 A version of objection (c) applies to an opposite policy proposal: that higher priority should be given to patients with high social value. This “social value” could either be instrumental (doctors, nurses, parents of young children perhaps) or moral (prioritising the virtuous). The fundamental objection to rewarding social value is that it infringes a principle of equal treatment but, putting that aside, it has the practical and fairness problems of the punishment proposal. How is social value to be determined and then how is it to be applied in a timely and cost-effective manner? And, given the potentially dire consequences of being assigned low social value (which could in practice be a “death sentence”), procedurally it seems reasonable to expect something akin to a court hearing. A version of allocating according to perceived social value (among other criteria) was tried in Seattle in the 1960s in allocating very scarce dialysis (Alexander 1962). The result seems to have removed any enthusiasm among transplant systems for trying it again.