ABSTRACT
This paper explores how the rationing of medical care for older people by frailty score was justified and operationalised in the UK during the COVID-19 pandemic. COVID-19 was expected to overwhelm the National Health Service (NHS) in the UK. In March 2020, the National Institute for Health and Care Excellence (NICE) published the ‘COVID-19 rapid guideline: critical care in adults', which advised that clinicians use the Clinical Frailty Score (CFS) to inform decisions about which patients over the age of 65 should be offered ventilatory support. We present a Foucauldian Critical Discourse Analysis of this guidance and the supporting online resources. Analysis shows how the guidance merchandises the CFS as a quick and easy-to-use technology that reduces social and physical complexity into a clinical score. This stratifies older people by frailty score and permits the allocation of resources along these lines. We show how this is justified through epidemiological discourses of risk, which are merged with the language of individual mortality prediction. We discuss the proceduralisation of the CFS alongside a growing body of research that problematises its application in resource allocation. We argue that the pandemic has increased the use of the concept of frailty and that this effectively obfuscates the concept's limitations and ambiguities;the ageism implicit in the response to COVID-19 in the UK;and the relative resource scarcity facing the UK's NHS.
ABSTRACT
The ongoing COVID‐19 pandemic has exacerbated existing inequalities and inequities. Injustices within the labor market mean that the lives particularly of women of color have been negatively affected by the crisis in multiple ways. Guided by standpoint epistemology, we take an intersectional approach and use autoethnographic methods in which we draw on our personal experiences within the United Kingdom's higher education institutions during the pandemic. We illustrate how institutional decisions, approaches, and policies enacted in the wake of COVID‐19 exacerbate inequalities and inequities. Three themes stand out from our experiences: (1) meritocracy and the problem of cumulative (dis)advantage, (2) the lack of racial awareness in management decisions, and (3) the operations of power and silencing. We show that universities justify decisions by deploying discourses of meritocracy and ignoring context and the ways women of color staff are persistently disadvantaged due to structural racism and sexism. We find that universities are likely to indicate that their response policies treat all staff absolutely equally without candidly assessing the intersectional impacts of the pandemic on minority staff, which consequently prevent the achievement of equity. We also describe the ways in which the pandemic exposes cultures of institutional silence and silencing when women of color speak up. We conclude with glimpses of hope for resisting the downward pressures of the pandemic crisis toward cultivating more equitable futures.