Chance and the Challenge of Living
My fourth justification of the lottery pivots on using chance to affirm common humanity. Patient selection will not avoid the implacable uncertainty to which everyone’s life is subject. Rescher notes that medical prognoses do not subvert chance. “Even the fullest knowledge of contemporary medicine provides no secure means for forecasting the future courses of human diseases in particular individuals.”
I noted in chapter four that organ transplantation is a developing pocket of medical excellence. It involves some prognoses that meet high standards of rational predictability. Even so, these prognoses are not certain bets. Medicine can use statistical trends and clinical tendencies to reliable short-term effect. But medicine cannot ensure the stability and fixity needed for more than conjectural prediction. In the domain of medical prognosis, science can underwrite plausible expectations but never secure forecasts. Chance can always play a decisive role in confounding expectation. The issue of prediction is pervasively connected with that of risk, be it a risk of harm or of things not working out as we expect. Thus, rational patient selection factors such as likelihood of success and expectation of future life go only so far. A reasonable calculation of clinical outcomes can help us to manage risk, but we cannot eliminate it.
KeywordsStake Ethos Tame
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