The rationing debate: Maximising the health of the whole community. The case against: what the principal objective of the NHS should really be

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Abstract
It is common ground I suppose that we have to think about the ethics both of means and of ends. Even if it were to be accepted that the healthcare system ought principally to aim at maximising aggregate health gain, it does not follow that the most effective ways of achieving this are legitimate. If all seriously ill people were to be allowed to die this might dramatically improve the aggregate health of the community at large. I hope such a policy would not seem ethically defensible. Yet this is precisely what measures which use quality adjusted life years, or similar mechanisms, do: they systematically accord preference to those who have better health prospects, and, by selecting against those with worse prospects, tend to improve the aggregate health status of the whole community at the expense of the life chances of those with poorer prognosis.

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