Rationality and consistency
In terms of rationality, the main rule of public health ethics is that
whatever rule is chosen must be applied consistently. Reasonable life
expectancy does not consider the dimension of narrative or care ethics.
Is it fair, can it be justified? For instance, young versus old, and the
equal value of life. One of the main issues of triage is the
discrimination based on age. When do we begin to count the value of
life? Is a fetus more important than a teenager? The idea of withdrawing
treatment in a situation of scarce resources, in order to provide a
respirator to a younger person for instance, may reach consensus in
times of war, but here the metaphor of war is certainly not appropriate.
This pandemic emphasizes mostly a bad governing of resources and not a
lack of resources in the long term. The lack of anticipation cannot
justify withdrawing treatment. It would be unfair.
In a utilitarian model, scarce resources go first to efficient patients.
What do we lose in such a simplistic model? Should we provide care only
to those who have instrumental value? This should be a societal choice,
which goes far beyond medical ethics and raises true biopolitical
dilemmas of distributive justice. Do we want to survive in a society of
care, or in a mere society of efficiency? We have known this situation
in Africa for access to drugs during the HIV/AIDS epidemic. Drugs where
so scarce that medical doctors had access priority, but then nothing was
left for the patients. The efficiency model can thus lead to absurd
decisions, if no good decisions can be made to resolve the dilemma.