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Resource expenditure not resource allocation: response to McDougall on cloning and dignity
  1. M J Williams
  1. M J Williams, Student Recruitment, Admissions and International Development, University of Manchester, Rutherford Building, Coupland Street, Manchester, M13 9PL; myfanwy.williams{at}


This paper offers some comments on bioethical debates about resource allocation in healthcare. It is stimulated by Rosalind McDougall’s argument that it is an affront to the human dignity of people with below “liberties-level” health to fund human reproductive cloning. McDougall is right to underline the relevance of resource prioritisation to the ethics of research and provision of new biomedical technologies. This paper argues that bioethicists should be careful when offering comments about such issues. In particular, it emphasises the need to represent accurately the reality of the situation—especially when we are passing judgement on technologies that are in their infancy and whose practical application is yet to be confirmed. The paper also emphasises the importance of the actual context to bioethical debate, and note that it would be better to talk about resource expenditure rather than resource allocation when it comes to discussing the rights and wrongs of how money is spent. It also reiterates the claims made by other writers that social and political philosophy need to have a transparent and considered role in debates about resources.

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  • Competing interests: None.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • i I do not want to understate the differences between different political theories: in practice, believing that what matters is people having equal rights and liberties can amount to something rather different than believing that they ought actually to have equal levels of goods. However, as Kymlicka has suggested, all plausible political theories rest on the same ultimate value, that of equality3—and I would suggest that on any plausible reading, this equality must include some conception of access to the most basic levels of health.

  • ii In this paper I am only concerned with McDougall’s very specific arguments about SCNT. There are many other ways in which we might take issue with SCNT research, and with the inequities it might feed into; however, I do not attempt to address these concerns here.

  • iii Pogge’s organisation, Incentives for Global Health, has recently launched the Health Impact Fund, in a campaign intended to stimulate provision of healthcare and provisions for poorer peoples at lower prices. (See Episode 22 (22 October 2008), The Macmillan Report, The Whitney and Betty MacMillan Center for International and Area Studies at Yale, at

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