In public health crises, such as the COVID-19 pandemic, ethical norms are understood to shift towards the benefit of the whole. In crisis standards of care, this has often been interpreted as a utilitarian form of fairness: save the greatest number of lives or life-years. This approach was not new to public health when White et al. developed their multi-principle framework for the allocation of scarce resources in crisis standards of care, which includes the use of the Sequential Organ Failure Assessment (SOFA) score to medically actualize the ethical rule of maximizing the number of lives saved. Today, twenty-three U.S. states with published Crisis Standards of Care outline use of the SOFA or Modified SOFA score to ration critical care resources. However, when SOFA scores are used to allocate medical resources to the most healthy to save the most lives, communities with underlying inequities in health and healthcare are disproportionately and systematically disadvantaged. Ultimately, SOFA provides a facade of medical evidence and fairness, but in truth depends on racist structures that create and maintain health disparities. It is time to imagine otherwise. In this panel, we will begin by deconstructing SOFA criteria and utilitarianism as its ethical foundation. Then, we will turn to critical race theory, virtue ethics, and care ethics to investigate new ethical foundations for anti-racist allocation of healthcare resources in crisis.

Abstract: Decisional capacity is, on its face, a genderless concept. However, gender norms are powerful and can impinge on how medical providers respond to women’s choices in the inpatient setting. A particularly complicated example is that of a patient requesting that an abusive partner serve as health care proxy. For healthcare providers, these choices pose a particular challenge to traditional principles of autonomy and beneficence. A conflict resides in the fact that survivors of abuse are vulnerable on two fronts. On the one hand, they are vulnerable to their abusive partners, who may not be “ethically appropriate” decision makers insofar as they consistently and characteristically act contrary to the best interests of the patient. On the other hand, survivors of abuse are vulnerable to the unwarranted revocation of decisional capacity, by a well-meaning clinical team who may conflate “accepting” abuse with lacking capacity. Patients with this social positioning can be particularly vulnerable to having their autonomous choices unnecessarily overridden for the sake of best interests or beneficence. In this paper, we reflect on one such clinical case and advocate for a response that balances these two vulnerabilities and hinges on the notion of relational autonomy.

The moral relevance of empathy is highly contested. Some argue that it is of little or no moral worth because of its proneness to personal bias, stereotypes, and lack of connection to altruistic behavior. Others contend that particular definitions of empathy are morally relevant in virtue of empathy's causal role in caring or altruistic behavior. In light of this discussion, I develop an important distinction between empathic practice, which is morall neutral, and empathic attunement, which identifies empathic practices done excellently. Further, equipped with four conditions of empathic attunement, I argue that empathic attunement is a virtue. However, unlike other accounts of empathy's moral worth, I maintain that its worth lies not in its causal connections to caring and altruistic behavior. Rather, the virtue of empathic attunement lies in its unique way of respecting, caring for, and connecting with others. In this way, empathic attunement is a distinct and important character trait that demonstrates, and is crucial to, human flourishing.