I think it's ridiculous to believe that all human life is equally valuable. Is my life worth the same as President Obama's? To who? Is a crack addicted prostitute's life worth the same as a cancer researcher? Is my wife's life worth the same as your life?
I'm sure to your loved ones your life is worth more than President Obama's
But, at the same time, to President Obama's loved ones and supporters, his life is worth more than yours.
When it comes down to it every life does not have equal value to everyone.
True.
But it is subjective, not objective.
And how might we objectively assign value to live? Is the life of someone that is about to die worth the same as the life of someone that has many years yet to live? If someone has a gun and says they will either kill the 5 year old healthy person or an 80 year old terminal cancer patient with a week to live at most... Can we say that the child's life has more value? Or must we still claim that both lives have the same value?
An ethical system also requires fairness in my mind. This is why systems which are based on, for example, personal vendetta are unethical - they are unfair, even though they may result in the same amount of total good.
1. What is fairness? How can I determine whether something is fair or not? (I'm not trying to be facetious here. In my experience, what's considered "fair" varies widely from person to person.)
2. Why does ethics require fairness?
3. I would argue that the "vendetta rule" has nothing to do with fairness, and everything to do with preserving the healthy functioning of the system. It's essentially just the concept of fiduciary duty. In other words, the administrator of the system has a duty to not profit (financially or personally) from the system he or she administers. This is to prevent the administrator from making sub-optimal decisions to privately benefit themselves.
1. What is fairness? How can I determine whether something is fair or not? (I'm not trying to be facetious here. In my experience, what's considered "fair" varies widely from person to person.)
Something is unfair if two people are given inequitable treatment for reasons other than inequitable desert.
2. Why does ethics require fairness?
Fairness is adherence to the claimed ethical principles. To be unfair is to give someone treatment, either positive or negative, that is undeserved.
3. I would argue that the "vendetta rule" has nothing to do with fairness, and everything to do with preserving the healthy functioning of the system. It's essentially just the concept of fiduciary duty. In other words, the administrator of the system has a duty to not profit (financially or personally) from the system he or she administers. This is to prevent the administrator from making sub-optimal decisions to privately benefit themselves.
You contend that this scenario does not have sub-optimal decisions, as any distribution saves the same total value of lives. Therefore, there is no risk of this, and personal vendettas would be harmless.
Maybe "prove" is too strong a word, but this is a debate about organ transplants and people potentially losing their lives; ethics obviously will play a role. You need to lay out why you believe what you believe in an orderly and coherent fashion so I can see where we disagree. Simply saying "X is ethical, Y is unethical" doesn't get us anywhere.
Sorry for the delay, this didn't show in my replies. I apologize, I didn't realize I hadn't made this more clear. I was skipping this step largely because there has already been a wealth of discussion and general agreement as to the ethical principles that would apply to scarce resources in a medical environment, largely taking place over the last ten years. Did I forget to post one of those papers? Here is a reference from the Lancet.
In any case, I think I see where the confusion is. In my previous posts, I was talking about situations where all factors about prognosis, instrumental values, life years, etc are equal. If they're not equal, I'm open to a more utilitarian approach. I was also referencing the American Healthcare system, where as a society we've made certain value judgments, and I was operating in that context. Those judgments include things like not allowing ability to pay determine whether or not someone receives life-sustaining treatment, which was the basis of EMTALA's anti-patient dumping laws. But if you want to talk more specifics about why that's not okay, I'll bite.
It boils down to the fact that everyone's life is valuable to them. Fluffy has already mentioned that lives have subjective value to other people, and those values will vary from person to person. So, objectively, the only consistent metric is that everyone values their own lives, unless stated otherwise. So how do we determine who lives or who dies when, while attempting to be impartial, all lives are equal? Well, we have to do it based on an attempt to be fair, or by metrics that can commonly be agreed on to have value (which is where the ethical principles come in). We have to do it in such a way that a third party could agree that everyone was treated fairly.
From a medical standpoint, your ability to pay for medical treatment isn't relevant to your medical condition. If a doctor is given a report on two patients, those patient's wealth isn't a medical criteria nor is it a medical condition, so why should it be a deciding factor in whether or not they live or die?
I think it's ridiculous to believe that all human life is equally valuable. Is my life worth the same as President Obama's? To who? Is a crack addicted prostitute's life worth the same as a cancer researcher? Is my wife's life worth the same as your life?
