In a world of bioethicists who primarily eschew the sanctity/equality of life ethic, Fordham University’s Charles Camosyis a refreshing ethicist worthy of the title. Of late, he has been warning against the dangers of the quality-of-life ethic that so many of his peers promote. Most visibly, he recently appeared on Tucker Carlson’s interview program arguing against assisted suicide.
Now, he has a fine opinion piece in the New York Post discussing the awful prospect of triaging coronavirus patients who need hospitalization. But how to do it ethically? What we shouldn’t do, Camosy writes, is to allow the rationer to decide who receives care and who is turned away based on an invidious judgment of the patient’s “quality of life.”
An Insidious Turn
Bioethicists like me disagree over which values should guide rationing, but we generally agree about focusing on those who can benefit from the treatment. If the age of a patient makes it unlikely she would benefit, the hard truth is that limited resources will likely go to someone else.
But then there is the “number of life years” the patient could “enjoy,” as the Italians put it. This consideration comes from providers’ growing tendency to think either implicitly or explicitly about how many “quality-adjusted life years” their interventions might produce.
It is a poisonously utilitarian and inherently discriminatory mentality. It is ageist — discriminatory against the elderly — and ableist — discriminatory against the disabled — to its core.
Camosy notes that people with Down syndrome are often the victims of such discrimination, particularly in Europe, and warns that even some U.S. hospitals are considering “quality of life as part of their rationing process.” That would be an insidious turn of events:
It should not be up to physicians to decide whose subjective quality of life deserves to be prolonged. Physicians almost always rate the quality of life of their patients significantly lower than patients do themselves — and miss the fact that their patients often prefer length of life to quality of life (whatever that means). In short, they are terrible deciders about who should live and who should die.
Suitably Objective Criteria
Camosy assures readers that New York State has already grappled with rationing in a time of pandemic, and bases these terribly hard decisions on suitably objective criteria:
Wisely, our state insists that age and health problems or disabilities unrelated to what is causing the epidemic shouldn’t serve as the basis for rationing. Prognosis for recovery is what matters.
A New York hospital could choose to give its last ventilator to the 72-year-old marathon runner rather than to the 57-year-old pack-a-day smoker. Again, based only on prognosis for recovery. The objectivity of the standard removes much of the physician’s subjective ideology from the picture.
Exactly right. And please note that such a decision would not be to punish the smoker — as some centralized health-care proponents would do — but based solely on the likelihood of recovering.
I am very pleased Camosy is making a prominent splash. Bioethics needs more thinkers who have their human-rights values screwed on straight advocating prominently in the public square. I look forward to reading more of his work.