"You cannot qualify war in harsher terms than I will. War is cruelty, and you cannot refine it; and those who brought war into our country deserve all the curses and maledictions a people can pour out." - William Tecumseh Sherman

Name: The General
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Friday, October 29, 2004
  Those Difficult Ethical Questions
Life is so hard for government bureaucrats, especially when people's lives hang in the balance. From Thursdays New York Times:
For the first time in its history, the Centers for Disease Control and Prevention has created a permanent panel of ethicists on vaccine distribution, to help navigate the life-and-death questions of who should get flu vaccines in the current crisis and how the agency should cope with any future epidemics.

"Ethicists have unique tools to help shape our decisions," Dr. Julie L. Gerberding, director of the C.D.C., said in an interview yesterday. "We want to make sure that whatever we decide is equitable."

The panel began deliberating Monday. One member, John D. Arras, a professor of bioethics at the University of Virginia, said the group might eventually tackle the question of whether babies should have priority over the elderly in receiving the flu vaccine, or vice versa. Another question the panel might have to decide is whether, in the event of a pandemic, members of crucial professions - perhaps even undertakers - should receive priority.

Such questions, Dr. Arras said, are explosive.

"This country doesn't like to talk about rationing at all," he said.
Yes, those are puzzling questions; who should be sacrificed first? Of course, this only leads to more difficult questions:
Dr. Arras said one health official at the meeting was grappling with the question of whether to vaccinate all residents of his state's nursing homes.

"Some of those people in nursing homes will be extremely old, extremely debilitated and also demented," Dr. Arras said. "The question arises, Where is the vaccine better deployed?"
Fortunately, our public officials are infused with strong doses of altruism, to help them decipher these unseemly questions. Uh oh, better increase the dosage; there's more confusion ahead:
Public health officers in North Dakota were able to agree that chronically ill patients in the state's nursing homes should be vaccinated first. The decision was reached for medical and practical reasons, said Larry Shireley, the state epidemiologist: such people not only are at great risk of contracting the disease, Mr. Shireley said, but also are easy to reach.

But state health officers could not agree, he said, on whether babies or the healthy elderly should be next on the list.

Babies are more susceptible to the disease, but the elderly are more likely to die of it. On the other hand, most babies, unlike most of the very old, have decades of life ahead.

A standard ethical argument is that "people are supposed to get a certain number of fair innings in a lifetime," Dr. Arras said.

"That would incline you to treat the young rather than the old," he said, "since the old have already had their innings."

But since the old are more likely to die of the disease, another way to decide the issue is to determine the number of years that would be saved by inoculating them first rather than the young.

The committee will examine all those issues, Dr. Arras said.
It makes me feel better knowing that responsible government officials are asking such important questions, and taking them so seriously. Of course, I'd feel infinitely better if they would look not for how to best ration vaccines, but instead how to insure that there was plenty available to anyone who wanted them. Then again, this would lead to messy issues like selfishness, property rights and capitalism (not to mention reason, ick!). We just can't have that.
"These are tough decisions," Dr. Gerberding said, "and they are not going to get any easier."

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