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The ethics of age limits

This informal workshop focuses on four papers dealing with a variety of ethical questions associated with the use of age limits, especially in health care.

Time: Wednesday, November 23, 14:00 - 18:00
Place: The Institute for Futures Studies (IFFS), Holländardgatan 13, Stockholm

Those interested in attending can e-mail Tim Campbell (tlc222@gmail.com) or Greg Bognar (greg.bognar@philosophy.su.se) for copies of the four papers. The papers should be read in advance. Speakers won't be giving talks--except for maybe a few words about their project.

Titles and abstracts
Axel Gosseries (UC Louvain): Age, Equality and Medical Efficiency in Organ Transplants
In this paper, I distinguish the use of age in organ transplant as a predictor of medical efficiency and as a life-length redistributor.  Based on this distinction, I look into the Swiss transplant legislation and argue that contrary to what it claims, it is unable to justify its uses of the age criterion merely on «medical efficiency»

Greg Bognar (Stockholm): The Value of Longevity
Longevity is valuable.  Most of us would agree that it's bad to die when you could go on living, and death's badness has to do with the value your life would have if it continued.  Most of us would also agree that it's bad if life expectancy in a country is low, it's bad if there is high infant mortality, and it's bad if there is a wide
mortality gap between different groups in a population.  But how can we make such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this paper, I take a few first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results.

Timothy Campbell (IF): Should Newborns Count for Less?
According to Jeff McMahan, we ought to save an individual, A, from dying as a young adult (e.g., at age 30) rather than save some other individual, B, from dying as a newborn, even if the latter intervention would give B twice as many years of full-quality life as the former intervention would give A.  Call this claim Young Adults over Newborns.  I argue that if we accept Young Adults over Newborns, then we must reject at least one of three other claims:

  • Saving Newborns from Death: All else equal, we ought to save the life of a newborn rather than let it die, even if saving it entails that it will die at age 30.
  • Weak Life-Extension: All else equal, we ought to extend the life of a certain newborn from age 0 to age 80 rather than extend the life of some other newborn from age 0 to age 70, provided that for either individual, the additional years of life would be full-quality. 
  • Acyclicity: The relation ‘ought to choose rather than’, as it applies to pairs of health interventions, is acyclic: for any three alternative health interventions a, b, and c, if a ought to be chosen rather than b when a and b are the only options, and b ought to be chosen rather than c when b and c are the only options, it is not the case that c ought to be chosen rather than a when a and c are the only options.

I argue that we should accept these three claims and reject Young Adults over Newborns.

Espen Gamlund (Bergen): Age, Death, and the Allocation of Life-Saving Resources
Each year policy-makers around the world must make hard decisions about how to allocate scarce health care resources. Given the scarcity of many life-saving interventions, such as vaccines, beds in intensive care units, and organs for transplant, making allocation decisions entails determining who lives and who dies. Interventions that are successful in preventing death save people’s lives. One relevant aspect of such allocation decisions concerns the relative importance of death at different ages. How should we value the prevention of deaths according to age? The purpose of this chapter is to provide an answer to this question by examining three age-specific allocation principles and their underlying moral foundations: a youngest first principle, prioritizing infants, a children’s first principle, prioritizing children, and a young adult’s first principle, prioritizing adolescents and young adults. Moreover, I show that these principles have their source in different accounts of the badness of death. My claim is that a youngest-first principle can draw support from a deprivation account, a children’s first principle can draw support from a gradualist account, and a young adult’s first principle can draw support from a complete lives account. I conclude, tentatively, that gradualism and children first allocation should be our favored choice.