Equal Treatment for Disabled Persons: The Case of Organ Transplantation

Abstract

Mill is famous for his clever preliminary solution to the conflict between justice and utility-maximizing. In Chapter 5 of Utilitarianism he notes that, because of declining marginal utility, one can often maximize utility by concentrating resources on the worst-off in society, thus providing a utilitarian explanation for our intuition that the worst off have special moral claims. In medical ethics, reflection on cases of persons with severe, chronic disabilities challenges this felicific, if fallacious, resolution (Mill, 1967, pp. 391–434). These persons can sometimes command enormous quantities of medical resources, but gain only marginal benefit from them. An organ transplant for someone who is worst off because she has only a short time to live would, for example, target the worst off, but produce only small benefit. Thus proposals for aggressive medical intervention to bring those with disabilities to levels of nearer normal health or restore them to that status provide a critical challenge to a theory of justice in the use of health resources.