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Explaining rule of rescue obligations in healthcare allocation: allowing the patient to tell the right kind of story about their life
Medicine, Health Care and Philosophy ( IF 1.917 ) Pub Date : 2021-09-12 , DOI: 10.1007/s11019-021-10047-y
Sean Sinclair 1
Affiliation  

I consider various principles which might explain our intuitive obligation to rescue people from imminent death at great cost, even when the same resources could produce more benefit elsewhere. Our obligation to rescue is commonly explained in terms of the identifiability of the rescuee, but I reject this account. Instead, I offer two considerations which may come into play. Firstly, I explain the seeming importance of identifiability in terms of an intuitive obligation to prioritise life-extending interventions for people who face a high risk of an early death, and I explain this in turn with a fair innings-style principle which prioritises life-extending interventions for people expected to die young. However, this account is incomplete. It does not explain why we would devote the same resources to rescuing miners stuck down a mine even if they are elderly. We are averse to letting people die suddenly, or separated from friends and family. And so, secondly, I give a new account that explains this in terms of narrative considerations. We value life stories that follow certain patterns, classic patterns which are reflected in many popular myths and stories. We are particularly averse to depriving people of the opportunity to follow some such pattern as they approach death. This means allowing them to sort out their affairs, say goodbyes to family and friends, review their life, or come to terms with death itself. Such activities carry a lot of meaning as ways of closing our life story in the right way. So, for someone who has not been given much notice of their death, an extra month is worth much more than for other patients. Finally, I review the UK National Health Service's end of life premium, which gives priority to patients with short life expectancy. I suggest it falls short in terms of such considerations. For example, the NHS defines its timings in terms of how long the patient can expect to live as at the time of the treatment decision, whereas the timings should be specified in terms of time from diagnosis.



中文翻译:

解释医疗分配中的救援义务规则:让患者讲述关于他们生活的正确故事

我考虑了各种原则,这些原则可以解释我们以巨大代价将人们从迫在眉睫的死亡中拯救出来的直觉义务,即使相同的资源可以在其他地方产生更多的利益。我们的营救义务通常以获救者的身份来解释,但我拒绝这种说法。相反,我提出了两个可能发挥作用的考虑因素。首先,我从直觉义务的角度解释了可识别性的表面重要性,即为面临早死风险的人优先考虑延长生命的干预措施,然后我用一个公平的局式原则来解释这一点,该原则优先考虑生命——扩大对预计英年早逝的人的干预。但是,这个帐户是不完整的。它没有解释为什么我们会投入相同的资源来营救被困在矿井中的矿工,即使他们是老年人。我们反对让人们突然死亡,或与朋友和家人分离。因此,其次,我给出了一个新的解释,从叙述的角度来解释这一点。我们重视遵循某些模式的生活故事,经典模式反映在许多流行的神话和故事中。我们特别反对剥夺人们在接近死亡时遵循某种模式的机会。这意味着允许他们整理自己的事务,与家人和朋友道别,回顾他们的生活,或者接受死亡本身。这些活动作为以正确方式结束我们的生活故事的方式具有很多意义。所以,对于那些没有得到太多死亡通知的人来说,多一个月比其他病人更有价值。最后,我回顾一下英国国民健康服务体系的临终保费,它优先考虑预期寿命较短的患者。我认为它在这些考虑方面有所不足。例如,NHS 根据患者在做出治疗决定时的预期寿命来定义其时间,而时间应根据诊断后的时间来指定。

更新日期:2021-09-13
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