Waiting Lists and Lotteries in Practice

Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 22)

Since the conflict of life with life precludes equality of either economic resources or welfare, I want to equalize prospect-regarding opportunity for adequate conscious life. This equalisandum does not make final selection contingent on the different personal characteristics of most candidates. Instead, it treats their lives as equally worth saving by respecting their common humanity.

But what means of selection best affirms this opportunity in a manner consistent with my egalitarian ethos? While I think that this means should also be chosen through a deliberative process, I propose random selection by lottery.

But defending this proposal is beside the point if time on the waiting list is a better means of random selection. The notion of first come, first served certainly has a stronger appeal to common morality. It is somehow less disturbing. It reflects customary practice and pledges an orderly but random sequence of fair chances. By contrast, the lottery seems an affront to this intuitive sense of etiquette. Why resort to a counsel of despair when we can simply wait our fair turn?

If our turn is not fair, then waiting will not make it so. In principle, waiting lists augur fair turns. In practice, they usually do not. I want first to elucidate my reasons for thinking this. I want then to look at how lotteries are actually used to allocate other types of Resources. Given these examples, organ lotteries could be a strong affirmation of some very basic and recognizable moral values. Lotteries that affront our moral sensibilities might have more to do with profit margins or literature than with saving lives when Resources are unavoidably scarce.


Liver Transplant Meld Score Common Morality Imminent Death Candidate Pool 
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© Springer 2004

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