An Egalitarian Ethos

I have been arguing that an egalitarian approach to patient selection should afford each candidate equal concern and respect. One philosophical question is “Why value equality?” Why not value autonomy, which allows persons to make choices about the kind of good life they want to pursue? I will argue that the principle of equal concern and respect balances equality, fairness and autonomy in an egalitarian ethos. On Dworkinian lines, the principle of equal concern and respect includes autonomy.

One can show that an egalitarian ethos involves values and concerns that require equalizing. If what makes us care about various inequalities is not inequality as such but the concern identified by an underlying principle (e.g., the hunger of the hungry, or the need to live of those who are dying from end-stage organ disease), then egalitarians might meet that concern by equalizing in the apposite way. Hence my argument below for equalizing opportunity in patient selection.

My final step will suggest a normative metric that applies at the micro level. This will tell us what aspects of a person’s condition should count in patient selection as “something which justice requires people to have equal amounts of.” How would an egalitarian patient selection process answer the question “Equality of what?” What would the right to equal concern and respect render transplant candidates equal in? My proposed equalisandum is equal opportunity for adequate conscious life6 above a threshold level of medical benefit.