I discussed this a little above, but basically the only consistent metric of a worth of a life is what the individual thinks it is for themselves. We have to operate under the assumption that all lives are equally valuable unless stated otherwise but the owner of said life (and this is of course skipping the issue of mental health and competency). An individual's social worth has no real bearing on their medical need, and unless those activities directly conflict with their ability to survive with a treatment (like with drug users, for instance), it really shouldn't be a rationale in making a medical decision.
I'd give this more leeway if we're talking instrumental value in a crisis situation: if we've only got a certain number of countermeasures, I think most people would find it reasonable that those countermeasures go to individuals who are most able to help the current situation. For instance, healthcare providers getting a priority in a medical emergency. This assumes that the 'countermeasure' will actually help the person in a given timeframe, though.
This information does not impose a requirement that I select the objects randomly so as to give all objects an equal chance. What it tells me is that it's irrelevant what schema I use to select the three objects. I could do so randomly, I could do so non-randomly. As long as I select three objects, I will necessarily maximize the total value of the objects I have selected.
(This exercise is for the purpose of isolating the ethical principle "all lives have equal value" and studying its implications. As we have already discussed, there is a second principle involved, which is that one must not act based on an improper motivation such as one's personal like or dislike of a person or group of persons.)
This is why I pushed earlier that only medical criteria should be major factors in making these decisions.
I think the real issue here is that you're talking about objects instead of people. If humans were purely individualistic, I would agree with you, but we live in a society where other people's opinions matter. If we've got a pool of people who all need the same scarce resources, we need a damn good reason why one individual got the resource while the others didn't. These people are all still patients, after all, and making the decision to give one the resource does not absolve us our responsibility to the others.
Is the life of someone that is about to die worth the same as the life of someone that has many years yet to live? If someone has a gun and says they will either kill the 5 year old healthy person or an 80 year old terminal cancer patient with a week to live at most... Can we say that the child's life has more value? Or must we still claim that both lives have the same value?
But I do know why people prefer to adhere to the general principle of "all lives are equal".
Otherwise you run into situations where people are given worth based on subjective values, and so essentially cause people to lose certain rights ,mainly right to self-determination that is fundamental to the concept of a democratic society and inherent in the U.S. philosophy of rights.
1. What is fairness? How can I determine whether something is fair or not? (I'm not trying to be facetious here. In my experience, what's considered "fair" varies widely from person to person.)
Something is unfair if two people are given inequitable treatment for reasons other than inequitable desert.
A lottery system that assigns organs randomly gives people "inequitable" treatment for reasons other than "inequitable" desert. (By "inequitable" I assume you actually mean "unequal." The word "inequitable" is just a synonym for "unfair," which would mean you're saying "something is unfair if it treats people unfairly.")
Actually every possible way of distributing a limited supply of organs gives people unequal treatment.
2. Why does ethics require fairness?
Fairness is adherence to the claimed ethical principles. To be unfair is to give someone treatment, either positive or negative, that is undeserved.
What are the "claimed ethical principles" and where do they come from?
Here's what I'm hearing:
Tiax: Ethics requires fairness.
Bitterroot: Why does ethics require fairness?
Tiax: Because fairness is ethical.
3. I would argue that the "vendetta rule" has nothing to do with fairness, and everything to do with preserving the healthy functioning of the system. It's essentially just the concept of fiduciary duty. In other words, the administrator of the system has a duty to not profit (financially or personally) from the system he or she administers. This is to prevent the administrator from making sub-optimal decisions to privately benefit themselves.
You contend that this scenario does not have sub-optimal decisions, as any distribution saves the same total value of lives. Therefore, there is no risk of this, and personal vendettas would be harmless.
I never said that at all. I said all possible distributions of organs do an equally good job of adhering to the principle "all human lives have equal value" since they all save the same total number of human lives.
Given that we have a tie with respect to the total value of life saved, we need to look at which system gives the best results for society as a whole. I contend a market-based system does the best job for society because it aligns people's incentives with the outcome we want - namely, it incentivizes people to devote resources towards solving the organ shortage.
Sorry for the delay, this didn't show in my replies. I apologize, I didn't realize I hadn't made this more clear. I was skipping this step largely because there has already been a wealth of discussion and general agreement as to the ethical principles that would apply to scarce resources in a medical environment, largely taking place over the last ten years. Did I forget to post one of those papers? Here is a reference from the Lancet.
