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Healthcare Rationing: When Is It OK?

In his last post, DrRich considered the differences between a system of healthcare rationing in which individual autonomy is honored, and one in which the good of the collective takes precedence. DrRich concluded that the former is more desirable than the latter, since the latter would amount to throwing aside the Great American Experiment. In response to this post, an astute reader calling him/herself Jupe wrote:

. . in the case of a limited supply of an effective vaccine during a deadly epidemic, it doesn’t weird me out to think of docs and nurses being prioritized over, say, me. Or a hypothetical situation of military leaders being prioritized in the event of bio warfare  So it’s not that collectivism inherently offends me across the board.

In my mind there seems to be some sort of invisible line in there somewhere, but I can’t identify what it’s based on or exactly where it’s at, or why. I just know when it’s been crossed.

Jupe then continues, quoting Ezekiel Emanuel on setting rules for healthcare rationing. Emanuel says, “. . .Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

Jupe continues:

[That] just screams “line WAY WAY WAY CROSSED! HOLY CRAP!” to me. I know (well, deeply suspect) there actually is a fundamental difference between “doctors, nurses and military first to be immunized in the event of a bio-warfare attack” and “no antibiotics for the feeble minded” but I can’t pinpoint it outside of “it just intuitively seems right/wrong”.

DrRich interprets Jupe’s question as follows: Why does it intuitively seem OK to ration healthcare in the manner described in the first instance, but not in manner described in the second?

The most obvious answer would be that in the former case there’s an emergency, and extraordinary times call for extraordinary measures. For instance, in times of a war that threatens our survival, most of us would agree that a military draft – perhaps the ultimate sacrifice of individual rights for the good of the collective – is appropriate. And Lincoln, who was fighting a war whose explicit purpose he defined as upholding the Great American Experiment (i.e., to see whether a nation “conceived in liberty and dedicated to the proposition that all men are created equal could long endure”) was himself quite willing to violate individual freedoms to achieve that goal. For instance, he was willing to suspend habeus corpus and jail newspaper editors for sedition. Read more »

*This blog post was originally published at The Covert Rationing Blog*

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