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Reflective disequilibrium: a critical evaluation of the complete lives framework for healthcare rationing
  1. Xavier Symons1,2
  1. 1 Plunkett Centre for Ethics, Australian Catholic University, Sydney, NSW, Australia
  2. 2 Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
  1. Correspondence to Mr Xavier Symons, Plunkett Centre for Ethics, Australian Catholic University, Sydney, NSW 2007, Australia; xavier.symons{at}


One prominent view in recent literature on resource allocation is Persad, Emanuel and Wertheimer’s complete lives framework for the rationing of lifesaving healthcare interventions (CLF). CLF states that we should prioritise the needs of individuals who have had less opportunity to experience the events that characterise a complete life. Persad et al argue that their system is the product of a successful process of reflective equilibrium—a philosophical methodology whereby theories, principles and considered judgements are balanced with each other and revised until we achieve an acceptable coherence between our various beliefs. Yet I argue that many of the principles and intuitions underpinning CLF conflict with each other, and that Persad et al have failed to achieve an acceptable coherence between them. I focus on three tensions in particular: the conflict between the youngest first principle and Persad et al’s investment refinement; the conflict between current medical need and a concern for lifetime equality; and the tension between adopting an objective measure of complete lives and accommodating for differences in life narratives.

  • resource allocation
  • badness of death
  • ageism
  • healthcare rationing
  • COVID-19
  • vaccination
  • organ transplantation

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  • Contributors I am the sole author of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement There are no data in this work.

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