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| New Orleans 2005, after Katrina |
In "Whose Lives Should Be Saved? To Help Shape Policy, Researchers in Maryland Ask the Public," Sheri Fink (2016) says that medical professionals need to make life of death decisions when the supply of resources is overwhelmed by the demand, whether in wealthy Japan following the Fukushima nuclear accident or poor African nations hits by Ebola, nor is the wealthy US economy exempt from these problems, as seen in the aftermath of hurricane Katrina in 2005 and the H1N1 outbreak in 2009. Fink reports that for the past few years a team from John Hopkins Hospital have been researching how the American public think that decisions about who gets limited medical resources should be made with the intention of using the results to inform official state, and perhaps national US, policy. There is considerable disagreement to all proposals, whether a lottery or some form of deliberative democracy, although there seems to be agreement that the research is worth pursuing in order also "to turn extremely complicated core ethical considerations into something people can make sense of and struggle with in ordinary language," as Fink quotes the founder of Johns Hopkins’s Berman Institute of Bioethics arguing.
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My Yes/No question is:
Should life and death be decided by a random lottery?
My answer is:
Yes, but only when healthy discrimination is not possible.
New York Times' articles are typically longer and more complex than BBC News articles, but I was still a bit worried about the length of my Source Background section. But I did manage to get all the bits that were important to me into three sentences that aren't too long. And you are always welcome to follow up my source.
And as you can see, I changed my mind soon after writing in my own initial answer to the Yes/No question that interested me. I do often have a few quick changes of mind before I write down my first answer, but that usually remains my answer; however, in this case, further thinking about the issues persuaded me to revise "Yes" to "No," and I thought it wouldn't be a bad idea to let readers see that. I certainly agree with the people Fink paraphrases and quotes that the issues are "extremely complicated."
The thing that really made me choose to blog this article in the face of competition from a few other NYT articles I read in this afternoon's coffee-time browsing was its fairly direct connection with the issues raised in Hartmann's (pp. 49 - 50) reading "Economic Systems": namely, how should decisions be made about the supply and demand of scarce medical goods and services? If you were choosing a topic for the essay question, it might be the economic system of John Hopkins Hospital. As the examples in the first sentence of my summary show, Fink's article also gives examples of very different types of economic systems where such life and death decisions must be made, but such decisions are also made every day in hospitals throughout Australia, Thailand and the rest of the world, with different economic systems giving very different outcomes, to the advantage of some and the disadvantage of others.
And the kidney question also came to mind again: should free markets be allowed to determine who gets new organs, or should controlling state laws dictate such decisions? Or something else?
Finally, I haven't actually explained my final answer to the Yes/No question. In some circumstances, I do think it's reasonable to decide who lives and who dies by a random lottery, such as throwing dice or drawing a card, or perhaps something a bit more high tech. and more seriously random. But if the right sort of discrimination is an option, that should normally be used first to save or kill., so you can reasonably infer that I don't think discrimination is necessarily a bad thing, quite the contrary, in fact.
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Reference
Fink, S. (2016, August 21). Whose Lives Should Be Saved? To Help Shape Policy, Researchers in Maryland Ask the Public. The New York Times. Retrieved from http://www.nytimes.com/2016/08/22/us/whose-lives-should-be-saved-to-help-shape-policy-researchers-in-maryland-ask-the-public.html
And now I'm wondering whether random is the right word to describe nature. Is it really random, or something else?
ReplyDeleteIs there really a true random algorithm? For me, random means unpredictable; you can't guess the result. The examples of random stuff maybe the radioactive decay and the quantum state of the particle. The answer to my question is no. If we trace the algorithm, my definition of random could not apply to this.
DeleteIf the nuclear radiation is total random, and there is no real random algorithm, we are not living in "the Matrix".
If there is no real random algorithm, might not that mean that we living in the Matrix, where every event is fully determined by a program?
DeleteI think nuclear decay and other events are that level do have true randomness, but would that save the Matrix residents from full determination by the laws of physics, or of the algorithms that generate them?
Would "design" random be random? Looking at creator perspective, if we really did live in computer simulation, the creator perspective would be like "how we really program a real random algorithm for neclear decay?". I think that this question is contradict itself because real random can't be generated by an algorithm.
DeleteThis is very good video https://www.youtube.com/watch?v=J0KHiiTtt4w
I think when discrimination falls short, randomly picking a patient to be saved is necessary. However, I question the possibility of using lottery in practice. In the given example of Fukushima nuclear accident, there would be too many people to go through the guidelines and carefully assess who should receive the lifesaving equipment, let alone waiting for the lottery. Therefore, I propose using first come, first served. In other words, in case that we couldn't decide who should get medical attention, rather than randomly pick a person, the first who arrive should get medication first. What do you think? Which one do you prefer? Is there any better idea?
ReplyDeleteGreat questions.
DeleteI agree with Oil that first come, first serve might be a good idea here. At least we should have the ability to choose to live or die by ourselves first. But if there are 2 people going to the hospital at the same time and there is only one medication to be treated, throwing a lucky dice might be the only option.
DeleteI think lottery is like a prize, money, or present for a person who has a good luck to win, but this case is opposite. I'm not sure that those phenomena or epidemics can judge people by killing bad people and keeping good people to live in the world. However, I believe that people who think well and do well will get a good reward back. In contrast, people who just concern about their interests and they do any bad things to interrupt the society will received a bad thing or disasters back.
ReplyDeleteI agree with you that life and death be decided by a random lottery in case of when healthy discrimination is not possible. According to government hospital in Thailand, there are very limitation of sickbed, so the doctor would judge patient who has severe symptom to admit first. However, other patient can be treated by the doctor but they can't admit into the government hospital except they have severe symptom. I think that making the decision for life and death by a random lottery couldn't be used in patient who has severe symptom.
ReplyDelete