Debating opportunities, outcomes and democracy: Young and Phillips on equality

Within recent egalitarian theory, the ideal of equal opportunity holds considerable sway. Liberal egalitarians increasingly concentrate on refining this ideal, as do a number of Marxist theorists. At the same time many radical critics are unhappy with various aspects of this hegemony of equality of opportunity, and this article examines the reasons for their unhappiness, as well as two possible solutions. The first would be to reject equal opportunities in favour of another conception of equality, or to argue that the ideal can only play a limited role within an egalitarian project. Another would be to try to radicalise the idea of equal opportunities: to argue that equality of opportunity can be a transformative ideal if it is interpreted sufficiently broadly or deeply. We can identify Anne Phillips with the first approach, and Iris Young with the second. On the question of whether equality of opportunity can provide an overarching normative framework for egalitarian politics, Young's response is in the positive, whereas Phillips' is in the negative. The article critically addresses this dilemma, and concludes by siding with Phillips, by arguing that equality of opportunity is not capable of standing in as an overarching normative principle for egalitarian politics

Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry

Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19. Funding: None