The rule of rescue

Soc Sci Med. 2003 Jun;56(12):2407-19. doi: 10.1016/s0277-9536(02)00244-7.


Jonsen coined the term "Rule of Rescue"(RR) to describe the imperative people feel to rescue identifiable individuals facing avoidable death. In this paper we attempt to draw a more detailed picture of the RR, identifying its conflict with cost-effectiveness analysis, the preference it entails for identifiable over statistical lives, the shock-horror response it elicits, the preference it entails for lifesaving over non-lifesaving measures, its extension to non-life-threatening conditions, and whether it is motivated by duty or sympathy. We also consider the measurement problems it raises, and argue that quantifying the RR would probably require a two-stage procedure. In the first stage the size of the individual utility gain from a health intervention would be assessed using a technique such as the Standard Gamble or the Time Trade-Off, and in the second the social benefits arising from the RR would be quantified employing the Person Trade-Off. We also consider the normative status of the RR. We argue that it can be defended from a utilitarian point of view, on the ground that rescues increase well-being by reinforcing people's belief that they live in a community that places great value upon life. However, utilitarianism has long been criticised for failing to take sufficient account of fairness, and the case is no different here: fairness requires that we do not discriminate between individuals on morally irrelevant grounds, whereas being "identifiable" does not seem to be a morally relevant ground for discrimination.

Publication types

  • Review

MeSH terms

  • Attitude to Death
  • Attitude to Health
  • Cost-Benefit Analysis
  • Critical Care / economics
  • Critical Care / ethics*
  • Ethical Theory
  • Humans
  • Motivation
  • Quality-Adjusted Life Years
  • Rescue Work / economics
  • Rescue Work / ethics*
  • Resource Allocation / economics
  • Resource Allocation / ethics*
  • Social Justice
  • Value of Life / economics*