The January 2009 The Lancet article by Persad, Wertheimer, and Emanual titled "Principles for allocation of scarce medical interventions" is a frequent target for libertarian criticism. These attacks are appropriate. The complete lives system advocated by the authors ignores the appropriate way to allocate scarce medical interventions: the libertarian rational natural-rights ethic (self-ownership and original appropriation and non-aggression).
The authors initially "evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness." None of the eight principles analyzed is the libertarian rational natural-rights ethic. Thus, the authors rule out the answer to their question at the beginning of the paper.
The authors then evaluate three multi principle allocation systems: disability-adjusted life-years, quality-adjusted life-years, and the United Network for Organ Sharing points systems. These systems are found wanting. The authors correctly identify fatal flaws in these three systems, though violations of the libertarian rational natural-rights ethic are not considered.
Next, the authors "recommend an alternative system-the complete lives system-which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles." Yes, dear reader of the LIBERTARIAN BIOETHICS BLOG, the complete lives system is as absurdly complicated as it sounds. The key idea in the complete lives section of the article is as follows: "... income, is a "non-medical criterion" inappropriate for allocation of medical resources." WRONG! WRONG! WRONG! Income, assuming the income has been justly acquired, is property that can be exchanged for scarce medical interventions if the owner of the income so desires. Scarce medical interventions, in a just society, can be sold by the owners of the scarce medical interventions (physicians, hospitals, medical corporations, etc.), if they so desire. This voluntary exchange of income for scarce medical interventions is the real-world manifestation of the abstract libertarian rational natural-rights ethic.
Finally, the authors state that "an allocation system must be legitimate. Legitimacy requires that people see the allocation system as just and accept actual allocations as fair." This is merely a restatement of Bastiat's recognition that governments only exist because people view the existence of governments as legitimate. The authors of this ridiculous paper will be sad to learn that the LIBERTARIAN BIOETHICS BLOG does not view the complete lives allocation system for the allocation of scarce medical interventions as legitimate or just or fair and will continue to advocate the libertarian rational natural-rights ethics as the only legitimate, just, and fair way to allocate scarce medical interventions.
The authors initially "evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness." None of the eight principles analyzed is the libertarian rational natural-rights ethic. Thus, the authors rule out the answer to their question at the beginning of the paper.
The authors then evaluate three multi principle allocation systems: disability-adjusted life-years, quality-adjusted life-years, and the United Network for Organ Sharing points systems. These systems are found wanting. The authors correctly identify fatal flaws in these three systems, though violations of the libertarian rational natural-rights ethic are not considered.
Next, the authors "recommend an alternative system-the complete lives system-which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles." Yes, dear reader of the LIBERTARIAN BIOETHICS BLOG, the complete lives system is as absurdly complicated as it sounds. The key idea in the complete lives section of the article is as follows: "... income, is a "non-medical criterion" inappropriate for allocation of medical resources." WRONG! WRONG! WRONG! Income, assuming the income has been justly acquired, is property that can be exchanged for scarce medical interventions if the owner of the income so desires. Scarce medical interventions, in a just society, can be sold by the owners of the scarce medical interventions (physicians, hospitals, medical corporations, etc.), if they so desire. This voluntary exchange of income for scarce medical interventions is the real-world manifestation of the abstract libertarian rational natural-rights ethic.
Finally, the authors state that "an allocation system must be legitimate. Legitimacy requires that people see the allocation system as just and accept actual allocations as fair." This is merely a restatement of Bastiat's recognition that governments only exist because people view the existence of governments as legitimate. The authors of this ridiculous paper will be sad to learn that the LIBERTARIAN BIOETHICS BLOG does not view the complete lives allocation system for the allocation of scarce medical interventions as legitimate or just or fair and will continue to advocate the libertarian rational natural-rights ethics as the only legitimate, just, and fair way to allocate scarce medical interventions.
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