Rethinking the Ethics of Pandemic Rationing: Egalitarianism and Avoiding Wrongs

Abstract

This paper argues that we ought to rethink the harm-reduction prioritization strategy that has shaped early responses to acute resource scarcity (particularly of intensive care unit beds) during the COVID-19 pandemic. Although some authors have claimed that “[t]here are no egalitarians in a pandemic,” it is noted here that many observers and commentators have been deeply concerned about how prioritization policies that proceed on the basis of survival probability may unjustly distribute the burden of mortality and morbidity, even while reducing overall deaths. The paper further argues that there is a general case in favor of an egalitarian approach to medical rationing that has been missed in the ethical commentary so far; egalitarian approaches to resource rationing minimize wrongful harm. This claim is defended against some objections and the paper concludes by explaining why we should consider the possibility that avoiding wrongful harm is more important than avoiding harm simpliciter.

What Do ‘Humans’ Need? Sufficiency and Pluralism

“…And yet while some such individuals do in fact have bad lives, this is not because they are incapable of living well. Such a judgment has potentially significant practical implications, for instance in the provision of healthcare when not all patients can be treated, or in arguments about whether an individual’s quality of life makes providing any life-sustaining care in their best interests (Hellman & Nicholson, 2021 ; Miller Tate, 2022 ; Scully, 2020 ; Wilkinson, 2021 ). Moreover, this implied judgment goes against the informed opinion of many people who care for individuals with significant cognitive disabilities.…”