Rationing policies and the limit of their rationality

Is a pandemic the appropriate moment to erase the plurality of judgements and stop weighing each particular case in the name of urgency? The risk of non-transparent rules of experts is to lose the confidence of the public. Real time decisions are certainly harder than applying efficiency rules. We should make room to moral intuition in entering the framework of decision that leads to adapt the rules in context. Should ethicists then help apply guidelines or assist with rationalizing decisions? I doubt it. It would mean to transfer the responsibility from the patient or his/her family to other efficiency bodies. I would suggest avoiding these real and false dilemmas to prevent the scarcity of medical resources by collaborating in solidarity with those who are still handling the matters, the medical doctors themselves.
Paradoxically, this pandemic has isolated half of humanity. It reminds us first that we are all mortals, and that is what makes us equals. Secondly, solidarity is the main ethical principle to escape from false dilemmas. What is a false dilemma? It questions rational evidence in the face of moral intuition. It is interesting to note that no regulation of triage rules has been adopted internationally, which reinforces the decision-making dimension associated with the survival and the preservation of people’s abilities to survive. It could simply mean that it is a matter of isolating patients at risk of dying or losing their motor or cognitive abilities, if they are not treated, as an arbitrary priority of these rules, or at least their relativity and adaptability.
These reflections force us to redefine the fairness models introduced in this rationalizing, and to rethink a model of public health founded not only on data driven medicine, but on deep and responsible democracy.
Can we really talk about scarcity, in our societies of abundance, or is it more linked to ineffective management of priorities for the social good, or to inadequate assets management?
The question will be why , and many speakers in the public debate have stressed the unpreparedness of most states. It will also be necessary to ask in what healthcare model this unpreparedness has been possible, to clearly determine the responsibilities shared among the different actors. We talk in peace time about the prioritization of care, but some rulers preferred to talk about war, a term used to justify all ethical transgressions. The wording of scarcity conditions is not acceptable. It is necessary to give common reasons to all caregivers as well as to the patients and their loved ones.
The procedural decision grids exist, but they do not free the medical doctors from the difficult freedom of personal responsibility in the heat of the moment. These tools are necessarily incomplete and therefore do not exist, because a clinician will always have to use his ethical imagination to practice a coherent care, adapted to any context and to a diversity of needs in terms of gender, race, or class, having fairness as its main horizon.
Indeed, if these decision-making grids are tools that have some effectiveness in the emergency, we must not overlook the after-effect of these decisions on the doctors and nurses in the aftermath of pandemics.
Prioritization is a societal choice that makes us all co-responsible. The main issue remains prevention, which can avoid both lockdown and tracking, and foster collective intelligence instead of infantilization. Fairness is thus more than equality because it is sensible to plural forms of vulnerability, while always aiming at the recovery of capabilities for each person. Fairness is a plastic notion that implies the articulation of care and justice.