Jackie Leach Scully

Jackie Leach Scully – “Disablism in a Time of Pandemic”

1. Why does Scully argue maximizing benefit is discriminatory?

• Scully critiques the maximization of benefit approach because it often embeds disablist assumptions. By focusing solely on clinical outcomes, this framework:

  • Assumes that people with disabilities inherently have worse prognoses, which is not always accurate.

  • Disregards the diversity and complexity of disabilities, leading to unfair exclusion of disabled individuals from critical care.

  • Reinforces societal biases that devalue the lives of disabled people based on assumptions about their quality of life or utility​.

2. What are the three disablist assumptions and how do they impact rationing protocols?

• Assumption 1: Disability Equals Poor Health:

  • Many protocols use disability as a proxy for poor health or reduced recovery likelihood, even when disability has no impact on health outcomes (e.g., people with visual or hearing impairments).

  • This leads to unfair exclusion of disabled individuals from care​.

• Assumption 2: Disabled People Have Poor Quality of Life:

  • Societal biases often perceive disabled lives as inherently less valuable or enjoyable.

  • These assumptions influence decision-making, leading to rationing protocols that implicitly prioritize individuals without disabilities​.

• Assumption 3: Social Utility Determines Value:

  • Protocols sometimes prioritize individuals based on perceived societal contributions, marginalizing disabled people who are wrongly deemed less "useful."

  • Scully argues that this approach dangerously shifts criteria away from clinical outcomes to societal worth, reinforcing systemic discrimination​.

3. On what grounds do Emanuel et al. and Scully disagree?

• Emanuel et al.:

  • Advocate for maximizing benefits by prioritizing patients who are most likely to survive and have the longest post-treatment life expectancy.

  • Emphasize instrumental value, such as prioritizing healthcare workers who play critical roles in the pandemic response​.

• Scully:

  • Critiques this utilitarian approach for embedding discriminatory biases against disabled people.

  • Argues that focusing on maximizing benefits disproportionately disadvantages individuals with disabilities by failing to consider their unique health profiles and lived experiences.

  • Emphasizes equality and individualized assessment over utilitarian frameworks​.

Relevant Terms:

• Disablism: Prejudice or discrimination against disabled people, often based on stereotypes or assumptions about their abilities, quality of life, or value to society.

• Maximization of Benefits: An ethical approach aiming to save the most lives or life-years, often used in triage settings during resource scarcity.

• Social Utility: The perceived societal value or contribution of an individual, used as a basis for prioritizing access to scarce resources.