A sort ofViewing the consequences is an integral part of every medical calculation. Every medical decision (including omissions) is an action that must be reasonable in terms of impact assessment. Cardiologist, researcher, and writer Bernard Lown, who died earlier this year, set the standard: Patients should feel better every time they see a doctor. Even if it’s just a trace of spiritual peace.
Is medicine and its ethical challenges an Eldorado for consequentialists? This impression was created after reading Annette Dufner’s analysis of the use of scarce resources in medicine. Due to the threat of the health system being overwhelmed by the Covid-19 pandemic, the public is also aware of these problems. However, the classification in ventilator allocation is treated as an appendix in Dufner only. The purpose of drafting this text is to take into account the often overlooked allocation conflicts that have existed for many years, namely the allocation of donor organs in transplant medicine in view of the long waiting list. But these two conflict areas have a lot in common.
Moral and mathematical formulas
The core of Dufner’s argument is the argument for the so-called “moral aggregation”. In the event of a conflict, are there more possible life-saving options that are decisive? Is the balance between life and life allowed? Is it morally reasonable to sacrifice one life in order to save two or more lives? Is overall happiness greater than a larger number? Therefore, is there a view of commodities that are independent of individuals and can outperform personal commodities?
Discussions on these issues will soon swing the constitution: human dignity prohibits the sacrifice of life for the benefit of others. People have forgotten that the medical aid conflict is not about instrumentalizing people, but just a lack of resources. In the case of transplant medicine, it cannot be increased with more money. Therefore, the Federal Constitutional Court’s decision on aviation law, which is often cited in such debates, is irrelevant, and Dufner correctly pointed out this point. Among them, the court prohibits shooting down hijacked airliners that have been hijacked and destroyed, and may even have been killed more than a thousand times, in order to prohibit instrumentalization.
The final reason is not worth looking forward to here
The principle of seeking to resolve the conflict of medical assistance constitutes the main part of this article. Annette Dufner guides readers through the current analytical literature on normative consequential arguments and guides readers in a parforce way. If people want to include not only the number of people who might be rescued, but also the degree of benefit and level of need in each case, then the apology of moral cohesion that Dufner seeks requires extremely fine-grained reasons. In her argument, Dufner also considered all aspects of decision theory. Its representatives often hope to express moral calculations in the form of mathematical formulas. But this just shifts the ethical challenge to the definition of the equation element, otherwise the ethical problem will be completely escaped. Because, as Leszek Kolakowski rightly pointed out, when a value is explained causally, it is no longer so.
Dufner’s comments did not deviate from the jargon of the consequential environment, leading to the formation of principles that she believed were suitable for resolving paramedical conflicts, with the abbreviation ARP: “Promote overall interests in related conflict cases. Benefits take precedence.” This means that An attempt should always be made to rescue as many people as possible, so their interests (emergency situations) must be relevant, and those who need the most help will be given priority.
The ultimate reason is unpredictable here. Dufner describes ARP as an intermediate principle. Medical ethics mentions this reluctantly. Many years ago, Tom Beauchamp and James Childress proposed their influential ethics that require compliance with four core principles: respect for patient autonomy, responsibility to avoid harm, and care and respect for justice. It is not easy to compare what profit ARP should have.
ARP may not catch a big fish, but the by-catch is extraordinary. As Dufner’s analysis of ARP applications in the second part of her book shows, when deciding on the allocation of limited resources-such as scarcity of intensive care unit space or insufficient organ donations-this is inevitable in medicine. , And make judgments on the quality of life within a limited range. A fact that is often overlooked. Generally speaking, this principle applies to the fact that doctors should make decisions on the allocation of scarce medical resources, regardless of the individual, so they should avoid making judgments on the quality of life of the affected people as much as possible. Dufner did not want to abolish this principle, but only mentioned its limits.
Annette Dufner: “Which lives should be saved?” The ethics of medical aid conflict. Suhrkamp Verlag, Berlin 2021. 261 pages, Br., 24 euros.
