Given the inevitability of scarcity, should public institutions ration healthcare resources so as to prioritize those who contribute more to society? Intuitively, we may feel that this would be somehow inegalitarian. I argue that the egalitarian objection to prioritizing treatment on the basis of patients’ usefulness to others is best thought of as semiotic: i.e. as having to do with what this practice would mean, convey, or express about a person's standing. I explore the implications of this conclusion when taken in conjunction with the observation that semiotic objections are generally flimsy, failing to identify anything wrong with a practice as such and having limited capacity to generalize beyond particular contexts.

中文翻译：

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意义、医学和优点

鉴于稀缺的必然性，公共机构是否应该对医疗资源进行定量分配，以优先考虑那些对社会贡献更大的人？直觉上，我们可能会觉得这在某种程度上是不平等的。我认为，基于患者对他人的有用性来优先考虑治疗的平等主义反对意见最好被视为符号学：即与这种做法对一个人的地位的意义、传达或表达有关。结合以下观察结果，我探讨了这一结论的含义，即符号学反对通常是站不住脚的，无法识别实践本身的任何错误，并且在特定上下文之外进行概括的能力有限。