The question is raised in a provocative report by two government scientists about who should get scarce medical resources. They argue that the standard policy for flu vaccinations that favors older men and women over younger adults should be changed in preparation for a possible pandemic of avian flu.
Ordinarily, people over 65 and those who have chronic illnesses are given priority. As a group, they are the most vulnerable. Protecting the most vulnerable saves the most lives.
But avian flu is not an ordinary flu. Chances are, it will never turn into a global catastrophe, but if it did, some researchers speculate that it could lead to 90 million cases and 1.9 million deaths. There is no way to manufacture enough vaccine in time to protect everyone in the United States. So who should get the potentially lifesaving vaccine?
"This is a tragic choice," says bioethicist Ezekiel J. Emanuel at the National Institutes of Health, who with his colleague Alan Wertheimer suggested an alternative policy in a report in the May 12 edition of Science magazine.
Both the rebel authors and the traditionalists (that is, the government's National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices) would give top priority to those working to manufacture and distribute the vaccine and to front-line health care professionals. And both would give preference to key government leaders. The fight is over what's left for the general public.
The rebels challenge the principle of saving the most lives. What about saving people with the most years yet to live?
Their formula is based on the principle that all people deserve the chance to live out their lives and grow old -- especially teenagers and young adults who have survived childhood and face many decades ahead. Twenty-year-olds, for example, are more "valued than 1-year-olds because the older individuals have more developed interests, hopes and plans but have not had an opportunity to realize them," write the authors.
Presumably, really older individuals -- those over 65 -- have had all the opportunities they need to realize their hopes and plans and interests -- so they are less valued than 20-year-olds.
In the new formula, the winning age cohort in the vaccine rationing sweepstakes would be healthy people 13 to 40. Next in line would be those 7 to 12 and people 41 to 50. After 50, forget it!