Re: vaccine prioritization during a pandemic

*We can talk all we want about the infinite value of a human life but we
just don't have infinite resources, & thus may have to make decisions about
who our finite resources will be used for.*

Of course. In conditions of scarcity, decisions must be made about
allocation. I'd venture that none of us would be willing to let the market
make the allocation under these circumstances, and I'd further venture that
the reason for this has nothing to do with a market failure problem. What
we're trying to do is make a non-market allocation on some moral basis.

But shying away from the market seems inconsistent with the otherwise
utilitarian thrust of the current draft policy. Generally, markets are
better than governments at determining welfare maximization questions.
Among other things, governments are notoriously ineffecient, subject to
special interest capture, and often corrupt, all of which increases
transaction costs and diminishes overall social welfare. If we want to
allocate the vaccine simply based on aggregate social utility, why not just
leave it to the market?

The answer must be, I think, that we are intuitively not comfortable with an
allocation on strictly utilitarian grounds, because those grounds favor the
wealthy and powerful members of society. What other grounds can we
provide? Exploring the virtue ethics perspective, what I'd float is the
idea of an allocation that would exemplify and inculcate virtues such as
courage and love. This means that perhaps the weaker members of society --
the very young and the very old, for example -- should get their doses
before the stronger members, and that the stronger members should be willing
to sacrifice their doses to the weaker. Doesn't this sound perhaps a bit
more like the kind of decision Jesus would make?

On 5/18/06, George Murphy <gmurphy@raex.com> wrote:
>
> It seems to me that with *any* system of ethics, people dealing with
> large-scale disasters have to make choices. We can talk all we want about
> the infinite value of a human life but we just don't have infinite
> resources, & thus may have to make decisions about who our finite resources
> will be used for. Triage is sometimes an unpleasant necessity, & a refusal
> to use it may mean more deaths than necessary as sacrifices to some ethical
> principles.
>
> Shalom
> George
> http://web.raex.com/~gmurphy/
>
> ----- Original Message -----
> *From:* David Opderbeck <dopderbeck@gmail.com>
> *To:* drsyme@cablespeed.com
> *Cc:* asa@calvin.edu
> *Sent:* Thursday, May 18, 2006 10:52 AM
> *Subject:* Re: vaccine prioritization during a pandemic
>
>
> Just an observation: apropos to our recent discussion of different
> approaches to ethics, this proposal seems entirely utilitarian. Taking a
> deontological approach, how this proposal fare in light of scriptural
> injunctions to care for the poor and oppressed? Or taking a virtue
> approach, is this the sort of proposal that supports the development of a
> virtuous community? The idea that *"within this framework 20 year olds
> are valued more than 1 year olds, because the older individuals have more
> developed interests, hopes, and plans but have not had an opportunity to
> realize them"* seems troubling under either a Christian-influenced
> deontological or virtue approach.
>
>
> On 5/17/06, drsyme@cablespeed.com <drsyme@cablespeed.com> wrote:
> > In the May 12 2006 isue of Science, Ezekiel Emanuel,
> > from the department of Clinical Bioethics at NIH, and Alan
> > Wertheimer propsed a scheme for rationing flu vaccine if
> > there is a H5N1 pandemic. They propose that healthy
> > people 13 to 40 years of age have the second highest
> > priority of being vaccinated. Those that produce the
> > vaccine and frontline health care workers are top
> > priority. This contrasts with the current recommendations
> > from the National Vaccine Advisory Council (NVAC), and
> > the Advisory Committee on Immunization Policy (ACIP),
> > recommendations that vaccine first go to vaccine makers,
> > and health care workers, followed by people 6 months to 64
> > years of age that are at high risk of complications from
> > the flu, and those that are otherwise at high risk to
> > contract the illness.
> >
> > The article gives examples of possible ethical principles
> > that can be used for rationing. "save the most lives",
> > "women and children first", "first come first served",
> > "save the most quality years", "save the worst off" (as
> > in organ transplantation today), "reciprocity" (you give
> > an organ you get an organ), "save those most likely to
> > fully recover", "save those most instrumental in making
> > society flourish"
> >
> > He claims that the NVAC and the AICP recommendations are
> > based on the principle of "save the most lives". They
> > disagree with this prioritization, because there is time
> > to deliberate about priority rankings. They propose
> > prioritization based on what they call a "life cycle
> > allocation principle". This prioritization starts with
> > the idea that each person "should have an opportunity to
> > live through all of life's stages". Basically the idea is
> > that younger people have priority over older people.
> > However they refine this idea into an alternative
> > prioritization called the "investment refinement of the
> > life cycle principle including public order." In this
> > prioritization gradations are given within a life span
> > such that adolescence to middle age has the highest
> > priority. They state "within this framework 20 year olds
> > are valued more than 1 year olds, because the older
> > individuals have more developed interests, hopes, and
> > plans but have not had an opportunity to realize them."
> > They also invoke the principle of public order, which
> > emphasizes "the value of ensuring safety and provision of
> > necessities, such as food and fuel."
> >
> > To summarize the NVAC and ACIP vs Investment refinement
> > of LCP (IRLCP):
> >
> > Vaccine production workers and health care workers are
> > vaccinated first in both proposals.
> >
> > Then NVAC/ACIP recommend high risk individuals 6 to 64,
> > pregnant women, others at high risk of exposure,
> > emergency response workers, high ranking government
> > officials. Followed by healthy individuals over 65,
> > people 6 to 64 of moderate risk, healthy children 6 to 23
> > months, other, public health and emergency response
> > workers. Followed by other government workers, funeral
> > directors, and last healthy people 2 to 64 years.
> >
> > In contrast IRLCP recommends (after vaccine producers and
> > health care workers) people 13 to 40 years of age that are
> > of low risk, public health, military, police and fire,
> > utility and transportation workers, telecommunications and
> > IT workers, funeral directors. Then people 7 to 12 years,
> > and those 41 to 50 years old that are low risk. Then
> > people 6 months to 6 years and 51 to 64 years that are low
> > risk. Followed by people over 65 that are low risk.
> > Finally those 6 months to 64 years that are high risk,
> > followed by people over 65 that are high risk.
> >
> >
> >
> > This is an interesting proposal and I think could spark
> > some interesting debate. Comments?
> >
>
>
Received on Thu May 18 16:03:55 2006