Harris J
Centre for Social Ethics and Policy, University of Manchester.
J Med Ethics. 1996 Aug;22(4):209-15. doi: 10.1136/jme.22.4.209.
This paper continues the debate between myself and Peter Singer et al started in the Journal of Medical Ethics volume 21, no 3 about the ethical respectability of the use of QALYs in health care allocation. It discusses the question of what, in the way of health care provision, would be chosen by rational egoists behind a Rawlsian "veil of ignorance", and takes forward the vexed question of what is to count as "doing good" and hence as "doing the most good" in health care. Most importantly, this paper argues that it would be unfair to discriminate against people because they have been disadvantaged by their genetic condition. It notes that McKie et al in their reply to my first contribution to this debate continue to fail to distinguish between chance and probability and it is argued that this failure causes them to miss the whole point of the argument.
本文延续了我与彼得·辛格等人在《医学伦理学杂志》第21卷第3期上展开的关于在医疗资源分配中使用质量调整生命年（QALYs）的伦理合理性的辩论。它讨论了在罗尔斯式的“无知之幕”背后，理性利己主义者在医疗保健提供方面会选择什么的问题，并推进了一个棘手的问题，即在医疗保健中什么应被视为“做好事”，从而被视为“做最大的好事”。最重要的是，本文认为，因为人们因其遗传状况而处于不利地位就对他们进行歧视是不公平的。它指出，麦基等人在回复我对这场辩论的第一篇文章时，仍然未能区分偶然性和概率性，并且有人认为这种失误导致他们完全没有抓住论点的要点。