First of all, simply pointing to consensus is argumentum ad populum, a fallacy.
That said, I respect the idea that these medical thinkers may have more intelligent ideas about this topic than I do, so I read the paper you linked. I noticed two things. First, the paper simply dismisses the idea of allocating by ability to pay, but never actually provides any reason or justification for doing so. (p. 423) That's fine and dandy, but that means it does not refute my arguments in any way, shape, or form.
Second, the paper never actually reaches any conclusion about how to allocate scare resources, other than a buzzword-laden platitude about holistically embracing the challenges of something something blah blah: "Ultimately, none of the eight simple principles recognise all morally relevant values, and some recognise irrelevant values. ... To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo." (p. 429)
I think the real issue here is that you're talking about objects instead of people. If humans were purely individualistic, I would agree with you, but we live in a society where other people's opinions matter. If we've got a pool of people who all need the same scarce resources, we need a damn good reason why one individual got the resource while the others didn't. These people are all still patients, after all, and making the decision to give one the resource does not absolve us our responsibility to the others.
I used the word "object" in a specific example so we could rigorously analyze a principle. I fully understand that we're talking about human beings in the real world here, and they will want a "damn good reason" why things are being done a particular way.
Where I don't see eye-to-eye with you is this: I think my involved and lengthy exposition of why a market-based system generates the best results for society counts as a damn good reason. I don't necessarily think "our lottery system selected him instead of you" counts as a damn good reason.
A lottery system that assigns organs randomly gives people "inequitable" treatment for reasons other than "inequitable" desert. (By "inequitable" I assume you actually mean "unequal." The word "inequitable" is just a synonym for "unfair," which would mean you're saying "something is unfair if it treats people unfairly.")
Actually every possible way of distributing a limited supply of organs gives people unequal treatment.
The lottery system gives each person an equal likelihood of receiving an organ.
What are the "claimed ethical principles" and where do they come from?
Here's what I'm hearing:
Tiax: Ethics requires fairness.
Bitterroot: Why does ethics require fairness?
Tiax: Because fairness is ethical.
The claimed ethical principle is that each person's life has equal value.
Yes, ethics and fairness are closely related. Fairness and justice have been at the heart of ethical systems for millenia. What does it mean to say all men are created equal if there is no need to treat them as such?
I never said that at all. I said all possible distributions of organs do an equally good job of adhering to the principle "all human lives have equal value" since they all save the same total number of human lives.
Fine, substitute "distribution" for "decision". Favoritism cannot result in a sub-optimal distribution, because all distributions are equal. So what harm do you claim there is in favoritism?
Given that we have a tie with respect to the total value of life saved, we need to look at which system gives the best results for society as a whole. I contend a market-based system does the best job for society because it aligns people's incentives with the outcome we want - namely, it incentivizes people to devote resources towards solving the organ shortage.
Sure, but the thing we disagree about is whether the total value of life saved is the important metric.
A lottery system that assigns organs randomly gives people "inequitable" treatment for reasons other than "inequitable" desert. (By "inequitable" I assume you actually mean "unequal." The word "inequitable" is just a synonym for "unfair," which would mean you're saying "something is unfair if it treats people unfairly.")
Actually every possible way of distributing a limited supply of organs gives people unequal treatment.
The lottery system gives each person an equal likelihood of receiving an organ.
And it then treats people unequally by giving some of them organs, but not others.
What are the "claimed ethical principles" and where do they come from?
Here's what I'm hearing:
Tiax: Ethics requires fairness.
Bitterroot: Why does ethics require fairness?
Tiax: Because fairness is ethical.
The claimed ethical principle is that each person's life has equal value.
But "each person's life has equal value" does not include any kind of "fairness" requirement, as I discussed in previous posts.
You're introducing a new principle into the mix: "ethics requires fairness." And I'm asking you to explain where that principle comes from.
Yes, ethics and fairness are closely related. Fairness and justice have been at the heart of ethical systems for millenia. What does it mean to say all men are created equal if there is no need to treat them as such?
Slavery and oppression of women were condoned or tolerated by many ethical systems for millenia. This is the same argumentum ad populum fallacy. Just because it's widely believed, or has be believed for a long time, doesn't necessarily mean it's correct. You need to set forth an actual argument for why ethics requires fairness.
