A Threshold Level of Medical Benefit

A standard of medical benefit should be used at the first stage of patient selection. This could be a non-comparative criterion that judges patients on their own merits. Feinberg’s notion of a non-comparative criterion of justice is relevant here. I will draw an analogy between first-stage judgements of medical benefit and judgements of non-comparative justice. Then I will argue that a non-comparative level of medical benefit should acknowledge a wide range of claims to an adequate conscious life.

A threshold level of medical benefit can exclude persons from the candidate pool whose notion of post-operative adequate conscious life falls below it. Such exclusions could reflect either a deliberative consensus or an adjudicated decision that treating such persons with Resources is medically futile. These exclusions do not conflate medical futility with rationing. One can justify these exclusions partly in terms of the obligatory goal of medicine to provide appropriate treatment.

I also discuss the need for a deliberative democratic approach to determining this threshold that emphasizes public accountability as a benchmark for reform. Like Daniels et al., I see no reason for assuming that health care providers can be relied upon to act in ways that are fair to everyone. If every person has an equal claim to life, then such professionals should be deliberating with those who could be subject to this threshold level. Consequently, we should rely on fair democratic procedures for drawing it.