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Unweighted lotteries and compounding injustice: reply to Schmidt et al
  1. Alex James Miller Tate1,2
  1. 1 Centre for Medical Law & Ethics, King's College London, London, Greater London, UK
  2. 2 Philosophy, King's College London, London, UK
  1. Correspondence to Dr Alex James Miller Tate, Centre for Medical Law and Ethics, King's College London, London WC2R 2LS, UK; alexander.miller_tate{at}


I argue that Schmidt et al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ (in the relevant sense) prior structural injustices. However, Schmidt et al do gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, I develop this idea, arguing that unweighted lottery procedures fail to satisfy healthcare providers’ duty to prevent unjust population-level health outcomes, and thus that lotteries weighted in favour of Black individuals (and others who experience serious health injustice) are to be preferred.

  • allocation of health care resources
  • COVID-19
  • distributive justice
  • minorities
  • Public Health Ethics

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  • Contributors AJMT is the sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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