Patient Selection and Medical Utility

My goals in this chapter are to present the seminal formulations of a two-stage patient selection process and to subject Childress’ most recent version to critique. I will argue that Childress’ reliance on medical utility can compromise an egalitarian approach to patient selection that aims to equalize opportunity for Resources. Although I will not begin to elaborate my own egalitarian approach until chapter seven, I will attempt to show that medical utility comparisons can exemplify the fair chances/best outcomes problem. I concur with Childress’ objection to comparative judgements of social worth when conditions of military emergency or natural disaster do not apply. Even so, I am not convinced that comparative judgements of medical utility are the best way to assess consequences at the second stage of patient selection. Nor do I think that rule utilitarianism will solve the problems that Childress wishes to avoid.

I will argue that medical utility judgements are liable in practice to biased social value judgements that would have a disproportionately negative impact on elderly candidates for Resources. I also claim that the fair chances/best outcomes problem is implicit in the application of medical utility to patient selection. Thus, making final selection decisions on the basis of greater medical utility is also problematic in principle.