Also, the meaning of "fairness" and "justice" has not been the same for all these ethical systems and time periods, which is why I'm still asking you to define these terms.
I never said that at all. I said all possible distributions of organs do an equally good job of adhering to the principle "all human lives have equal value" since they all save the same total number of human lives.
Fine, substitute "distribution" for "decision". Favoritism cannot result in a sub-optimal distribution, because all distributions are equal. So what harm do you claim there is in favoritism?
No, you're still missing my point. You are right that nothing about the principle "all human lives have equal value" says that vendettas or favoritism is bad. But saying a distribution adheres to the principle "all human lives have equal value" is not the same thing as saying the distribution is "optimal." A distribution is only optimal if it is the best possible distribution, i.e. it maximizes the total well-being of society. "All human lives have equal value" is just one principle that is necessary, but not sufficient, to attaining an optimal result.
Vendettas cause a loss of value to society, which is why they're unethical. For example, let's say someone assigns organs based on who he is friends with. That means people will devote resources toward trying to curry favor with the decisionmaker, rather than devoting those resources to more productive goals. This results in a net loss of society's resources, and is thus a sub-optimal outcome. So we say vendettas are bad because they tend to result in sub-optimal outcomes.
Given that we have a tie with respect to the total value of life saved, we need to look at which system gives the best results for society as a whole. I contend a market-based system does the best job for society because it aligns people's incentives with the outcome we want - namely, it incentivizes people to devote resources towards solving the organ shortage.
Sure, but the thing we disagree about is whether the total value of life saved is the important metric.
Right, you say "fairness" is more important. And you have yet to justify that.
And it then treats people unequally by giving some of them organs, but not others.
Sure, but this is unavoidable. The best we can do is give an equal chance. If we could divide organs into fractional parts that maintained their value, we'd give each person a fraction of an organ.
But "each person's life has equal value" does not include any kind of "fairness" requirement, as I discussed in previous posts.
You're introducing a new principle into the mix: "ethics requires fairness." And I'm asking you to explain where that principle comes from.
The notion that each person's life has equal value leads directly to a fairness requirement. This is what it means to be equal. To be equal is to deserve equal treatment. To be treated equally is fairness. If we agree that lives are equal, then we agree they ought to be treated equally. If we agree they ought to be treated equally, and do not do so, then we have failed to uphold our ethical imperative.
Slavery and oppression of women were condoned or tolerated by many ethical systems for millenia. This is the same argumentum ad populum fallacy. Just because it's widely believed, or has be believed for a long time, doesn't necessarily mean it's correct. You need to set forth an actual argument for why ethics requires fairness.
Also, the meaning of "fairness" and "justice" has not been the same for all these ethical systems and time periods, which is why I'm still asking you to define these terms.
The meaning of fairness and justice are pretty straightforward. As Aristotle said, "justice consists of treating equals equally and unequals unequally". When we agree that two people have equal value, we must immediately conclude that they are to be treated equally - for that is what having equal value means.
No, you're still missing my point. You are right that nothing about the principle "all human lives have equal value" says that vendettas or favoritism is bad. But saying a distribution adheres to the principle "all human lives have equal value" is not the same thing as saying the distribution is "optimal." A distribution is only optimal if it is the best possible distribution, i.e. it maximizes the total well-being of society. "All human lives have equal value" is just one principle that is necessary, but not sufficient, to attaining an optimal result.
Vendettas cause a loss of value to society, which is why they're unethical. For example, let's say someone assigns organs based on who he is friends with. That means people will devote resources toward trying to curry favor with the decisionmaker, rather than devoting those resources to more productive goals. This results in a net loss of society's resources, and is thus a sub-optimal outcome. So we say vendettas are bad because they tend to result in sub-optimal outcomes.
Suppose then that the decision-maker is secret, or otherwise uninfluencable. Besides, the system in which people spend their money on appeasing the decision-maker is not so different from your proposed system in which they give their money to the government for the same outcome. If the cost of organs is that you have to pay money someone, what difference does it make if that someone is a corrupt decision-maker?
And it then treats people unequally by giving some of them organs, but not others.
Sure, but this is unavoidable. The best we can do is give an equal chance. If we could divide organs into fractional parts that maintained their value, we'd give each person a fraction of an organ.
