A proposed ethical standard for rationing

I propose an equal opportunity standard (EOS) for balancing the two ethical precepts in the outer sphere:

The EOS standard: All individuals should have an equal opportunity to enjoy the fruits of life, within the constraints imposed on them by nature.

This EOS is a reformulation of the principle of distributive justice, suitably bounded for the purposes of rationing. It says that, while we ought to let fairness (that is, distributive justice) predominate, we also ought constrain it to allow society to accrue a reasonably optimal amount of good.

The EOS gives primacy to fairness by recognizing that all individuals are of equal intrinsic worth, that is, all individuals should have an equal opportunity to enjoy the fruits of life. However, the EOS prevents the excesses of unfettered fairness in two ways.

First, the EOS does not insist that the principle of distributive justice requires equivalent outcomes among individuals. It strives only to gain for individuals an equal opportunity for those good outcomes. Not all opportunities, even equal opportunities, yield equivalent results. Given equal opportunities for a favorable result, some individuals will have good outcomes and others poor outcomes. The EOS accepts this.

Second, the EOS recognizes that not even equal opportunity is possible in all cases. Sometimes the vagaries of nature limit opportunities. A person's illness or disability may reduce their odds of responding favorably to a therapy. Under the EOS, society does not have to spend unlimited amounts to provide a therapy that is unlikely to yield a good outcome.

In rationing healthcare under the EOS, the distribution of resources would not be based on either attempting to maximize the overall good that accrues to society or attempting to equalize outcomes among all individuals. The EOS does not make the problem of maximizing fairness vs. maximizing good go away, but it changes the question. Instead of asking, Saving which of these two individuals will maximize overall good? or How can we guarantee equivalent outcomes for these two individuals to maximize fairness? we will be asking, Given these two equally worthy individuals, how can we optimize the opportunity for good outcomes for both?

The EOS-a statement of math as well as ethics

The EOS is a compromise between a strict beneficence standard and a strict justice standard. It reinforces distributive justice while helping optimize total societal good; and it offers sufficient flexibility for tackling difficult rationing problems.

The EOS, in addition to being a statement of principles, is a statement of mathematics. As we develop our scheme for the open rationing of healthcare, one way or another we're going to have to rank medical services by some numeric value. And the EOS shows us how to do the math.

In particular, there are four ethical questions that must be resolved before we can conduct the business of openly rationing healthcare, and the EOS leads us to specific answers to these questions.