Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

Previous edition, 1st, published in 1971.

abstract A police technique known as racial profiling draws on statistical beliefs about crime rates in racial groups. Supposing that such beliefs are true, and that racial profiling is effective in fighting crime, is such profiling morally justified? Recently, Risse and Zeckhauser have explored the racial profiling of African‐Americans and argued that justification is forthcoming from a utilitarian as well as deontological point of view. Drawing on criticisms made by G. A. Cohen of the incentives argument for inequality, I argue (...) that, assuming that crime rates between different racial groups would converge in the absence of racial discrimination and unjust inequality, racial profiling is comprehensively unjustified. I also explain that, because Risse and Zeckhauser simply compare the status quo with an outcome that differs from it only in respect of the practice of racial profiling, they fail to show that such profiling is non‐comprehensively justified. And, exploring the problem from the point of view of a deontological concern for fairness, I identify a number of situations in which it would be non‐comprehensively unjustified to implement racial profiling (as well as some in which it might be non‐comprehensively unjustified not to implement racial profiling). (shrink)

The increasing complexity of modern hospital care and the decisions that must be made were the reasons we began our research on the Acute Physiology, Age and Chronic Health Evaluation project. As a clinician in an intensive care unit, I felt very uncomfortable making the sorts of decisions that are common today without any source of information or any reference points. These decisions are not avoidable, they are not discretionary, and they are going to become more frequent in the future (...) because we are treating people at later stages of disease. (shrink)

How, exactly, must we strike the balance between security and equality? Must we insist, out of respect for the equality of persons, that the police refrain from using ethnic profiling and opt for some other strategy in their pursuit of terrorists, or must we allow the police to continue with this policy, which seems to sacrifice equality for the sake of security? This paper assesses the ethical status of ethnic profiling from the perspective of the ideal of equality. The paper (...) shows how the ethical status of ethnic profiling changes depending on how exactly we specify the egalitarian ideal. Furthermore, it argues that on a plausible interpretation of the ideal of equality, ethnic profiling is not in principle objectionable. (shrink)

We have benefited from conversations with Archon Fung, Brian Jacob, Todd Pittinsky, Peter Schuck, Ani Satz, Andrew Williams, and students in a joint class on statistics and ethics at the John F. Kennedy School of Government in October 2002. We are also grateful to our audience at the conference “The Priority of Practice,” organized by Jonathan Wolff at University College London in September 2003, and to Arthur Applbaum, Miriam Avins, Frances Kamm, Simon Keller, Frederick Schauer, Alan Wertheimer, and the Editors (...) of Phi- losophy & Public Affairs for insightful comments. We have benefited from prepublication reading of Schauer’s work on profiling, Profiles, Probabilities, and Stereotypes (Cambridge, Mass: Harvard University Press, 2003). We thank Avedis Koutoujian for research assistance. (shrink)

Kerstein and Bognar (2010) and Persad, Wertheimer, and Emanuel (2009) defend specific principles for the allocation of health care resources, but their choice of principles is influenced by the exa...