1186/1472-6939-1-1

SCANLON, T. What We Owe To Each Other. Cambridge (MA): Harvard University Press, 1998.

SIAARTI - Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care. Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments in exceptional, resource-limited circumstances, 2020. Link: https://d1c2gz5q23tkk0.cloudfront.net/assets/uploads/3017015/asset/SIAARTI_-_Covid-19_-_Clinical_Ethics_Reccomendations.pdf?1606745893

SINGER, P. Is Age Discrimination Acceptable?. Project Syndicate, June 10, 2020 Link: https://www.project-syndicate.org/commentary/when-is-age-discrimination-acceptable-by-peter-singer-2020-06

TALLMAN, R. Valuing Lives and Allocating Resources: A defense of the Modified Youngest First Principle of Scarce Resource Distribution. Bioethics, V. 28, N. 5, p. 207-213, 2012. DOI: https://doi.org/10.1111/j.1467-8519.2012.01994.x

UP – Department of Critical Care Medicine, School of Medicine, University of Pittsburgh. Allocation of Scarce Critical Care Resources During a Public Health Emergency, 2020. Link: https://bioethics.pitt.edu/sites/default/files/Univ%20Pittsburgh%20-%20Allocation%20of%20Scarce%20Critical%20Care%20Resources%20During%20a%20Public%20Health%20Emergency.pdf

Downloads

Published

2023-11-29

Issue

Section

Dossiê Justiça Pandêmica Global