Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available for transplant without (...) requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free. (shrink)

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. (shrink)

In order to prevent the rapid spread of COVID-19, governments have placed significant restrictions on liberty, including preventing all non-essential travel. These restrictions were justified on the basis the health system may be overwhelmed by COVID-19 cases and in order to prevent deaths. Governments are now considering how they may de-escalate these restrictions. This article argues that an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly. While this discriminates against the elderly, there (...) is a morally relevant difference—the elderly are far more likely to require hospitalisation and die than the rest of the population. If the aim is to ensure the health system is not overwhelmed and to reduce the death rate, preventing the elderly from contracting the virus may be an effective means of achieving this. The alternative is to continue to keep everyone in lockdown. It is argued that this is levelling down equality and is unethical. It suggests that in order for the elderly to avoid contracting the virus, the whole population should have their liberty deprived, even though the same result could be achieved by only restricting the liberty of the elderly. Similar arguments may also be applied to all groups at increased risk of COVID-19, such as men and those with comorbidities, the obese and people from ethnic minorities or socially deprived groups. This utilitarian concern must be balanced against other considerations, such as equality and justice, and the benefits gained from discriminating in these ways must be proportionately greater than the negative consequences of doing so. Such selective discrimination will be most justified when the liberty restriction to a group promotes the well-being of that group (apart from its wider social benefits). (shrink)

A disaster is an occurrence disrupting a community’s normal functioning and existence. The disruption may render it impossible to comply with principles and to respect, protect, and fulfill rights as it happens in ordinary times; it may induce an overwhelming shortage of resources and make tragic decisions unavoidable. From its very beginning, the COVID-19 pandemic evoked the scenario of disaster medicine, where triage is likely to imply not simply postponing a treatment but letting someone die. However, it is not only (...) the health care system that faces disruption risks. Lockdown measures and other restrictions were imposed to curb the pandemic, impinging upon individual freedom as well as economic activities. The proposal of mandatory vaccination implied a suspension of the principle of autonomy, which is a fundamental pillar of modern medicine. Out of the ordinary balancing efforts may be required, and two questions arise. Do such exceptional circumstances suggest reconsidering the criteria to apply, especially when essential, life-saving treatments are at stake? Who should decide? Science offers the premises to build on, but the last word does not belong to science. It remains the province of ethics and politics. (shrink)

I argue that Schmidtet al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ (in the relevant sense) prior structural injustices. However, Schmidtet aldo gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, (...) I develop this idea, arguing that unweighted lottery procedures fail to satisfy healthcare providers’ duty to prevent unjust population-level health outcomes, and thus that lotteries weighted in favour of Black individuals (and others who experience serious health injustice) are to be preferred. (shrink)

When humanity has either suppressed coronavirus disease 2019 or learned to come to terms with its continued existence, governments and corporations probably return to their prepandemic stances. Solutions to the world’s problems are sought from technology and business innovations, not from considerations of equality and well-being for all. This is in stark contrast with the pandemic-time situation. Many governments, at least initially, listened to the recommendations of expert advisers, most notably public health authorities, who proceeded from considerations of equality and (...) common good. I suggest that we should continue on this path when the immediate threat of the disease is over. Other crises are already ongoing—poverty, conflicts, climate change, financial bubbles, and so on—and it would be good to use expert knowledge rather than interests and ideologies in dealing with them. To assist in this, I outline the characteristics of a new kind of counsellor,impartial adviser, who is normatively motivated by a sense ofcopathyand who takes into account all views, nice and not-so-nice alike. I illustrate the nature and ideological orientation of copathic impartial advisers by placing them on a map of justice and examining their relationships with the main political moralities of our time. (shrink)

Trolley-like dilemmas are other cases of what Bermúdez refers to as (conscious) quasi-cyclical preferences. In these dilemmas, identical outcomes are obtained through morally non-identical actions. I will argue that morality is the context where descriptive invariance and ecological relevance may be crucially distinguished. Logically irrational moral choices in the short term may promote greater social benefits in the longer term.