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Why sore throats don't aggregate against a life, but arms do
  1. Alex Voorhoeve
  1. Correspondence to Dr Alex Voorhoeve, Department of Philosophy, Logic and Scientific Method (LSE), London School of Economics and Political Science, Houghton Street, London Wc2A 2AE, UK; a.e.voorhoeve{at}lse.ac.uk

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Part IV of Bioethical Prescriptions1 masterfully joins philosophical imagination and rigour in its discussion of moral questions that arise in allocating scarce healthcare resources. I shall focus on a question on which Kamm's analysis yields remarkable insight, even though I disagree with some of her conclusions. The question is: Suppose that one must either (a) save all members of a group of A-people (who are otherwise fine) from an identical individual loss, short of death or (b) save a single young person, B, from a terminal illness, thereby restoring him to good health for a normal lifespan. What ought one to do?

In Bioethical Prescriptions and elsewhere, Kamm argues for the following two-part answer:

  1. If the loss to each person in the A-group is very small, then one must save B's life, no matter how numerous the A-group.

  2. If the loss to each person in the A-group is close enough to B's loss, then for a very large number of people in the A-group, one is permitted to save the A-group.

Kamm offers the following principle underlying (i): Each of us who is otherwise fine has a duty to suffer (at least) a relatively minimal loss (e.g., a sore throat) in order to save another person's life. So long as suffering the small loss is a duty for any given person, no number of the small losses can be aggregated to outweigh saving the life (p. 369).1

This antiaggregation principle has an …

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