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The Ethics of Rationing

Sharon Begley in today’s WSJ raises the issue of rationing in a life or death situation:

You have 100 doses of a vaccine against a deadly
strain of influenza that is sweeping the country, with no prospect of
obtaining more. Standing in line are 100 schoolchildren and 100 elderly

The elderly are more likely to die if they catch the
flu. But they also have fewer years left to live and don’t get out
enough to easily spread or catch the disease. The kids are more likely
to act like little Typhoid Marys, sneezing virus over anyone they
encounter, and have almost their whole life ahead of them. But they’re
also less likely to die if they get sick.

Whom do you vaccinate?

This dilemma is haunting experts concerned that avian
influenza might start spreading from person to person instead of (as
far as we know) mainly from birds to people. But it also applies to
regular old flu, which always has the potential to reach pandemic
proportions. In response, studies now are shedding light on the ethical
issues and the most effective strategy for reducing illness and death
if vaccine must be rationed. Sadly, they make a pretty good case that
current U.S. policies leave a lot to be desired.

But how could we possibly find ourselves in this situation. We never ask, if there’s not enough shoes to go around, should young or old people get the shoes. Or the oranges. Or the houses. Or cars. We don’t even have to ask these questions about the rich and the poor, let alone, the young and the old. It certainly is a tough question, once you only have 100 vaccines or some number less than people would like. But how could that possibly happen?

But it has been happening. In the winter of 2004 there were serious shortages with the President reduced to begging healthy people to forego flu vaccination to leave enough for those at risk. So it could easily happen again.


Part of the answer is that in the name of making sure that everyone has equal access to vaccine, we have taken the profit out of making vaccines. In addition, Attorneys General threaten anyone who charges what the market will bear in a time of shortage. So we have protected the poor and elderly and the children and made sure that they will not be outbid by the rich and the relatively healthy. And through that protection we have created a situation where increasing numbers of Americans cannot be sure of getting medicine. As a result, a political mechanism, rather than a market mechanism, must be used. Some form of rationing becomes inevitable. And inevitably, that rationing will be subject to political rather than truly ethical influences.

But even if politicians stepped aside (something they are genetically and psychologically incapable of) the most benevolent philosopher cannot answer the question of who should live or die when there is a vast shortage.

But if we let markets work, there would be fewer people at risk of death.

In every other market, innovation, driven by the profit motive, improves access to life-giving, life-enhancing devices, products and services.

People often say that medicine or some other good is too important to be left to the marketplace.

The opposite is true. Medicine is too important to be left outside the marketplace.