Our intention in the following is to use the WHO declaration as a basis for considering the allocation of resources in health care. We shall first argue that most of the criteria suggested as grounds for fair allocation of scarce medical resources have their difficulties if one tries to apply them one by one to medical practices. We shall then go on to claim that, if we take the right of all human beings to health or health care even moderately seriously, increasing the resources would in most cases be more ethical than attempting to allocate them 'fairly'.
No abstract
Rioclkw lSSN 0269-9702 Volurnc 4 Nurnbn 2 1990 EUTHANASIA, ETHICS AND ECONOMICS HETA HAYRY AND MATT1 HAYRY 1 In reviewing Daniel Callahan's book Setting Limits ' in a recent issueof Bioethics Peter Singer points out an important failure in many recent attempts to tackle the growing financial problems of organized health care.2 There are theorists who in the name of economic necessity put forward views arguing that the elderly or the disabled or the poor can without qualms be denied the benefits of advanced medicine, but who at the same time firmly refuse every attempt towards legalizing medical euthanasia. Yet euthanasia would very probably have some effect at least on the monetary side of the issue, since it would put an end to the waste of many expensive life-prolonging treatments which are performed at present on terminal and suffering patients against their own wishes.Although the pros and cons of euthanasia have been thoroughly discussed in philosophical and legal debates during the 70s and 80s, the financial aspect has not often been brought to the fore by proponents of permissive p~licies.~ This is probably because their opponents have been busy drawing attention to the alleged similarities between the Nazi euthanasia programmes and attempts to defend people's right to die. Therefore in the eyes of the general public any implication of economic considerations has underlined, rather unfairly, the supposed inhumanity of legalizing euthanasia. But there are, in ' D. Callahan, Setting Limits: Medical Goals in an Aginf Society (New York: Simon P. Singer, 'Review essay: Setting Limits', Bioethics 2 (1988): 151-169, pp. As was pointed out to us by one of our referees, an exception to this is M. Tooley, who discusses the cost of maintaining life in his 'Decisions to terminate life and the concept of a person', in J. Ladd (ed.), Ethical ZSSUCS Related to Lye and Death (Oxford: Oxford University Press, 1979), pp. 72-75. and Schuster, 1987). 167-169.
In different countries responses to important bioethical issues are different, as exemplified by the attitudes towards the voluntary and active forms of medical euthanasia. But why is this the case? My suggestion is that the roots of the variety are, to be considerable degree, ideological. The most important present-day political ideologies all have their roots in the prevailing doctrines of moral and social philosophy. In the paper these doctrines are outlined and the predicted response towards active voluntary euthanasia within each model is sketched. The conclusion reached is that while it would in some countries be dangerous to allow euthanasia in the prevailing circumstances, the solution is not to hinder the legalization process but to alter the circumstances.
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