RESPONSIBILITY
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lottery is the only way which avoids arbitrariness and shows equal respect for equal rights to life. My first reaction to the plan of selecting patients for dialysis by lot was that it was a cop out, an abdication of the human responsibility to make a hard rational decision. At worst, I thought, it was a superstitious pretense of leaving the decision in the hands of God; at best it was decision by refusal to decide at a time when the best possible human decision is called for. If either of these is the mentality behind random selection. then of course it is unconscionable. But that does not have to be the mentality. There is, I think, a deeper and wiser principle here. Random selection of those to be saved when all cannot be saved cuts to the heart of it. It says that a human person is of transcendental value, that the value of a human life transcends one's usefulness or social worth. On this deeper level all lives should be respected equally, and each one given an equal chance. Random selection by lot or on a first-come fir¡stserved basis is the only fair and equitable way. Therefore as a general policy I think that first strictly medical criteria should be applied: is the patient an apt subject for treatment. No judgment should be attempted about his social worth either implicitly in the medical opinion or openly by a lay committee. After some have been screened out on medical grounds, selection should be made randomly, on a first-come first-served basis or by lot. I do not say that this rule is absolute; few things are. But as a general policy I think it is the most honest and fair. It is founded in the belief that the true value of a man's life cannot be calculated in utilitarian terms, that at its deepest level every human life has a meaning which transcends its usefulness and social worth, and that as a matter of fact even a man's social worth can seldom be rightly measured in a pluralistic society with unfocused values and goals. Finally, I do not want to pretend to too much wisdom here. This question has not yet been thoroughly discussed in the literature and no clear consensus has emerged. Nonetheless the solution I have given is gaining increasing support anrl so I propose it for your thoughtful consideration.