Thread by @GovindPersad

This op-ed by Harald Schmidt @PennMEHP is a hugely valuable contribution to the #bioethics debate over ventilator allocation, & would have applications to other scarce resources as well. Some thoughts /1

https://twitter.com/DrRupaliGandhi/status/1250625063382142977

Modifying SOFA score w/"weights" based on race would be struck down in federal court (& certainly by this SCOTUS) under #ParentsInvolved precedent scholar.google.com/scholar_case?c…. Not endorsing that precedent, but crucial to recognize it. Area Deprivation Index is better approach /2

Rather than using Area Deprivation Index "weights" to adjust SOFA scores, it would be better to use the Area Deprivation Index as a tiebreaker within each SOFA-score group ("red" to "green"). Would likely save more lives of disadvantaged patients /3

And whether a patient's health resulted from “factors beyond their control” is a misguided road to go down, politically & in making medical decisions. We should try not to exacerbate disparity as we work to save lives, not attempt to compensate those we perceive to be unlucky /4

I agree w/Harald that Rosa is subject to factors beyond her control. But many people--especially people not on Twitter--won't. In rejecting a focus on bad fortune, I am indebted to Elizabeth Anderson's pathbreaking "What is the Point of Equality" jstor.org/stable/10.1086… /5

Harald says it'd be hard to explain that "Rosa has to be moved off a ventilator, so that John can be admitted." Correct. But would also be hard to explain that John must be moved off for Rosa. Ventilator re-allocation is the wrong case for testing our judgments about fairness /6

Last, I agree that incorporating priority to the least advantaged alongside saving more lives is justified. Ideally, the 2 coexist, saving more lives & more disadvantaged lives. But saving more lives shouldn't be jettisoned for random selection in an effort to achieve equality /7

Even though saving more lives benefits from supplementation w/priority to the least advantaged, random selection and 1st-come, 1st-served are the wrong principles for allocating ventilators. On this, not just bioethicists but the public agree. jopm.jmir.org/2020/1/e18272/… /fin

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