Jonathan Marks, Professor of Bioethics, Humanities, Law, and Philosophy

In the early days of the pandemic, ethicists were called upon to help draft triage policies and guidelines to determine who lives or dies when there are not enough resources (such as ventilators, hospital beds, or antivirals). Many of these policies employ lotteries to break a tie between patients who receive equal "scores" in the algorithms applied to determine who will receive crisis care. Later in the pandemic, when vaccines became available, many governors and employers launched prize lotteries as incentives for people who were reluctant to get vaccinated. I argue that lotteries often mask both historic and current structural injustice. For example, resource lotteries can make the consequences of choice—notably, policymakers’ failure to adequately prepare for the pandemic—appear to be chance. Similarly, while prize lotteries create incentives for vaccination, they fail to address the reasons for the reluctance of some marginalized populations to get vaccinated—in particular, distrust resulting from unjust treatment in medical research and practice. In this seminar, I explore the relationship between choice and chance, drawing on literature and art, as well as ethical texts, to illuminate what many choose not to see.