This paper is a reply to proposals to base priority health-care decisions on public opinion surveys. Whilst it is recognised that current practice is less than satisfactory, it is argued here that basing health-care priorities on societal attitudes in this way is not a solution and does not provide a satisfactory basis for bringing democracy to the health service.

A relative value of life dependent on age has been produced from a survey of 721 randomly selected individuals together with other observations of professional practice. The results are presented in diagrammatic form. If two identical people, except for age, present for medical treatment for a life-threatening condition and only one can be treated then the diagram indicates what the choice should be.

There is a need to bring ethics and medical practice closer together, despite the risk and problems this may involve. Deontological ethics may promote sanctity of life considerations against the quality of life considerations favoured by consequentialists or utilitarians; while talk of respect for life and the value of life may point to more qualified ethical positions. This paper argues for a respect-for-life position, dismissing a utilitarian cost-benefit outlook as too simplistic; but an unqualified fixed principles approach is also ruled (...) out, both because of its unacceptable consequences in individual cases and also because of its reliance on the slippery slope argument which, it is argued, is logically and psychologically deficient. The case of genetic engineering provides an example in which the notion of respect may operate, but in which broad general principles also apply. A cautious conservatism towards accepted principles is recommended in the development of medical technologies. (shrink)