Abstract

For a variety of reasons, the AIDS epidemic is forcing a thorough reassessment of many of the standards by which the terminally ill and other medical patients are treated by health-care systems throughout the world. This has generally been a good thing. It has provided needed motivation for public policy-makers to take seriously a range of health-care issues that have often been downplayed, ignored, or debated with vigour only within the relatively mute pages of the academic journals of health-care professionals, philosophers, law professors and others. Issues such as euthanasia, testing for dangerous communicable diseases, palliative care, and even important general questions about the distribution and availability of health-care resources have been pushed toward the front of the public health-care agenda largely because of the impact of AIDS. And it is fair to say that these matters are often being addressed with an urgency and sensitivity that would be absent without the political impetus that was unleashed along with this disease. One of the most controversial issues that has arisen concerns access to experimental therapies by the terminally ill. As is the case in other areas, the political forces generated by the AIDS tragedy have created an opportunity for productive review of policies and practices that undoubtedly deserve scrutiny and reform. However, my aim in this paper is to urge caution on some of the advocates of reform. I will argue that many recent proposals to enhance access to experimental therapies by the terminally ill rest on philosophically unsupportable grounds and pose an unjustifiable threat to the public interest in finding safe and effective therapies for terminal illnesses.