In his NY Times article, Peter Singer suggests that we must ration health care, indeed we already are, and that the best way to do so is by computing the Quality-Adjusted Life Years (QALY) that a given procedure will provide, and outweighing that number with the procedure’s financial costs to determine which procedures will produce the best “bang for your buck.” Unfortunately for people with disabilities, Singer’s theory argues that saving the life of a paraplegic is not equal to saving the life of a non-paraplegic.

His arguments are too abstract to be taken seriously. There are a lot of assumptions involved—like assuming that we know how much a certain treatment would prolong life, or assuming we could establish a consensus on the type of life the “majority” considers worth living, or considers more preferable living (how does he suggest we do this? and who will be calling the shots?)

On the other hand, he is addressing the very difficult question about what to do with a finite amount of health care resources, which it seems we’ll inevitably have to deal with at some point. It seems that if we are going to have a sustainable health care system, not everyone can get all the care they need or want—an idea we struggle with, both when we need care and when our loved ones need care.

He makes the point that in our current system, we are rationing care on the basis of “ability to pay”, and discriminating against lower and working class people. Singer claims to be offering a solution that doesn’t use moral or prejudiced judgments by not taking into account whether someone is a parent, or is talented, or is an alcoholic, etc. But since his solution would promote that people with disabilities would always get less care than people without disabilities, he clearly fails in this regard.

But of course, we then go back to the question, in a world with finite resources, who gets them?