The rule of rescue.
Jonsen coined the term "Rule of Rescue"(RR) to describe the imperative people feel to rescue identifiable individuals facing avoidable death. In this paper we attempt to draw a more detailed picture of the RR, identifying its conflict with cost-effectiveness analysis, the preference it entails for identifiable over statistical lives, the shock-horror response it elicits, the preference it entails for lifesaving over non-lifesaving measures, its extension to non-life-threatening conditions, and whether it is motivated by duty or sympathy. We also consider the measurement problems it raises, and argue that quantifying the RR would probably require a two-stage procedure. In the first stage the size of the individual utility gain from a health intervention would be assessed using a technique such as the Standard Gamble or the Time Trade-Off, and in the second the social benefits arising from the RR would be quantified employing the Person Trade-Off. We also consider the normative status of the RR. We argue that it can be defended from a utilitarian point of view, on the ground that rescues increase well-being by reinforcing people's belief that they live in a community that places great value upon life. However, utilitarianism has long been criticised for failing to take sufficient account of fairness, and the case is no different here: fairness requires that we do not discriminate between individuals on morally irrelevant grounds, whereas being "identifiable" does not seem to be a morally relevant ground for discrimination.
Centre for Health Program Evaluation, Monash University, West Heidelberg, 3081, Victoria, Australia. johnmckie@ains.net.au <johnmckie@ains.net.au>
John
J
McKie
Jeff
J
Richardson
D001293:Attitude to Death; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000941:ethics*; D028663:Ethical Theory; D006801:Humans; D009042:Motivation; D019057:Quality-Adjusted Life Years; D018635:Rescue Work / Q000191:economics / Q000941:ethics*; D040841:Resource Allocation / Q000191:economics / Q000941:ethics*; D012935:Social Justice; D026712:Value of Life / Q000191:economics*