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Bioethical Prescriptions
  1. Frances M Kamm
  1. Correspondence to Professor Frances Kamm, Harvard University, Cambridge, MA 02138, USA; frances_kamm{at}harvard.edu

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I am very grateful to my three commentators for the time and attention they have given to Bioethical Prescriptions.1 I have learnt from their challenging comments.

Voorhoeve:2 Voorhoeve examines some of the things I have said, in Bioethical Prescriptions and earlier in Morality, Mortality. Vol 1.3 and Intricate Ethics,4 about the place of aggregation in allocating scarce medical resources. He notes that I suggested that we do pairwise comparison to see how each person will fare if not helped and save a young person to a normal life span rather than help any number of people who would suffer a sore throat if not helped but are otherwise fine. He further notes one possible justification I gave for this: each person has a duty to suffer a sore throat if this will save the young person's life and the duty holds regardless of how many would have to perform it. Given this proposed justification, he thinks that I should support a principle according to which, when the loss to each of many people would be more than they would have a duty to suffer in order that a young person live a normal life span (eg, giving up an arm), then we may aggregate the smaller losses and help many people avoid the smaller loss rather than help the one person avoid death. (Call this Principle X.)

In fact, I had considered but argued against Principle X (which I called Sobjectivity 2) in Morality, Mortality. Vol 1. (pp. 170–1)3 because some losses (eg, of several fingers) are too great for someone to have a duty to suffer them to save another's life, yet an impartial resource allocator should not weigh the loss as the one who would suffer it does, …

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