Fair Innings: An Empirical Test

The fair innings principle states that fairness requires allocating life-saving treatments to younger rather than older patients when each would gain the same extension in longevity. It is motivated by the notion that older patients have already benefited from a longer life and so have less claim to scarce treatment resources than younger patients who have not yet lived their “fair innings.” The principle can be theoretically justified by a prioritarian social welfare function applied to lifetime wellbeing. We conducted an online survey to test whether there is support for the principle in the general population (in France). We find substantial but not universal support. When choosing to allocate a treatment that would provide the same life extension to an older or a younger patient, about one-half the respondents would allocate the treatment to the younger patient while about one-third are indifferent to which patient is treated and about one-fifth would allocate treatment to the older patient. Holding the life extension to the older patient fixed, decreasing the life extension to the younger patient decreases (increases) the fraction of respondents that would allocate treatment to the younger (older) patient. These results highlight the tension between principles of equal treatment and of giving priority to those who are worse off that confound healthcare policy.