The hope of a dilemma-free world is naïve where it is not power-hungry

screen-shot-2016-12-14-at-19-05-57The problem, says Dalrymple, with a nationalised health system’s

incontinent sharing of risk

is that

it deprives people of one possible motive for behaving responsibly. They believe, not without reason, that someone will always pick up the pieces for them at no cost to themselves. Irresponsibility thrives where there is no penalty for it.

He points out, however, that the problem with individualised insurance is that

it may place intolerable or unsustainable burdens on people through no fault of their own.

In short,

incontinent sharing of risk is unjust: too little sharing of risk is inhumane. Since both justice and humanity are desirable qualities, but not always compatible, now one, now the other, will be the more important; but the tension between them will remain.

Dalrymple writes:

That ethical decisions sometimes cannot be made that are indisputably correct, that entail no injustice or no inhumanity, is difficult for rationalists and utilitarians to accept. They want every division to be without remainder. They want a formula that will decide every question beyond reasonable doubt. They want a universal measure of suffering, so that the worth (in units of suffering averted) of every medical procedure can be known and compared. There is a cognitive hubris at play, according to which information will resolve all our dilemmas; and if our dilemmas have not been answered, it is only because we do not have enough information.

As for the doctor,

he cannot be so limitlessly compassionate as to deny patients’ responsibility where it exists, nor should he deny his patients his compassion by blaming them even when they are to blame.

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