Map of life expectancy at birth from Global Education Project.

Tuesday, September 13, 2005

Finding the Bottom Line . . .

and more on the rule of rescue.

What should be the goal of public health? According to the constitution of the World Health Organization, to which the United States and nearly all the countries of the earth are signatories:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”


“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

Wow! I guess we should all step up and claim our fundamental right to complete physical, mental and social well-being! While we all were waiting for whoever is responsible for honoring our fundamental right to come through, the family of brain dead Susan Rollin Torres kept her body alive on life support for three months in order to try to save the life of her fetus, which was surgically delivered after seven months gestation, and died about five weeks later. Supporters around the world mailed the family $600,000 to pay for this effort.

Meanwhile, during those 4 months plus, more than two million children under five (already born) died from malnutrition. The family of Ms. Rollins Torres, like the family of Terri Schiavo, is devoutly Christian. They believed it was their duty as Christians to raise the $600,000 to save their fetus. Left over funds will be used to establish a college savings fund for Mr. Torres's two children.

Obviously, nobody takes the WHO constitution seriously. The definition of health -- as well being -- is circular. What, then, is well-being? If health includes social well-being, it is logically contradictory to say that everyone has a right to it without regard to their social condition. If everyone has a right to the highest attainable standard, who decides what that is? The Torres family had their own definition, but obviously, the resources used to provide the highest attainable standard for one person will not be available for the next -- and resources are not infinite.

Nevertheless, the WHO constitution does force us to think about justice. The rule of rescue -- the seemingly instinctive impulse that humans have to make any sacrifice, expend every resource, to save one or a few people in desperate circumstances -- conflicts with utilitarian ethics, because when we obey the rule of rescue, we deprive innumerable other people -- some of them not desperate, others perhaps equally so -- of resources that could improve their well being or even save their lives. This is an ancient puzzle but now, more than ever perhaps, it demands our attention.

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