120 - Who Lives? Who Dies? Ethical Criteria in Patient Selection

Who Lives? Who Dies? Ethical Criteria in Patient Selection

By John F. Kilner

New Haven, Yale University Press, 1990. 359 Pp. $29.95.

Believing that one should avoid patient-selection whenever possible, Kilner nevertheless criticizes those who deny its necessity. Until national budgetary decisions make patient selection unnecessary, he believes that hard decisions must be made. Kilner, therefore, examines sixteen patient-selection criteria that are currently in use (the patient's social value, age, ability to pay, etc.), giving the strengths and weaknesses of each.

Kilner then offers his own proposal for a structure of criteria to be employed in patient-selection. Criticizing utilitarian tendencies that emphasize productivity-oriented criteria, he gives priority to person oriented criteria while seeking to diminish productivity as little as possible. Because Kilner describes criteria actually in practice today, even those who disagree with patient-selection criteria will find the book informative. Nevertheless, one wishes that Kilner had not discussed patient selection apart from issues of justice that, when ignored, make patient selection necessary.

Nancy J. Duff, Princeton Theological Seminary, Princeton, N.J.