Langford M J
J Med Ethics. 1992 Mar;18(1):12-7. doi: 10.1136/jme.18.1.12.
This paper considers the problem that arises when the number of patients who need a resource exceeds the supply. An initial decision-making model is proposed that uses two essential criteria, medical prognosis and the priority of life-threatening situations. The model is then subjected to the criticism that it is grotesque to ignore questions relating to the value of, for example, a productive mother over against an aged recluse, and to treat them as having equal rights to access. It is argued that this criticism need not be an expression of prejudice but may reflect a defendable view in which utilitarian considerations enter into the selection process provided that certain fundamental, or 'deontological' rights are observed for all. In the light of the discussion the model is modified in order to contain both a non-utilitarian feature that stresses the intrinsic importance of all persons, and a utilitarian feature that can allow one, in certain circumstances, to take consequences into account, especially those that follow from the 'irreplaceability' of some people.
本文探讨了所需资源的患者数量超过供应时出现的问题。提出了一个初始决策模型，该模型使用两个基本标准：医学预后和危及生命情况的优先级。该模型随后受到批评，认为忽视诸如一位有生产能力的母亲相对于一位年迈隐士的价值等问题，并将他们视为具有平等的获取权利是荒诞不经的。有人认为，这种批评不一定是偏见的表达，而是可能反映了一种可辩护的观点，即在为所有人遵守某些基本或“道义论”权利的前提下，功利主义考虑因素进入选择过程。根据讨论结果，对模型进行了修改，以便既包含强调所有人内在重要性的非功利主义特征，又包含在某些情况下能够让人考虑后果，特别是那些源于某些人“不可替代”的后果的功利主义特征。
