In the wake of a national terrorist attack such as the ones that occurred on September 11, 2001, the nation was lost. While attempted terrorist attacks had been carried out in the past, many of them had been foiled and the successful ones weren’t nearly of this magnitude. While most victims of September 11th were killed, the survivors and first responders suffered many health complications.
Health professionals across the nation were called upon for their expertise in dealing with the aftermath of such a disaster. It was important for people to know how the attack had harmed the environment and how their lives would be impacted as a result. While still in the early stages of cleaning up from 9/11, offices across the country began receiving anthrax and biological terrorism became a major concern as well. Public policy for dealing with terrorism of any kind has been a hot topic ever since. Preventative measures have been put into place to prevent a future attacks and protocols for what to do should we ever face an attack again have been drafted.
There has, however, been large debate about strategy. Topics of debate include: whether or not to have universal vaccines against harmful infectious diseases, how resources should be devoted to research, and which victims to benefit in the wake of an attack. The implicit premises in the effort to make these changes are that all American understand the guiding principles of justice and those principles are widely endorsed by the American population.
These premises form the basis of the arguments made in the article. The author argues that there is no single principle that supports all of the relevant policies that have been enacted as a result of September 11th. And since there is no principle supporting the resulting health endorsements, the endorsements that have risen out of September 11th challenge an authoritative conception of justice.
Utilitarianism is argued to be the dominant view of justice in medical and public health policy today. Utilitarianism aims at maximizing an outcome over an entire population instead of one person. A utilitarian view ignores differences among people and aims to make everyone equal. It often ignores cost in order to benefit everyone.
John Rawls, a 20th century philosopher, wrote two different books that have become standards in deliberations about non-utilitarian criteria for the allocation of medical resources. While Rawls did not intend his original ideas to become standards in medicine, other philosophers such as Norman Daniels have used Rawlsian concepts to argue that healthcare should be treated as a basic need. Daniels believes that all members of society deserve access to healthcare that maintains “normal species function.”
Prioritarianism is a philosophical view that aims to “prioritize” patients. Prioritarianism advantages those who are in a worse position than those around them. This was the philosophical viewpoint of choice when it came to treating victims of September 11th. Emergency Triage is the term for the medical use of prioritarianism. Patients are sorted into three groups: the ones who are treated right away, the ones who are turned away, and the ones who are asked to wait for treatment.
The author criticizes emergency triage as it does not provide an equal share of treatment nor does it provide an equal opportunity for future social interactions. Emergency triage does not provide everybody with a decent minimum of medical services. Triage is not completely in line with either utilitarianism or prioritarianism; the two most widely accepted philosophical medical standpoints. Emergency triage takes everybody’s prognosis into account and no priority is given to those who would be generally considered as worse off. However, it is used as a policy in treatment anyway.
Later in the article, the author goes on to criticize the use of resources into research for public health in the wake of a future attack. It is unknown when a future attack will occur and if it even will occur. Public health research in this area allocates resources into an area that may never be useful. This is wasteful as funds can be allocated in other ways. Terrorist attacks also generally affect a specific target of people. In an effort to promote fair equality, no extra funds should be given to the aftermath of a terrorist attack as this isn’t a fair allocation of funds.
A broad consensus of people supports many of the policies that were instituted during and as a result of the terrorist attack of September 11, 2001 and the biological warfare attacks that occurred shortly after. However, neither utilitarianism nor prioritarianism fully back the policies that have been accepted on medical and public health issues after the fall of 2001.
The differences between the typical conceptions of justice and the policies that have been created post 9/11, shows that society and public health leaders are making a mistake in searching for the ruling principle of justice. In reality, millions of dollars are being wasted in research for the best principle of justice in public health when there is no single best principle of justice in public health. The complex nature of human health and human values and the many different scenarios where public health policies come into play can justify the need for a variety of ruling principles of justice in medicine as we currently have.
The just allocation of public health resources should be governed by many considerations. The scarcity of resources makes it impossible to provide funds everywhere they are needed. When making considerations for the allocation of resources, there is no reason to presume that one priority will trump the other. It is difficult to reach justice in public health policy as there is no single governing principle. Public health policy just relies on the things that people would find most compelling.