In this paper, I address the familiar argument that heritable genome editing will lead to a dystopian future in which there are two classes of human beings: an elite with enhanced mental and physical abilities and a vast underclass of ordinary humans who do not enjoy the advantages of genetic enhancement technologies. Contrary to previous discussions, however, I assume that this development takes place in a decent, liberal democratic state. This allows ideas from political theory to be applied to the argument. I  begin by describing a possible pathway to the dystopian future, building on the ideas of knowledge resistance, social distrust, and cognitive biases that lead a large part of the population to reject beneficial genetic technology. Then I ask: How should a liberal state respond to the resulting inequalities? Does liberal political theory have the resources to give us some guidance? I examine the issues from the perspective of both distributive and relational egalitarianism.

This paper provides a general framework for conceptualizing triage for intensive care unit admissions in public health emergencies such as the COVID-19 pandemic. It applies this framework to some of the guidelines issued during the pandemic and addresses some controversial issues, including the role of age, the use of lives or life years, and the relevance of quality of life considerations. The paper defends a view on which triage protocols for public health emergencies should aim to maximize the number of life years saved, may take into account age as a proxy, and should ignore quality of life considerations.

Public health emergencies sometimes require the restriction of civil liberties through social distancing: lockdowns, quarantines, the closure of public spaces and institutions, and so on. Social distancing measures can decrease mortality and morbidity, but they also cause social and economic harm. Policymakers have to make trade-offs between lives and livelihoods, while introducing only minimally necessary restrictions on civil liberties. Traditionally, cost-benefit analysis has played a central role in formulating these trade-offs. Recently, however, some philosophers have argued that the trade-offs should instead be made on the basis of contractualist moral theory. In this essay, I argue against the use of contractualism for this purpose.

This book aims to contribute to the essential and ongoing discussion on age, ageism, population ageing, and public policy. It attempts to demonstrate the breadth of the challenges of this subject by covering a wide range of policy areas, from health care to old-age support, from democratic participation to education, from family policy to taxation and fiscal policy. Its short, incisive chapters bridge the distance between academia and public life by putting in dialogue fresh philosophical analyses and new specific policy proposals. The book's contributors provide a multidisciplinary discussion, with authors from backgrounds in philosophy, political science, sociology, economics, and law, approaching familiar issues such as age discrimination, justice between age groups, and democratic participation across the ages from novel perspectives. The book is especially timely in light of the ongoing process of critically scrutinizing our societies from the perspective of injustice and discrimination as well as the increasing societal problems posed by population ageing. 

During the COVID-19 pandemic, some hospitals found themselves short of ventilators, intensive care unit (ICU) beds, and qualified medical personnel to take care of patients. Physicians had to make difficult, life-and-death choices. They were aided by various guidelines and recommendations, issued by governments and medical associations. This chapter reviews some of these guidelines, looking in particular at the role of age and life expectancy as criteria for the rationing of healthcare resources. It defends the view that the ethical aim of triage should be to maximize benefits and concludes that while neither age nor life expectancy should be used to categorically exclude patients, both may have a role in triage by virtue of their connection to capacity to benefit.

This book aims to contribute to the essential and timely discussion on age, ageism, population ageing, and public policy. It attempts to demonstrate the breadth of the challenges by covering a wide range of policy areas from health care to old-age support, from democratic participation to education, from family to fiscal policy. It bridges the distance between academia and public life by putting into dialogue fresh philosophical analyses and new specific policy proposals. It approaches familiar issues such as age discrimination, justice between age groups, and democratic participation across the ages from novel perspectives. This introductory chapter provides an overview of the structure of the book and its topics. 

The rationing of health care is universal and inevitable, taking place in both poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources.

The Ethics of Health Care Rationing is a clear, timely, and much-needed introduction to this important topic. Substantially revised and updated, this second edition includes new chapters on disability discrimination and age discrimination, and on the price of drugs and medical therapies. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics:

• What sort of distributive principles should we rely on when thinking about health care rationing?
• What is the relation between ethics and cost-effectiveness in health care?
• How should we think about controversies surrounding discrimination over disability and age?
• How should we approach controversies surrounding rationing and the price of pharmaceutical drugs and medical therapies?
• Should patients be held responsible for their health?
• Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality?

Throughout the book, examples from the United States, the United Kingdom, and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading, and discussion questions have also been updated, making this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work.

A basic principle of the Global Burden of Disease (GBD) studies is that all units of health loss have the same value. However, in earlier iterations of the GBD studies this principle had some qualifications. One was that the value of the same health loss may differ between individuals of different ages; that is, DALYs were age-weighted. Age-weighting has now been removed for ethical reasons. A year of healthy life has the same value regardless of the age of the person living it. Contrary to this claim, however, the author argues that a form of implicit age-weighting is still implied by the GBD methodology. But the author also argues that this kind of age-weighting can be defended on moral grounds.

Cost-effectiveness analysis (CEA) is an analytical tool in health economics. One of the most important objections to it is that its use can lead to unjust discrimination against people with disabilities. This chapter evaluates this objection. It begins by clarifying its nature, then it examines some alleged forms of discrimination. It argues that they are either not cases of unjust discrimination, or they are based on misunderstandings of CEA. However, the chapter does point out that there is one case in which the use of CEA may disadvantage people with disabilities. It goes on to consider several proposals for explaining the wrongness of discrimination but argues that none of them accommodates this case. It concludes that the case should not be thought as a matter of unjust discrimination; rather, it should be thought of as raising an issue for justice in the allocation of health-care resources.

With healthcare systems under pressure from scarcity of resources and ever-increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We find that the standard justifications for patient representation, such as to achieve patient-relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants.