Public Preferences about Fairness and the Ethics of Allocating Scarce Medical Interventions

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Ethics, Allocation, Rationing, Scarce medical resources, Descriptive ethics, Experimental philosophy

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Sturm College of Law


When there are not enough medical resources to go around, society faces the question of how to fairly allocate them. And when these resources are not only scarce but essential to treat a potentially deadly condition, fair allocation becomes a question of—as Life magazine once put it—deciding “who lives, who dies” (Alexander, 1962). These questions have prompted attention and refection from medical professionals, ethicists, theologians, and the general public. Some scholars, frequently social scientists, have conducted survey or focusgroup research on various groups’ preferences regarding how scarce medical resources should be allocated. My focus in this chapter is to examine how socialscientifc research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientifc researchers might fnd an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by frst distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which I have previously defended, and a brief recap of socialscientifc research on the allocation of scarce medical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarce medical resources.