This point-counterpoint presents arguments for and against allocation of scarce life-saving treatment resources using age as a criterion.
The argument against considering age includes three points. First, simple preference for younger patients is morally arbitrary. There is likely to be no difference between an 18-year-old and a 19-year-old, and even using larger age ranges creates challenges in distinguishing in non-arbitrary ways between patients just to either side of the threshold and in generalizing across large age groups. Second, the “fair innings” argument that younger persons should be prioritized because they have yet to experience as many stages of life as older persons is challenging because of the heterogeneity in life course and the role of luck and circumstances. Third, prioritization based on age may send a negative message about the value of older persons and may stigmatize them as second-class citizens compared to younger persons.
The argument in favor of prioritization considering age notes that age is already used as a criterion for resource allocation in health care, giving as examples solid organ transplant and renal dialysis. Additionally, prioritization of children based on their age appears to reflect broad consensus in various circumstances, such as emergency evacuation of ships. Beyond these examples, the notion of “fair innings” of life is intended to address fair opportunity, not relative value, and allow persons to have an equitable opportunity to experience life, pursue goals, and flourish as human beings. Lastly, allocation based on age serves the goal of maximizing the number of lives saved with scarce resources when there is a diminishing chance of survival with increased age, as there generally is for ventilators, among some other examples.