RT Journal Article SR Electronic T1 Unweighted lotteries and compounding injustice: reply to Schmidt et al JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP medethics-2021-107395 DO 10.1136/medethics-2021-107395 A1 Alex James Miller Tate YR 2021 UL http://jme.bmj.com/content/early/2021/04/27/medethics-2021-107395.abstract AB 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.