Right, but you said fairness requires equal treatment. Now you're saying a system that manifestly does not treat people equally is still fair. And you still have not explained why for either scenario, nor have you defined "fair."
You're not debating here. You're just baldly asserting things, and then changing your assertions when I point out that you've contradicted yourself.
But "each person's life has equal value" does not include any kind of "fairness" requirement, as I discussed in previous posts.
You're introducing a new principle into the mix: "ethics requires fairness." And I'm asking you to explain where that principle comes from.
The notion that each person's life has equal value leads directly to a fairness requirement. This is what it means to be equal. To be equal is to deserve equal treatment. To be treated equally is fairness. If we agree that lives are equal, then we agree they ought to be treated equally. If we agree they ought to be treated equally, and do not do so, then we have failed to uphold our ethical imperative.
"all lives have equal value" does not necessarily mean "all people deserve equal treatment." We haven't even discussed what it means for someone to "deserve" something, or who is the arbiter of what people deserve. Do you mean "deserve" under the law, as in legal entitlement? Do you mean "deserve" in a cosmic sense, like karma or something? Do you mean something different?
And once you answer this question, then you can show me the logical steps to go from "all lives have equal intrinsic value" to "all people deserve equal treatment." You can't just assert that these two statements are equivalent. I don't agree that they are.
Slavery and oppression of women were condoned or tolerated by many ethical systems for millenia. This is the same argumentum ad populum fallacy. Just because it's widely believed, or has be believed for a long time, doesn't necessarily mean it's correct. You need to set forth an actual argument for why ethics requires fairness.
Also, the meaning of "fairness" and "justice" has not been the same for all these ethical systems and time periods, which is why I'm still asking you to define these terms.
The meaning of fairness and justice are pretty straightforward. As Aristotle said, "justice consists of treating equals equally and unequals unequally". When we agree that two people have equal value, we must immediately conclude that they are to be treated equally - for that is what having equal value means.
First of all, just quoting Aristotle without any supporting argument or justification is a fallacy. It's an appeal to authority. You need to back up this proposition with an argument.
Second, if "justice consists of treating equals equally," then your lottery system is manifestly unjust because it does not treat equals equally.
No, you're still missing my point. You are right that nothing about the principle "all human lives have equal value" says that vendettas or favoritism is bad. But saying a distribution adheres to the principle "all human lives have equal value" is not the same thing as saying the distribution is "optimal." A distribution is only optimal if it is the best possible distribution, i.e. it maximizes the total well-being of society. "All human lives have equal value" is just one principle that is necessary, but not sufficient, to attaining an optimal result.
Vendettas cause a loss of value to society, which is why they're unethical. For example, let's say someone assigns organs based on who he is friends with. That means people will devote resources toward trying to curry favor with the decisionmaker, rather than devoting those resources to more productive goals. This results in a net loss of society's resources, and is thus a sub-optimal outcome. So we say vendettas are bad because they tend to result in sub-optimal outcomes.
Suppose then that the decision-maker is secret, or otherwise uninfluencable. Besides, the system in which people spend their money on appeasing the decision-maker is not so different from your proposed system in which they give their money to the government for the same outcome. If the cost of organs is that you have to pay money someone, what difference does it make if that someone is a corrupt decision-maker?
If you don't see the difference between spending money to influence a corrupt decisionmaker, versus spending money in a market, then you can't possibly have understood my argument at all up to this point. My argument is not that we should just make people pay for the sake of making them pay. My entire argument for why a market system is good, is the fact that it channels money into the organ market incentivizing suppliers to increase the number of available organs (both real and artificial). Money spent to influence a corrupt decisionmaker does not enter the organ market at all, and therefore does not have any of the beneficial incentive effects that I'm talking about.
Right, but you said fairness requires equal treatment. Now you're saying a system that manifestly does not treat people equally is still fair. And you still have not explained why for either scenario, nor have you defined "fair."
You're not debating here. You're just baldly asserting things, and then changing your assertions when I point out that you've contradicted yourself.
The system is equal because each person's expected value is the same. Certainly a system in which each person received an actual fraction of an organ (again, assuming that a fraction of an organ still had fractional utility) would be more fair, but that's not an option.
