IS OLD AGE A DISEASE?
when confronting the reality that we cannot provide all the required medical treatment simultaneously to all those who seek it, the question we ought to ask is: how can we utilize the resources at our disposal so as to maximize our ability to fulfill this mitzvah? This question does figure in Feinstein’s calculations, to the extent that he rules that when treatment has not yet begun, we grant precedence to the patient whose life we can save, for whom we can actually do medicine. It is also completely consistent with a commitment to human equality. It does not require that we judge which patient is more deserving of life, for such a judgment surely lies beyond our intellectual and our moral capacity. It requires, rather, that we consider the best and most effective means of practicing medicine in a situation of severe material constraint. To ask this question, to define our situation in this light, is to conclude that the principle of medical efficiency, which Feinstein himself adopts in part but subordinates to the principle of the equality of persons, ought to be
the central criterion for making decisions regarding resource allocation. Accordingly, we would grant priority in treatment in all, or virtually all, cases to the patient or patients that need it the most” or who could benefit from it the most, whether or not another patient or patients have already begun to receive it.
We see that our problem, which patient to treat first, can be defined in two different ways, classified under two different halakhic principles that rest on two different sets of texts. It is either, as Feinstein sees it, an issue of comparative evaluation of persons, or it is an issue of how best to fulfill the mitzvah of the practice of medicine, as I suggest here. The adoption of one or the other classification carries a great deal of practical significance, for, depending on the choice made, a patient already admitted for treatment might be displaced by another patient on the grounds that the physicians
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