Kilner J F
Harvard University, Cambridge, Mass.
Arch Intern Med. 1989 Oct;149(10):2343-6.
Age criteria are increasingly being advocated as means of determining who should receive treatment. Four types of medical justification have been proposed. Three of these, namely, length of medical benefit, quality of medical benefit, and likelihood of medical benefit, entail comparisons of patients. The fourth, medical benefit, involves identifying for each patient whether or not a significant benefit is likely to result from treatment. I contend that the three types of comparative justification are questionable. For example, they rest on statistical generalities that are misleading in particular situations, and they value characteristics of persons (such as life-years) more than they respect persons themselves. I also contend that the fourth type of medical justification, rooted as it is in response to human need, is ethically sound, but that it warrants a medical-benefit criterion rather than an age criterion.
年龄标准越来越多地被倡导为确定谁应接受治疗的手段。已提出了四种医学上的理由。其中三种，即医疗益处的时长、医疗益处的质量和医疗益处的可能性，需要对患者进行比较。第四种，医疗益处，涉及为每位患者确定治疗是否可能带来显著益处。我认为三种比较性理由存在问题。例如，它们基于在特定情况下具有误导性的统计概括，而且它们对人的特征（如生命年数）的重视超过了对人本身的尊重。我还认为，第四种医学理由，因其基于对人类需求的回应，在伦理上是合理的，但它需要的是医疗益处标准而非年龄标准。