"all lives have equal value" does not necessarily mean "all people deserve equal treatment." We haven't even discussed what it means for someone to "deserve" something, or who is the arbiter of what people deserve. Do you mean "deserve" under the law, as in legal entitlement? Do you mean "deserve" in a cosmic sense, like karma or something? Do you mean something different?
And once you answer this question, then you can show me the logical steps to go from "all lives have equal intrinsic value" to "all people deserve equal treatment." You can't just assert that these two statements are equivalent. I don't agree that they are.
I of course mean deserve in an ethical sense. If you feel the statement that people have equal value says nothing about how they are to be treated, then what meaning does that statement have?
First of all, just quoting Aristotle without any supporting argument or justification is a fallacy. It's an appeal to authority. You need to back up this proposition with an argument.
Second, if "justice consists of treating equals equally," then your lottery system is manifestly unjust because it does not treat equals equally.
I'm quoting Aristotle to demonstrate that the meaning of the term has been consistent, which you contend it has not. That's not a fallacy.
If you don't see the difference between spending money to influence a corrupt decisionmaker, versus spending money in a market, then you can't possibly have understood my argument at all up to this point. My argument is not that we should just make people pay for the sake of making them pay. My entire argument for why a market system is good, is the fact that it channels money into the organ market incentivizing suppliers to increase the number of available organs (both real and artificial). Money spent to influence a corrupt decisionmaker does not enter the organ market at all, and therefore does not have any of the beneficial incentive effects that I'm talking about.
In either case, people are incentivized to develop artificial organs. If people are spending X dollars on the decision maker, that demonstrates an market for artificial organs at that cost.
In your version, who are these suppliers, and where are they getting piles of real organs?
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And how might we objectively assign value to live? Is the life of someone that is about to die worth the same as the life of someone that has many years yet to live? If someone has a gun and says they will either kill the 5 year old healthy person or an 80 year old terminal cancer patient with a week to live at most... Can we say that the child's life has more value? Or must we still claim that both lives have the same value?
1. What is fairness? How can I determine whether something is fair or not? (I'm not trying to be facetious here. In my experience, what's considered "fair" varies widely from person to person.)
2. Why does ethics require fairness?
3. I would argue that the "vendetta rule" has nothing to do with fairness, and everything to do with preserving the healthy functioning of the system. It's essentially just the concept of fiduciary duty. In other words, the administrator of the system has a duty to not profit (financially or personally) from the system he or she administers. This is to prevent the administrator from making sub-optimal decisions to privately benefit themselves.
Something is unfair if two people are given inequitable treatment for reasons other than inequitable desert.
Fairness is adherence to the claimed ethical principles. To be unfair is to give someone treatment, either positive or negative, that is undeserved.
You contend that this scenario does not have sub-optimal decisions, as any distribution saves the same total value of lives. Therefore, there is no risk of this, and personal vendettas would be harmless.
Sorry for the delay, this didn't show in my replies. I apologize, I didn't realize I hadn't made this more clear. I was skipping this step largely because there has already been a wealth of discussion and general agreement as to the ethical principles that would apply to scarce resources in a medical environment, largely taking place over the last ten years. Did I forget to post one of those papers? Here is a reference from the Lancet.
In any case, I think I see where the confusion is. In my previous posts, I was talking about situations where all factors about prognosis, instrumental values, life years, etc are equal. If they're not equal, I'm open to a more utilitarian approach. I was also referencing the American Healthcare system, where as a society we've made certain value judgments, and I was operating in that context. Those judgments include things like not allowing ability to pay determine whether or not someone receives life-sustaining treatment, which was the basis of EMTALA's anti-patient dumping laws. But if you want to talk more specifics about why that's not okay, I'll bite.
It boils down to the fact that everyone's life is valuable to them. Fluffy has already mentioned that lives have subjective value to other people, and those values will vary from person to person. So, objectively, the only consistent metric is that everyone values their own lives, unless stated otherwise. So how do we determine who lives or who dies when, while attempting to be impartial, all lives are equal? Well, we have to do it based on an attempt to be fair, or by metrics that can commonly be agreed on to have value (which is where the ethical principles come in). We have to do it in such a way that a third party could agree that everyone was treated fairly.
From a medical standpoint, your ability to pay for medical treatment isn't relevant to your medical condition. If a doctor is given a report on two patients, those patient's wealth isn't a medical criteria nor is it a medical condition, so why should it be a deciding factor in whether or not they live or die?
