Academic journal article Issues in Law & Medicine

A Critique of Callahan's Utilitarian Approach to Resource Allocation in Health Care

Academic journal article Issues in Law & Medicine

A Critique of Callahan's Utilitarian Approach to Resource Allocation in Health Care

Article excerpt

ABSTRACT: The rationale of this article is grounded in the liberal tradition. It places the individual at the center of concern, and attempts to fortify the individual's basic right to health care. Attention is focused on the writings of Daniel Callahan, arguing that his approach is too cold and detached, and that age should not serve as the decisive criterion. The criticism of his views on older patients and on patients in post-coma unawareness (PCU) stems from two different lines of reasoning: the medical and the moral-contractual. From the medical perspective, while age is an important variable in determining a patient's medical condition, there are other--no less important--factors that influence one's health. From the moral-contractual line of reasoning, liberal society should not desert its citizens at the time they need its help most. The age criterion is too simple, too general, too sweeping. It provides too convenient an answer to a tough and troubling question. Similarly, the argument with regard to PCU patients should be qualified, taking into account the age of the patient, the cause of the condition, and the length of time in state of unawareness.

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In most liberal societies, basic health is seen as one of the necessary conditions for the exercise of personal autonomy. It is generally acknowledged that individuals have a right to health care. The prevalent assumption is that this right generates an obligation or duty on the part of the state to ensure that adequate health care is made available and which further requires that equal access to available health care is provided through public funds. The state has no obligation to provide a health-care system itself, but the state does have the obligation to ensure that such an adequate system is provided. Basic health care is now recognized as a "public good" rather than a "private good" that one is expected to buy for oneself. (1) The Constitution of the World Health Organization states: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. (2)

The constraints on the financial resources allocated for care of the ill force us to consider, in an honest and serious manner, the tension between the ideal and the real. Currently, challenges to our health have medical solutions, albeit sometimes partial, that were unimaginable in the previous century. The new technology is very costly, and some have claimed that saving lives is not a goal that should be achieved at any cost. (3) Costs and benefits must be examined and priorities determined so as to invest resources only in "worthy cases." The term "worthy cases" is often juxtaposed with the term "quality of life." (4) The claim is that expensive technology should be used to help patients who are likely to maintain a certain quality of life. When there is a low quality of life, it is preferable to exercise discretion as a society and to reserve our finite resources to treat patients who are more likely to lead autonomous lives.

The financial resources are obviously limited, and the national budget must be prioritized according to various needs: technology, security, education, culture, health, housing, food, transportation, science, the legal system, environmental protection, etc. The debate about how to allocate health care resources revolves around three basic concepts: duty, ability, and rights. The central questions are: Does a democratic society have a duty to provide optimal health care for each and every citizen? Can the state provide optional health care for each and every citizen? Do citizens have a right to demand such a commitment from their government?

In the liberal framework, the concept of "rights" is understood in terms of a need that is perceived by those who demand it as legitimate and, therefore, the state has a real responsibility to provide health care for each and every citizen. …

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