• Allocation of Health Care Resources
• Distributive Justice
• Philosophical Ethics
• Resource Allocation

Part IV of Bioethical Prescriptions 1 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 …