Re: vaccine prioritization during a pandemic

It seems to me that planners should try to preserve those people who will be
most essential for the survival of society. Having said that, I hesitate to
offer a set of rules derived from this. Society is too complex for some people
sitting in a star chamber to decide who is essential for the survival of
society.

--- David Opderbeck <dopderbeck@gmail.com> wrote:

> *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?
> > >
> >
> >
>

Bill Hamilton
William E. Hamilton, Jr., Ph.D.
248.652.4148 (home) 248.303.8651 (mobile)
"...If God is for us, who is against us?" Rom 8:31

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Received on Thu May 18 22:00:20 2006