I am currently editing a journal article discussing flu pandemic response plans in the United States. If a flu pandemic were to break out in the US, there would be nowhere near enough vaccines available to treat everyone, so there has to be some kind of priority distribution system. The US’s Pandemic Response Plan relies on principles of medical triage (French term meaning: sorting, picking, or grading according to quality; today defined as the medical screening of patients to determine their priority for treatment). The priority system consists of 4 Tiers:
Tier 1:
-People who are essential for vaccine production
-Medical and public health care workers
Tier 2:
-People 6 months-64 years who are most susceptible to influenza excluding those over 65 and those with compromised immune systems based on the idea that treatment would be futile
-Other emergency responders and public safety workers
Tier 3:
-Government decision makers
-Funeral directors and embalmers
Tier 4:
-Healthy people 2-64 years of age not otherwise included in other categories (the reasoning being that this group is least likely to actually catch influenza in the first place)
The US’s Flu Pandemic Response Plan is based on distributing vaccines in a manner to maximize the common aggregate benefit. In other words, sacrificing individual interests to obtain the greatest good for the greatest number of people. Is this a fair system?
I could not help but notice that similar ideas of medical triage seem to be pervasive in our organ donation allocation system. It appears from my minimal research that organ priority is currently based on “need.” However, if the US is going to apply consequentialist ideas of obtaining the greatest “aggregate good” in its Pandemic Response Plan, why not apply the same logic in organ transplantation? Wouldn’t this mean factoring in the ability of the persons on the wait list to contribute to society? Wouldn’t it be more beneficial to give organ priority to young, otherwise healthy people with more years ahead of them to contribute to society? Although certain elderly persons may be unfairly denied organs with such a system, the whole idea should be the aggregate good, shouldn’t it?
Although I do not necessarily agree with the ideas of triage over a lottery or need based system for organ allocation, it is an interesting argument from a consequentialist point of view.
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3 comments:
I agree that, from a consequentialist perspective, applying a "triage" framework to organ allocation presents an interesting scenario - but for what its worth, I think it presents a very dangerous one. I posted a blog entry on just that - the changes being contemplated in the kidney donation system. I think the intent to serve the greatest good or to maximize the benefit of the donation, for example, by giving a kidney to a young otherwise healthy mother over a senior citizen is a valid concern. However, I think this approach runs the risk of arbitrarily evaluating human lives and people's contribution to society - and if this system is in place, it would seem all people are not equal. Would a scientist get a kidney before a janitor if both are the same in all other regards? I know this is an exaggeration, but I feel this is the type of problem that would develop if such a "utilitarian" approach was implemented.
I liked your blog, Amy. The article that you cited reminds me of a cable TV documentary where the sponsor had a mock pandemic project that included several countries, to see how the lack of vaccines for everyone would be handled. I don't remember the outcome, but I remember that I was glad to be a healthcare worker after seeing it. Jo
Other than the problem of allocating scare resources, I do not see a lot of similarity between allocating donor organs and allocating vaccine during a pandemic.
I do see where consequentialism may be in play in establishing triage during a public health crisis where a good outcome is can be defined in terms of the public good of ‘lives saved’. But I really cannot see how “the end justifies the means” can apply to organ donation.
In a pandemic, the argument can be made that the public policy objective is to protect and preserve the lives of as many people as possible. In this particular case, the order in which lives are protected by vaccination has a direct impact on the number of additional lives that can subsequently be protected during a defined event. There is some moral distance inherent in decisions that are based not on the individual in terms of personal worth, but on classes of individuals – e.g., their role and likely contribution to limiting or extending the remainder of the event. In the flu triage system, at-risk individuals are as likely to be in Tier 2 to minimize the risk they pose to society from catching and spreading the disease as they are to be in Tier 2 to minimize the risk they pose to themselves in catching and dying from the disease.
I don’t think similar principles can be applied to the allocation of organs. If for no other reason, there is no general agreement on what constitutes the ‘best’ outcome of a transplant – either for the individual or for society. Is it the quality or length of post-transplant life for the recipient? Who determines what is ‘quality’? From what perspective is quality determined, the individual or society? Where the comparison totally breaks down fo rme is in considering the value a transplant recipient offers society. It is simply not possible to evaluate the value or contribution of an individual life in any meaningful way.
I am absolutely fine with Joanne and my local funeral home director being ahead of me on a vaccination list in the face of an epidemic or pandemic, based on their value to me in keeping me - and the rest of society - from exposure. I am much less comfortable trying to decide the fate of organ recipients based on their value to me personally – or to society – when I have no reasonable way to evaluate that value.
PJM
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