Thirty years of debate have passed since the term "Rule of Rescue" has been introduced into medical ethics. Its main focus was on whether or why medical treatment for acute conditions should have priority over preventive measures irrespective of opportunity costs. Recent contributions, taking account of the widespread reluctance to accept purely efficiency-oriented prioritization approaches, advance another objection: Prioritizing treatment, they hold, discriminates against statistical lives. The reference to opportunity costs has also been renewed in a distinctly ethical fashion: It has been stipulated that favoring help for identifiable lives amounts to a lack of benevolence for one's fellow creatures. The present article argues against both objections. It suggests that the debate's focus on consequences (deaths or severe ill health) should be reoriented by asking which aspects of such states of affairs are actually attributable to a decision maker who judges within a specific situation of choice.
The "Rule of Rescue" refers to the practice that, in order to save people from immediate peril, societies incur high costs largely irrespective of the fact that many more lives could be saved under alternative uses of the resources. The practice has been found difficult to explain, let alone justify, and has often been criticized. In the early literature in the context of the Oregon rationing experiment, the irrationality objection dominated in view of the obvious lack to consider opportunity costs. More recent contributions, taking account of the declining support for purely efficiency-oriented prioritization approaches, advance an equity objection: The practice discriminates against statistical lives. This article provides a critical assessment of both objections. The following contentions result from the analysis: 1. The equity objection is unfounded; 2. Following the rule of rescue is (in a certain sense) inefficient, but it is not irrational; 3. The criticized judgments result from deep-seated shortcomings in the action-theoretical concepts used (or rather, omitted) in the literature. These shortcomings are inherent in the consequentialist framework dominating the debate and deserve more attention.
Im Zuge der steigenden Angewiesenheit von Entscheidungsinstanzen auf den Sachverstand wissenschaftlicher Berater findet das Phänomen mangelnder Übereinstimmung mehrerer Gutachten zum selben Thema zunehmend Beachtung. Manche behandeln das Problem als ein wissenschaftsethisches:
Sie schließen vom Faktum divergierender Äußerungen auf die mangelnde Erfüllung von Normen intellektueller Redlichkeit durch mindestens einen der Beteiligten. Denn da von zwei einander widersprechenden Aussagen höchstens eine wahr sein kann, müsse mindestens
einer der Beteiligten mehr behauptet haben, als er wissenschaftlich beweisen könne. Hier wird dazu folgende, gegen rein moralisierende Kommentare gerichtete Position vertreten: Die steigende unmittelbar legitimatorische Bedeutung der Wissenschaften bietet zunehmend Anlaß zur Wahrnehmung
bisher unproblematisiert gebliebener pragmatischer (das heißt Entscheidungen involvierender) Aspekte in den Wissenschaften selbst - etwa bei der Eingrenzung einer Fragestellung, bel der Methodenwahl, bei der Wahl von Signifikanzkriterien oder bei anderen (zum Teil konventionalisierten,
aber nicht ergebnisneutralen) Wahlmomenten. Diese betreffen, wie an Debatten über die Aussagekraft toxikologischer Signifikanztests erläutert wird, auch den Beweisbegriff selbst. Die gegebenenfalls ungeheuren praktischen Folgen der wissenschaftlichen Geltung oder Nichtgeltung einer
Aussage verändern die Pragmatik der Forschung in eine Richtung, in der diese Wahlmomente nicht mehr durch die wissenschaftsintem üblichen Konventionalisierungen entproblematisiert werden können. Abstract & Keywords → p. 238
Der folgende Beitrag analysiert Unstimmigkeiten in der Ad hoc-Empfehlung "Solidarität und Verantwortung in der Corona-Krise" des Deutschen Ethikrats und in den klinisch-ethischen Empfehlungen "Entscheidungen über die Zuteilung von Ressourcen in der Notfall-und der Intensivmedizin im Kontext der COVID-19-Pandemie" der einschlägigen medizinischen Fachgesellschaften. Es wird gezeigt, dass die Orientierungsfunktion solcher Stellungnahmen leidet, wenn grundlagentheoretische Probleme, die innerhalb der Normwissenschaften kontrovers sind, in den Texten versteckt anstatt gezielt thematisiert werden. Um normative Orientierung in der Corona-Krise zu leisten, ist der Diskussionsstand in den beteiligten Disziplinen derzeit nicht ausreichend integriert.
Many statements on the allocation of health care resources show an appreciation of the two criteria "efficiency" and "fairness" as two values which are to be weighed against each other in case of conflict. This article provides a critique of this model, which is conceived to rest on a hybrid (partly utilitarian, partly counter-utilitarian) basis. The most important fairness-related argument, or so it is argued, is of a sort which is incompatible with the reasons utilitarianism (or, indeed, consequentialism) provides as a basis for the efficiency criterion. If the argument is right, we have to provide another basis, at least as far as moral inhibitions are strong about taking efficiency into account. The present article does not go into detail about such an alternative. It relates to the on-going discussion on John Taurek's (1977) article about "numbers", especially on the so-called aggregation argument against Taurek's "no-worse-claim", and argues against the majority of commentators, consequentialist and deontological alike, that Taurek was right.
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