Dignity, Autonomy, and Allocation of Scarce Medical Resources During COVID-19
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SYMPOSIUM: COVID-19
Dignity, Autonomy, and Allocation of Scarce Medical Resources During COVID-19 David G. Kirchhoffer
Received: 7 May 2020 / Accepted: 17 July 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in times of critical care resource shortages. Dignity affirms the worth of the human individual as a meaning-making embodied subject, who is always in relationship to others, the world, time, and transcendence, and who realizes their dignity through their moral behaviour. Such an understanding means people should be helped to make morally right decisions about their own treatment, which may include forgoing potentially beneficial treatment for the good of others. Respect for dignity does not require fulfilling the morally wrong choices of one who insists on treatment at the expense of others. Dignity also protects the discretion of clinicians to make decisions appropriate to their competence by prohibiting the application of broad-based criteria such as age. Keywords Dignity . Autonomy . COVID-19 . Justice . Resource allocation . Resource rationing D. Kirchhoffer (*) Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia e-mail: [email protected]
Introduction Ruth Macklin (2003) argued that “dignity is a useless concept.” For Macklin, dignity merely means respect for persons or their autonomy. The COVID-19 pandemic has heightened the problem of scarce medical resource allocation. This is particularly so for the allocation of critical care resources, such as ventilators, for patients with acute respiratory distress syndrome (Rosenbaum 2020; Gibson, Qin, and Puah 2020). This has resulted in a proliferation of ethical guidelines attempting to address the problem of how to fairly allocate these resources (e.g. Emanuel et al. 2020; World Health Organization 2020). One thing is clear from these guidelines: respect for autonomy cannot alone do the ethical work to justify rationing. Indeed, it appears that concerns about autonomy may well be overridden in crisis moments. I argue that dignity is not a useless concept. Rather, a proper conceptualization of human dignity can help guide ethical decision-making during COVID-19 and similar critical care crises. Instead of being reducible to respect for autonomy, dignity explains both why we care about autonomy and why it is appropriate to ration scarce medical resources even when this seems to be at odds with respect for autonomy. I begin by demonstrating that concerns for both autono
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