Journal
JOURNAL OF MEDICAL ETHICS
Volume -, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jme-2023-108972
Keywords
Decision Making; Ethics
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Fair priority setting is based on morally sound criteria. However, when these criteria are tied, tiebreakers such as lotteries or allowing secondary considerations have been suggested. This paper discusses the arguments for these tiebreakers. While holding a lottery to preserve impartiality is reasonable, using tiebreakers as secondary considerations is not. The instances where tiebreakers seem necessary are precisely the situations where lotteries should be preferred.
Fair priority setting is based on morally sound criteria. Still, there will be cases when these criteria, our primary considerations, are tied and therefore do not help us in choosing one allocation over another. It is sometimes suggested that such cases can be handled by tiebreakers. In this paper, we discuss two versions of tiebreakers suggested in the literature. One version is to preserve fairness or impartiality by holding a lottery. The other version is to allow secondary considerations, considerations that are not part of our primary priority setting criteria, to be decisive. We argue that the argument for preserving impartiality by holding a lottery is sound, while the argument for using tiebreakers as secondary considerations is not. Finally, we argue that the instances where a tiebreaker seems necessary are precisely the situations where we have strong reasons for preferring a lottery. We conclude that factors that we consider valuable should all be included among the primary considerations, while ties should be settled by lotteries.
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