When Richard Lamm made the statement that old people have a duty to die, it was generally shouted down or ridiculed. The whole idea is just too preposterous to entertain. Or too threatening. In fact, a fairly common argument against legalizing physician-assisted suicide is that if it were legal, some people might somehow get the idea that they have a duty to die. These people could only be the victims of twisted moral reasoning or vicious social pressure. It goes without (...) saying that there is no duty to die. (shrink)

La pandemia de la COVID-19 ha levantado sospechas de edadismo y gerontofobia en diversas prácticas de racionamiento sanitario. La edad es un criterio de triaje controvertido. En este artículo se esclarece la relevancia ética de la edad dentro de los sistemas de triaje, analizando particularmente su rol dentro de los principios de equidad y de eficiencia. La equidad requiere dar más oportunidades a aquellos que han cumplido menos ciclos vitales. La eficiencia tiene en cuenta la edad de manera subrepticia al (...) tratar de maximizar los beneficios a corto plazo (salvar vidas) y a largo plazo (salvar años de vida). Finalmente, la edad no debe ser la última ratio de las decisiones de triaje, aunque es una variable a tener en cuenta debido a su presencia implícita en principios fundamentales de priorización. The COVID-19 pandemic has raised suspicions of ageism and gerontophobia in various health rationing practices. Age is a controversial triage criterion. This article clarifies the ethical relevance of age within triage systems, particularly its role within the principles of fairness and efficiency. Fairness requires giving more opportunities to those who have completed fewer life cycles. Efficiency takes age into account surreptitiously when trying to maximize short-term (saving lives) and long-term (saving years of life) benefits. Finally, age should not be the final rationale in triage decisions, although it is a variable to be taken into account because of its implicit presence in fundamental principles of prioritization. (shrink)

When the Covid‐19 pandemic reached the United States in spring 2020, many states and hospitals announced crisis standards of care plans that used age as a categorical exclusion criterion. Such age choosing was quickly flagged as discriminatory, and so some states and hospitals shifted to embedding age as a tiebreaker deeper in their plans. Different rationales were given for using age as a tiebreaker: that younger patients were more likely to survive than older patients, that saving younger patients would save (...) more life years, and that younger patients deserved a chance to live through life's stages. We provide a critical analysis of these three rationales, noting the differences between them, and then questioning the ethical and legal justifications for such age choosing. (shrink)

The role of a journal like HPLS during the novel coronavirus pandemic should serve as a means for scholars in different fields and professions to consider historically and critically what is happening as it unfolds. Surely it cannot tackle all the possible issues related to the pandemic, in particular to the COVID-19 pandemic, but it does have a responsibility to foster the best possible dialogue about the various issues related to the history and philosophy of the life sciences, and thus (...) to solicit contributions from potential authors working in different parts of the world and belonging to different cultural traditions. Only a real plurality of perspectives should allow for a better, large-scale comprehension of what the COVID-19 pandemic is. (shrink)

COVID-19 has been called “a disaster for feminism” for numerous reasons. In this short piece, we make sense of this claim, drawing on intersectional feminism to understand why an analysis that considers gender alone is inadequate to address both the risks and consequences of COVID-19.

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Pandemics such as COVID-19 place everyone at risk, but certain kinds of risk are differentially severe for groups already made vulnerable by pre-existing forms of social injustice and discrimination. For people with disability, persisting and ubiquitous disablism is played out in a variety of ways in clinical and public health contexts. This paper examines the impact of disablism on pandemic triage guidance for allocation of critical care. It identifies three underlying disablist assumptions about disability and health status, quality of life, (...) and social utility, that unjustly and potentially catastrophically disadvantage people with disability in COVID-19 and other global health emergencies. (shrink)