Who Gets the Ventilator?

Suppose that you have a ventilator with which you can prevent either Ahmed or Barbara from dying. Whilst Ahmed would live for nine years were you to save him, Barbara would only live for five. There are no other relevant differences between them. What should you do? Does the fact that Ahmed would live for longer than Barbara make it better to give him the ventilator? This is an awful decision for anyone to be faced with. Nonetheless, it is a decision which some of us must sometimes make.

It might seem that it would obviously be better to save Ahmed. Since each year of a good life is a significant benefit, and nine is a bigger number than five, Ahmed would benefit more from the ventilator than Carmen would. This seems to show that saving Ahmed would be more beneficent than saving Barbara. Even if it would not be wrong to ventilate Barbara, it seems that it would be worse to do so. By this line of reasoning, you should save Ahmed.

On reflection, however, things are not quite so obvious. Barbara will die if you do not save her, and five years are the most you could give her. Would saving Barbara really be worse than saving Ahmed? Could it really be better to let Barbara die? Not only do Ahmed and Barbara both have a claim to your assistance, but as moral equals, their claims matter just as much. This suggests that Barbara has just as much claim to the ventilator as Ahmed. If this is right, you would act just as beneficently in saving her. That Ahmed would live for longer is then irrelevant.

This raises a more general question about benefiting people. When we cannot benefit everyone, would it be more beneficent to benefit those who would benefit more? More precisely, does the fact that we could benefit one person more than another make it more beneficent to do so? On most theories of beneficence, the answer to this question is yes. According to these theories, you should compare the amount that you could benefit different people and do that which would benefit a person most. You should save Ahmed rather than Barbara since he would benefit more. As we have seen, however, this may be a mistake.

It seems to me that the problem with these theories is that they suppose that people are like benefit factories. If we should benefit those who would benefit more, we should help people who can convert resources to benefits more efficiently. On these theories, if there is a person that we could always help more than other people, it would always be better (or at least more beneficent) to help her out. Similarly, if there is a person that would always get less from our help than other people, then it would always be worse (or at least less beneficent) to help her out. Yet it seems like this cannot be correct.

What motivates these theories is the thought that well-being is intrinsically good. Whilst it is clear enough that we should improve people’s lives, a theory of beneficence must attempt to explain why this is the case. The standard answer is that we should promote a person’s well-being because doing so results in their life going well. What is supposed to explain this is that a person’s well-being is intrinsically good. Yet it is then hard to resist the claim that we should maximise the total sum of well-being. In particular, it is hard to resist the claim that we should benefit those who would benefit more.

We reach a different answer on claim that we should treat each person beneficently because she is a person. On this Kantian theory, to benefit a person is to help her to pursue her goals, rather than to make her life better, and we should do so because each of us undertakes such a pursuit as a rational being, rather than because well-being is intrinsically good. What matters on this theory is helping one another to live our lives so as to realise our shared rationality, rather than making lives good so that the world is a better place. Since we would help Barbara as much as possible in giving her the ventilator, on this theory it would be no worse to do so.

It seems to me that it would not be any worse (or less beneficent) to give Barbara the ventilator. I favour a Kantian theory of beneficence, partly because I think that treating people like benefit factories is a mistake. As we have seen, however, this question raises some difficult theoretical questions. Moreover, things are more complicated when the person who must decide is a medical professional, and the ventilator is the product of a complex economy. Regardless, I hope that this brings out the practical importance of philosophy. Whilst it does not offer us quick or easy answers, these are the sorts of questions which together we must face.