I discussed this a little above, but basically the only consistent metric of a worth of a life is what the individual thinks it is for themselves. We have to operate under the assumption that all lives are equally valuable unless stated otherwise but the owner of said life (and this is of course skipping the issue of mental health and competency). An individual's social worth has no real bearing on their medical need, and unless those activities directly conflict with their ability to survive with a treatment (like with drug users, for instance), it really shouldn't be a rationale in making a medical decision.
I'd give this more leeway if we're talking instrumental value in a crisis situation: if we've only got a certain number of countermeasures, I think most people would find it reasonable that those countermeasures go to individuals who are most able to help the current situation. For instance, healthcare providers getting a priority in a medical emergency. This assumes that the 'countermeasure' will actually help the person in a given timeframe, though.
This is why I pushed earlier that only medical criteria should be major factors in making these decisions.
I think the real issue here is that you're talking about objects instead of people. If humans were purely individualistic, I would agree with you, but we live in a society where other people's opinions matter. If we've got a pool of people who all need the same scarce resources, we need a damn good reason why one individual got the resource while the others didn't. These people are all still patients, after all, and making the decision to give one the resource does not absolve us our responsibility to the others.
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I do not know.
But I do know why people prefer to adhere to the general principle of "all lives are equal".
Otherwise you run into situations where people are given worth based on subjective values, and so essentially cause people to lose certain rights ,mainly right to self-determination that is fundamental to the concept of a democratic society and inherent in the U.S. philosophy of rights.
A lottery system that assigns organs randomly gives people "inequitable" treatment for reasons other than "inequitable" desert. (By "inequitable" I assume you actually mean "unequal." The word "inequitable" is just a synonym for "unfair," which would mean you're saying "something is unfair if it treats people unfairly.")
Actually every possible way of distributing a limited supply of organs gives people unequal treatment.
What are the "claimed ethical principles" and where do they come from?
Here's what I'm hearing:
Tiax: Ethics requires fairness.
Bitterroot: Why does ethics require fairness?
Tiax: Because fairness is ethical.
I never said that at all. I said all possible distributions of organs do an equally good job of adhering to the principle "all human lives have equal value" since they all save the same total number of human lives.
Given that we have a tie with respect to the total value of life saved, we need to look at which system gives the best results for society as a whole. I contend a market-based system does the best job for society because it aligns people's incentives with the outcome we want - namely, it incentivizes people to devote resources towards solving the organ shortage.
First of all, simply pointing to consensus is argumentum ad populum, a fallacy.
That said, I respect the idea that these medical thinkers may have more intelligent ideas about this topic than I do, so I read the paper you linked. I noticed two things. First, the paper simply dismisses the idea of allocating by ability to pay, but never actually provides any reason or justification for doing so. (p. 423) That's fine and dandy, but that means it does not refute my arguments in any way, shape, or form.
Second, the paper never actually reaches any conclusion about how to allocate scare resources, other than a buzzword-laden platitude about holistically embracing the challenges of something something blah blah: "Ultimately, none of the eight simple principles recognise all morally relevant values, and some recognise irrelevant values. ... To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo." (p. 429)
I used the word "object" in a specific example so we could rigorously analyze a principle. I fully understand that we're talking about human beings in the real world here, and they will want a "damn good reason" why things are being done a particular way.
Where I don't see eye-to-eye with you is this: I think my involved and lengthy exposition of why a market-based system generates the best results for society counts as a damn good reason. I don't necessarily think "our lottery system selected him instead of you" counts as a damn good reason.
The lottery system gives each person an equal likelihood of receiving an organ.
The claimed ethical principle is that each person's life has equal value.
Yes, ethics and fairness are closely related. Fairness and justice have been at the heart of ethical systems for millenia. What does it mean to say all men are created equal if there is no need to treat them as such?
Fine, substitute "distribution" for "decision". Favoritism cannot result in a sub-optimal distribution, because all distributions are equal. So what harm do you claim there is in favoritism?
Sure, but the thing we disagree about is whether the total value of life saved is the important metric.
And it then treats people unequally by giving some of them organs, but not others.
But "each person's life has equal value" does not include any kind of "fairness" requirement, as I discussed in previous posts.
You're introducing a new principle into the mix: "ethics requires fairness." And I'm asking you to explain where that principle comes from.
