The Last Ventilator

A utilitarian approach would compare expected outcomes. One common version uses expected life-years or quality-adjusted life-years saved. On that basis, B is likely to be preferred: B is younger, has a higher survival probability, and may have more life-years ahead. C might rank second, while A would rank lowest on expected benefit. A rule-utilitarian might still worry about the effects of using age and social worth as criteria, because this could undermine trust in hospitals.

A Kantian/deontological approach would resist treating patients merely as containers of expected utility. Each patient has equal moral worth, so age, parenthood, and social role cannot by themselves justify ranking lives. A Kantian might favour a fair procedure such as a lottery or a first-come-first-served rule, provided the rule is applied consistently and publicly. The key contrast is between maximising aggregate expected benefit and respecting persons equally. The case is hard precisely because both values are morally important.

The offer should not influence the clinical decision. Using Kant's formula of humanity, accepting the donation would treat the other patients as means to the hospital's financial gain rather than as ends in themselves. It would also violate a basic principle of justice: like cases should be treated alike, and medical need should not be converted into a market price. A rule-utilitarian argument reaches a similar conclusion. If hospitals allowed payments to determine access to life-saving treatment, public trust would collapse and the poor would be systematically disadvantaged. That long-term harm outweighs the short-term financial benefit. One might object that the donation could save other lives, which is a genuine consequentialist consideration. However, the appropriate response is to separate charitable giving from clinical allocation: the family may donate freely, but the donation must not be conditional on selecting A.

I would recommend using a transparent, publicly justified triage rule that combines expected clinical benefit with a fair tie-breaker. Under that rule, B is selected first because B has the highest survival probability and the greatest expected life-years. A and C are not dismissed as persons of lesser worth; their claims are considered, but the rule prioritises expected benefit when resources are scarce. The strongest objection is that this approach smuggles in quality-of-life judgements and could disadvantage older or disabled patients. That objection is serious. I accept the recommendation only if the rule is applied consistently, is open to appeal, and is reviewed after the emergency. If the hospital cannot justify such a rule publicly, a lottery among all three patients would be ethically safer, because it expresses equal respect without pretending to rank lives.