Doctors make decisions based on likely clinical outcomes, not ‘value of life’ judgements
All human beings are equal in value and worth, says Dr Calum Mackellar
In these strange and difficult times of a Covid-19 pandemic new biomedical challenges can arise such as in the allocation of limited healthcare resources in an emergency setting when hospitals are overwhelmed with very ill patients. If such a situation does arise despite the heroic work of the NHS, it is being suggested that some form of healthcare rationing and selection of patients should take place based on reasonable and objective criteria. This is defined as ‘triage’ which is a French word expressing the idea of ‘sorting-out’ and reflects the manner (and on what basis) patients should be selected for limited healthcare treatments.
In a way, the problem is not new since even before the coronavirus came to the UK, clinicians have been making very similar difficult decisions. For example, because of the acute shortage of organs for transplantation, healthcare professionals have been selecting which patients should receive a lifesaving organ.
In making such a selection, however, it is important to remember that all human beings are absolutely equal in value and in worth. There is, therefore, no basis in a civilised society for racism (discrimination on race), ageism (discriminating on age) and ableism (discriminating on ability or disability). As Article 1 of the United Nations’ Universal Declaration on Human Rights indicates: ‘All human beings are born free and equal in dignity and rights.’ This means that equality in value and in worth is not a subjective aspiration, as some academics may suggest, but a very important reality – a fragile reality that must exist if a civilised society is to survive. In this regard, it is worth remembering from past historic experience about what may happen when this absolute equality in value and in worth of all persons is no longer recognised. Indeed, when this occurs, and when discrimination is seen as acceptable based on race, ability, age or even quality of life, society quickly collapses into barbarism and savagery. Some lives are then seen as unequal, meaning that they may be considered of lower worth or even expendable. If this happens, society may then believe that it may even be appropriate to actively terminate some lives.
Thisallmeansthat,inanidealworld where no restrictions on healthcare resources are necessary, all individuals must be treated in an equal way based on requirements. Problems arise, however, when resources are limited. The only way frontline clinicians,engagedinthestruggleagainst an epidemic, can then decide, ethically, which patients to treat is to select them on the perceived effectiveness of clinical outcomes and not on any other factors such as age. In this regard, it is important to remember that healthcare professionals are not trained nor entitled to make ‘quality of life’ or ‘value of life’ evaluations but only clinical decisions.
In other words, when resources are insufficient it is generally accepted that clinicians can select which