Ethicists are quoted re: #COVID19 as saying things like "in a public health emergency, medical #ethics shifts from clinical ethics (priority to worst off, patient autonomy) to the #publichealth #utilitarian value of saving the most lives." This is a damaging simplification. 1/9

In the @NEJM allocation article, the argument is presented: "it is difficult to justify asking health care workers and the public to take risks and make sacrifices if the promise that their efforts will save and lengthen lives is illusory." What kind of argument is that? 2/9

(Singling out @upshur_ross @GovindPersad @maxwellsmith @michaelethox @DrPhillipsMD et al. https://www.nejm.org/doi/full/10.1056/NEJMsb2005114
for discussion, but there is good, subtle reasoning in their work, apart from what I've quoted, and the claim about utility is being made by many in #bioethics.) 3/9

HCWs and the public are committed to saving lives AND to saving the worst off and to doing justice. Balancing these commitments doesn't make the any one of them "illusory". Especially given controversies around "save the greatest life years" (vs. survival to discharge) 4/9

What's wrong w/SGN as a goal? Some known limits: It means treating the healthiest and not those in greatest need. Depending on how people are grouped into categories, it can perpetuate existing injustices. It abandons fundamental human equality in the form of the claim... 5/9

...to be offered a chance ie do you want to treat the diff btwn 80% and 20% survival probability the same as the diff btwn 67% and 72%? As a categorical cutoff denying people the chance of access to lifesaving resources? (H/T @peterubel for research on that choice situation.) 6/9

It may put undue faith in our ability to prognosticate. Informal prognostication can be shaped by all sorts of biases. Formal measures can mitigate those biases but not completely, as these biases run through discourse and science more broadly. 7/9

And it runs counter to our commitment to the #disabled and those in need of care: their rights to meaningful social inclusion involve society accepting the resource differences involved in realizing equal respect and opportunity. 8/9

I'm not saying that the balance of values doesn't shift in a public health emergency. But #publichealthethics is misrepresented as utilitarian in nature. #Socialjustice is at (or near to) the heart of public health. "Balancing" includes specification, mitigation—and critique. 9/9