Disabled activists and philosophers have made a number of interventions on social media, blogs, podcasts, and so on with respect to the pandemic and disabled people. Most of these contributions to critical discourse about the pandemic and disability have been concerned with distribution, disability, and discrimination: who should get medical attention, who should have access to resources and why, who should have priority to ventilators, etc.

On a recent Facebook post, I argued that disabled activists, bioethicists, and philosophers should change the subject, that is, should shift the terms of discussion away from arguments for equal access to medical and other resources and services to arguments for increased production of the required resources and expansion of the services, to arguments for the required modifications of manufacturing, and so on. The shift in the terms of discourse that I recommended relies upon an approach to the pandemic that consrtrues it as a systemic social and political problem rather than a sum of individual pathologies.

In the third part of a three-part series of posts at bioethics.net, disabled bioethicist Joseph Stramondo expanded on my conviction, distinguishing my position from more common positions with respect to disability and the pandemic, that is, positions on distribution of medical resources, their scarcity, and how to adjudicate prioritizing them. Here is an excerpt of the bioethics.net post:

by narrowly focusing on triage protocols as the most morally salient problem that we face during this unprecedented era, perhaps we are not even advancing the most important conversation.  In fact, feminist philosopher of disability, Shelley Tremain, argues that bioethicists should shift the focus of the conversation altogether because targeting these protocols as the primary object of our analysis seems to sanction the idea that these hard choices are inevitabilities.  Rather than carefully parsing how to fairly deny treatment to some patients to maximize lives saved, Tremain maintains that we, as professional bioethicists, should be putting our energy behind efforts to reduce the need to make such choices at all.

As we expand and prolong efforts to slow the spread of the virus by eliminating or radically altering all sorts of features of our daily lives, it becomes more and more obvious that the presumed need for triage will be driven by economic, political, and personal choices, not an inevitable march of events. Tremain points out that there are many ways people at the grassroots can themselves help to expand the capacity of our medical institutions, like using 3-D printers to make personal protective equipment like face shields. Additionally, there have been a steady stream of news reports about engineering innovations that may reduce the need for triage like a new, easier to mass produce ventilator design.  The American Society of Anesthesiologists has stated that “If the pandemic overcomes the capacity of the hospital ICUs to provide ventilators, unused operating room anesthesia machines can be repurposed for use in the ICUs,” even though there are significant differences between the two kinds of devices. While controversial, some hacks are even being proposed to sustain more than one person on a single ventilator.

Tremain is suggesting a really powerful paradigm shift, here.  If professional bioethics is serious about maximizing the number of people saved as the top priority, we should put ourselves and our considerable social capital into the service of slowing down the spread of the virus and building the capacity of the medical response.  While we may not be engineers or manufacturers who can try to make up for the shortfall, there are some very specific ways bioethicists can work to reduce the need for triage in the United States that are likely to save many more lives than perfecting a triage protocol.

The entire third part of the three-part series by Stramondo is here.

The first post in the series is here. The second post in the series is here.

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