Slavery and oppression of women were condoned or tolerated by many ethical systems for millenia. This is the same argumentum ad populum fallacy. Just because it's widely believed, or has be believed for a long time, doesn't necessarily mean it's correct. You need to set forth an actual argument for why ethics requires fairness.
Also, the meaning of "fairness" and "justice" has not been the same for all these ethical systems and time periods, which is why I'm still asking you to define these terms.
No, you're still missing my point. You are right that nothing about the principle "all human lives have equal value" says that vendettas or favoritism is bad. But saying a distribution adheres to the principle "all human lives have equal value" is not the same thing as saying the distribution is "optimal." A distribution is only optimal if it is the best possible distribution, i.e. it maximizes the total well-being of society. "All human lives have equal value" is just one principle that is necessary, but not sufficient, to attaining an optimal result.
Vendettas cause a loss of value to society, which is why they're unethical. For example, let's say someone assigns organs based on who he is friends with. That means people will devote resources toward trying to curry favor with the decisionmaker, rather than devoting those resources to more productive goals. This results in a net loss of society's resources, and is thus a sub-optimal outcome. So we say vendettas are bad because they tend to result in sub-optimal outcomes.
Right, you say "fairness" is more important. And you have yet to justify that.
Sure, but this is unavoidable. The best we can do is give an equal chance. If we could divide organs into fractional parts that maintained their value, we'd give each person a fraction of an organ.
The notion that each person's life has equal value leads directly to a fairness requirement. This is what it means to be equal. To be equal is to deserve equal treatment. To be treated equally is fairness. If we agree that lives are equal, then we agree they ought to be treated equally. If we agree they ought to be treated equally, and do not do so, then we have failed to uphold our ethical imperative.
The meaning of fairness and justice are pretty straightforward. As Aristotle said, "justice consists of treating equals equally and unequals unequally". When we agree that two people have equal value, we must immediately conclude that they are to be treated equally - for that is what having equal value means.
Suppose then that the decision-maker is secret, or otherwise uninfluencable. Besides, the system in which people spend their money on appeasing the decision-maker is not so different from your proposed system in which they give their money to the government for the same outcome. If the cost of organs is that you have to pay money someone, what difference does it make if that someone is a corrupt decision-maker?
Right, but you said fairness requires equal treatment. Now you're saying a system that manifestly does not treat people equally is still fair. And you still have not explained why for either scenario, nor have you defined "fair."
You're not debating here. You're just baldly asserting things, and then changing your assertions when I point out that you've contradicted yourself.
"all lives have equal value" does not necessarily mean "all people deserve equal treatment." We haven't even discussed what it means for someone to "deserve" something, or who is the arbiter of what people deserve. Do you mean "deserve" under the law, as in legal entitlement? Do you mean "deserve" in a cosmic sense, like karma or something? Do you mean something different?
And once you answer this question, then you can show me the logical steps to go from "all lives have equal intrinsic value" to "all people deserve equal treatment." You can't just assert that these two statements are equivalent. I don't agree that they are.
First of all, just quoting Aristotle without any supporting argument or justification is a fallacy. It's an appeal to authority. You need to back up this proposition with an argument.
Second, if "justice consists of treating equals equally," then your lottery system is manifestly unjust because it does not treat equals equally.
If you don't see the difference between spending money to influence a corrupt decisionmaker, versus spending money in a market, then you can't possibly have understood my argument at all up to this point. My argument is not that we should just make people pay for the sake of making them pay. My entire argument for why a market system is good, is the fact that it channels money into the organ market incentivizing suppliers to increase the number of available organs (both real and artificial). Money spent to influence a corrupt decisionmaker does not enter the organ market at all, and therefore does not have any of the beneficial incentive effects that I'm talking about.
The system is equal because each person's expected value is the same. Certainly a system in which each person received an actual fraction of an organ (again, assuming that a fraction of an organ still had fractional utility) would be more fair, but that's not an option.
I of course mean deserve in an ethical sense. If you feel the statement that people have equal value says nothing about how they are to be treated, then what meaning does that statement have?
I'm quoting Aristotle to demonstrate that the meaning of the term has been consistent, which you contend it has not. That's not a fallacy.
In either case, people are incentivized to develop artificial organs. If people are spending X dollars on the decision maker, that demonstrates an market for artificial organs at that cost.
In your version, who are these suppliers, and where are they getting piles of real organs?