Abstract

The central issue of this dissertation is known in bioethics as the problem of fair chances versus best outcomes. The decision-making context is patient selection for scarce, transplantable organs. This problem poses two options for patient selection: either select by a procedure which affords fair chances to all medically suitable transplant candidates or select those whose prognoses indicate the highest levels of prospective medical benefit. The fair chances/best outcomes problem is essentially a problem of choosing between lives. An egalitarian approach to patient selection favours fair chances. A utilitarian approach favours best outcomes. My project is a sustained defence of an egalitarian approach. It targets first a rule utilitarian argument for maximizing medical benefit. It targets second an argument that fairness in patient selection requires a preference for saving younger lives. I argue that patients should have prognoses at or above a threshold level of medical benefit to be medically suitable candidates. I propose random selection by lottery as a means of final selection that equally values lives. I argue that equality of opportunity best reflects an egalitarian commitment to equal concern and respect