Bolstering the epistemic argument against desert-based medical resource allocation

Journal article

The proper distribution of scarce medical resources is a heavily debated topic in medical ethics. Some have argued that allocation strategies should sometimes incorporate whether a particular health need is likely a result of an individual’s own voluntary choices. One reason to include this variable in resource triage decisions is that individuals who acquired a medical need as the result of their voluntary choices may appear more responsible for their condition, and thus less deserving of treatment than patients who were simply unlucky in developing their medical need. One argument against this position is the epistemic argument, which points out challenges in determining desert. In this article, I build on recent work on the epistemic argument by reducing its assumptions and developing a robust defence of its most crucial premise. After considering some counterarguments, I conclude that while the epistemic argument is successful in casting significant doubt on justice motivations for considering patients’ voluntary choices in resource allocation, utilitarian motivations for this position deserve further study.

Authors: Mech, NR

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Journal of Medical Ethics
• Article number: jme-2025-110993
• Publication date: 2025-10-23
• Acceptance date: 2025-10-03
• DOI: 10.1136/jme-2025-110993
• EISSN: 1473-4257
• ISSN: 0306-6800
• Language: English
• Keywords: Policy; Decision Making; Ethics; Resource Allocation; Transplantation