Difference Between Fair Innings And Equal Opportunity

Fair Innings and Equal Opportunity

The justification behind fair innings and equal opportunity as an age-based rationing tool, contains the idea that it would be best to allow people an equal opportunity to live for a long time, by shifting resources to the young so that they may also ideally reach the arbitrary ‘old age’ figure, thereby maximising the life-years saved. Kilner argues that such justification is dubious as it “places value on the potential life-years saved rather than the actual lives (i.e. persons)” (Kilner 1988; Pxx).

Striving to preserve or a extend a life of one person (the young) is a worthy effort, however doing so at the expense of refuting any chance of living to another (by denying resources to the old) is ethically
contemptible. Physicians at the bedside cannot treat patients as sums of statistical ‘life-years’. Persons are individuals of equal value and must be considered as such. As the well-known example goes: “all other factors being equal, murders are normally not punished less for killing a 70 year old than a 40 year old”. Life is uniformly precious at any age.

Another complex problem with the equal opportunity argument is its central assessment of opportunity. The argument assumes that age is a calculation that equates to opportunity in experiencing life. Suppose you have a 65 year old just released from prison after innocently being framed for a crime that subsequently resulted in his imprisonment for 20 years. Yet upon his release he develops cancer to which he is informed that resources for his treatment that is likely to only prolong his life for a few years is no longer available as it is to be directed to treating ailments that will allow the younger 45 year old patient to have the equal opportunity to reach a similar age to him. Would such a patient see himself as having had an equal opportunity? A previously presented and less complex example is two women both in need of scarce lifesaving resource. One of them is thirty-four years old, the other is thirty-five but has recently woken from a year spent in a coma. Using the age-based criteria it is of no doubt that if we had to choose to whom the resource was allocated to, we would have to opt for the younger woman as she has had a lesser opportunity based on her age. However what about the older woman who was also unfortunate to lose a year of ‘opportunity’?

A counterargument to this point could be that well, that is just hard luck and no practical resource allocation policy could tailor for that, or alternatively healthcare workers could take such individual circumstances into account, when rationing.
Yet, if we concede that it is valid to consider issues like this in making resource allocation decisions, we open the doors to endless examples of patients who had lesser opportunity to experience life. A leading advocate for ‘equal opportunity’ Robert Veatch himself, admits that such assessments would be “an over-whelming and complicated task” naming it “procedurally and administratively a nightmare”. Therefore age is too rough an indicator of lifetime opportunity to be applied in decisions about life and death.

The other associated problem related with equalising opportunity, is that it does not take into account any quantification of previous utilisation of resources by the young. For example would a 60 year old who had never utilised any excessive health resources be considered to have had her ‘fair-innings’ in resources when compared to a young adult who was born with a heart defect and subsequently received twenty years of life-extending medical
care?

If the two individuals face an evaluation on to which resources should be allocated, the age-based criteria would suggest that it should go to the younger person, as she has not been given as great an opportunity to live as the older person.
Yet in allocation and economic terms, this does not appear to be fair or sensible. Granted, the argument here could be that it doesn’t matter how much each person gets provided they all reach old age that is what is meant by equal opportunity – therefore the 60 year old is lucky to have never had to utilise the healthcare system in the past, while the young adult born with disease should be supported to reach a certain age as she was more disadvantages to begin with. However this would no longer be an argument of “equal opportunity” and treating people equally, instead it is simply favouring the young and worst-off.

I realise within health policy there will always be some level of inequality and exceptional circumstances if you dig deep enough, and that such age-based rationing proposals do not deny this fact. However the argument presented here is that the ‘equal opportunity’ justification it neither sensible nor
ethical.