How do we choose which life to save? Equality of access or a fair go?

This paper examines the ethics of distributing limited resources when demand exceeds supply. I examine two ethical theories, egalitarianism and utilitarianism, applied to an example of allocating hearts to children who have cardiac failure. I examine the strengths and weaknesses of these approaches. I argue that we must include some concern for equality of access (equal treatment for equal need). But this should occur within a context qof first evaluating the impact of a medical intervention on how long an individual will live, his or her quality of life and the probability of the intervention succeeding, I propose a third more plausible approach: 'a fair go'. I also examine whether the cost of treatment, the existence of dependants and responsibility for illness should play a part in the allocation of limited resources. Finally, I briefly discuss the role of patients and their family in making these decisions. © 2002 Elsevier Science Ltd.