The Rule of Rescue

Jonsen coined the term `Rule of Rescue' in 1986 to describe the imperative people feel to rescue identifiable individuals facing avoidable death. In this paper we explore the tension between this tendency and conventional cost-effectiveness analysis, where the latter uses the QALY as the unit of effectiveness. We conclude that the standard gamble, time trade-off, and other measures of individual utility, do not measure all relevant utility associated with the change in health states brought about by a health program. This is so because, inter alia, the utility from the Rule of Rescue is ignored. If the Rule of Rescue is indeed quantitatively significant and if there is a desire to incorporate an individual perspective in the evaluation of health programs then, we argue, existing measurement techniques are defective, even in principle. Concerning the moral status of the Rule of Rescue, we argue that there is a tension between two principles. If the total social utility gained from the Rule of Rescue, including the utility gained from having reinforced within the community the belief that life is valuable and worth great effort to preserve, outweighs the utility sacrificed by not putting resources to the best alternative use, then the Rule of Rescue would be justifiable from a utilitarian point of view. On the other hand, fairness requires that we do not discriminate between individuals on morally irrelevant grounds, and being `identifiable' - being in a context that evokes the `Rule of Rescue' response in others - does not seem to be a morally relevant ground for discrimination. We conclude by observing that utilitarians can make their case stronger by distinguishing between cases where the societal demand for rescue measures is contrived by media coverage, and cases where it is not. Discrimination against anonymous individuals is more objectionable in the former cases than in the latter.