Abstract
During the coronavirus pandemic, communities
have faced shortages of important healthcare resources such as COVID-19 vaccines, medical staff, ICU
beds and ventilators. Public health officials in the
U.S. have had to make decisions about two major issues: which infected patients should be treated first
(triage), and which people who are at risk of infection should be inoculated first (vaccine distribution).
Following Beauchamp and Childress’s principlism,
adopted guidelines have tended to value both whole
lives (survival to discharge) and life-years (survival
for years past discharge). This process of collective
moral reasoning has revealed our common commitment to both Kantian and utilitarian principles. For
Kant, respecting people’s rights entails that we ought
to value whole lives equally. Therefore we ought to
allocate resources so as to maximise the number of
patients who survive to discharge. By contrast, the
principle of utility has us maximise life-years so that
people can satisfy more of their considered preferences. Although people are treated impartially in the
utilitarian calculus, it does not recognise their equal
worth. Subjecting Kantian ethics and utilitarianism
to the process of reflective equilibrium lends support
to the idea that we need a pluralistic approach that
would accommodate our moral intuitions regarding
both the equal value of whole lives and the additive
value of life-years.