Allocation and Ageism in Aotearoa: An exploration of the ethical justification for age-based healthcare rationing – Deborah Lambie

Here is another example of the research carried out by students of the Bioethics Centre.

Allocation and Ageism in Aotearoa: An exploration of the ethical justification for age-based healthcare rationing 

Bachelor of Medical Science (Honours)


New Zealand’s population, like many first world countries, is ‘ageing’.  This will place our healthcare system under increasing and changing pressures, as there will be a greater proportion of older people in our population who have particular health needs and generally require greater levels of care over longer periods.  These projected changes have resulted in calls to ration healthcare resources to the elderly.  This is driven in part by concerns that the elderly will consume resources at the expense of other generations.  Such proposals have been met with staunch criticism, most of which focuses on the idea that age-based allocation devalues those discriminated against, viz. the elderly.  In this thesis I argue that this criticism can theoretically be overcome if the principles of age prioritisation are applied consistently over the lifetime of members of society, so that everyone is equally affected.  I then introduce Norman Daniels’ ‘Prudential Lifespan Account’, which provides a moral basis from which such principles can be derived.  This shows us that as a society we should protect the ‘normal range of opportunity’ available to citizens.  This creates a need for resources to be distributed fairly between generations in order to ensure that each is given the best chance possible of having the normal range of opportunity.  Under this theory, certain forms of age-based allocation can be justified.  I go on to outline Daniel Callahan’s view of the nature of mortality and end-of-life care, which incorporates Daniels’ Prudential Lifespan Account.  This provides a helpful framework for reflecting on our collective response to ageing and dying, which will place certain limits on the amount spent on care for the elderly.  However, these limits will not ultimately address the challenges our healthcare sector is currently facing due to the ageing population.  With this in mind, I consider whether a straightforward cut-off for healthcare allocation is ethically justifiable.  I argue that it cannot because it contradicts the basic principles of justice underpinning Norman Daniels’ theory, and so lacks an adequate moral foundation.  Some other responses must be taken in order to ensure that members of our society receive their share of opportunity.  In the final chapter I outline some possible strategies that are consistent with the ideals put forward by both Daniels and Callahan.

Deborah Lambie


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