Appalling to see such racists among those making life and death decisions

Oof.  If you want moral guidance, talk with a person who has helped people through difficult times.  Grandparents, sometimes priests, teachers occasionally.  People from all walks of life.  But be leery about philosophers of ethics.  Something is generally just not right with those folks.

From The Elderly vs. Essential Workers: Who Should Get the Coronavirus Vaccine First? by Abby Goodnough and Jan Hoffman.  Just the sort of thing callow youth love to bandy around in college bull sessions when you have ideas and no responsibilities.

And immediately you have passionate advocates, not seeking to do what is right, but seeking to fight their corner.

“It’s damnable that we are even being placed in this position that we have to make these choices,” said the Rev. William J. Barber II, a co-chairman of the Poor People’s Campaign, a national coalition that calls attention to the challenges of the working poor. “But if we have to make the choice, we cannot once again leave poor and low-wealth essential workers to be last.”

 It would seem to me that Reverend Barber is making an empty argument.  I hear no one arguing that poor and low-wealth essential workers should be last.  I hear people trying to figure out what priorities make sense given unresolved goal definition.

Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”

OK, now we are getting into mixed signals here and in a place where definitional clarity is absolutely critical.  Preventing death is one goal, but likely the more precise goal is to minimize total years of life lost.  That is a pretty critical distinction.  If most the deaths are among the young with many years ahead of them, then that is who gets prioritized.  But if statistically few die below age of seventy, then you focus on the elderly but again with attention to prognosis.  If you are gaining just a couple of months of extra life, then the vaccine can almost certainly be used with greater effect among other target groups.

Definitions matter.

The trade-off between the two is muddied by the fact that the definition of “essential workers” used by the C.D.C. comprises nearly 70 percent of the American work force, sweeping in not just grocery store clerks and emergency responders, but tugboat operators, exterminators and nuclear energy workers. Some labor economists and public health officials consider the category overbroad and say it should be narrowed to only those who interact in person with the public.

So Essential Workers hardly helps here since it covers the majority of the population.  

But there is another issue in here.  We have experts making decisions about who should be getting vaccinated first without public agreement on priorities.  In addition, while the public might endorse targeting rate of infection, experts have not covered themselves with glory in terms of track and trace, controlling infection rates, etc.  If they are so frequently wrong, why do they decide?  It is a legitimate question which should not be elided.  

There is a passage in here which highlights an issue I see more and more frequently.  An argument for a position which most people would support except for the nature of the argument being made.  They agree with the outcome but not the justification.

The passage is this.

Historically, the committee relied  on scientific evidence to inform its decisions. But now the members are weighing social justice concerns as well, noted Lisa A. Prosser, a professor of health policy and decision sciences at the University of Michigan.

“To me the issue of ethics is very significant, very important for this country,” Dr. Peter Szilagyi, a committee member and a pediatrics professor at the University of California, Los Angeles, said at the time, “and clearly favors the essential worker group because of the high proportion of minority, low-income and low-education workers among essential workers.”

Not only are frequently wrong "experts" make decisions without the public, they appear to be applying repugnant ideological criteria for selection.

And this is the oddity.  If we restrict essential workers to high public contact workers, I suspect you would get very substantial support for that argument.  So why interject a racist argument into the debate?  Szilagyi is arguing that we should save people based on their race.  Other than intellectual idiots, few would accept such a heinous racist argument.  Why make that argument which will turn away supporters from the very proposition that they otherwise would support.

Likely because, especially in academia, we have both intellectual class-based bubbles where the highly privileged are shielded from the realities of the majority of Americans.  And also they are idiots.  To argue so transparently for proactive racism is simply astonishing and horrifying.  And, of course, self-defeating.

On the one hand, we have "experts" such as Szilagyi wanting to make life-and-death decisions based on race and without hindrance from the public or even simply sane people.  Strikingly, Szilagyi is making his argument against the advice of many institutions which are not always well-aligned with the public.  

That position runs counter to frameworks proposed by the World Health Organization, the National Academies of Sciences, Engineering, and Medicine, and many countries, which say that reducing deaths should be the unequivocal priority and that older and sicker people should thus go before the workers, a view shared by many in public health and medicine.

And I would agree with these institutions with the caveat of switching to "years of life saved", not the simpler "lives saved."

And get rid of the strained evil of racist decision-making.  There will be differential impacts based on patterns of individual and group behaviors and those patterns will map on to religion and race and class and geography and familial status and a range of other identities.  But we are seeking the most number of years of life, not save Protestants or Blacks or Singletons or Northeasterners.  

Focusing on identities is evil and divisive.  Keep it simple, go with years of life saved.  And stop all the posturing and divisive foolishness.