Public outrage over the unvaccinated is driving a crisis in bioethics

[Shiloh]

Source: https://www.cbc.ca/news/politics/pandemic-covid-vaccine-triage-omicron-1.6319844

Public outrage over the unvaccinated is driving a crisis in bioethics
Pandemic brings 'unprecedented disagreements' among doctors over how to triage those who refused the shot
Evan Dyer · CBC News · Posted: Jan 22, 2022 4:00 AM ET | Last Updated: 42 minutes ago

The pandemic has triggered a new debate over what used to be a settled principle of bioethics — that you don't treat patients differently based on past behaviour that may have contributed to their condition.

"The core fundamental principle of clinical ethics tells us that once a person enters the hospital as a patient, whatever got them there is no longer part of the equation," said Vardit Ravitsky, who teaches bioethics at the Université de Montreal and Harvard Medical School.

"The most extreme example I have ever seen was when I lived in Israel and a suicide bomber detonated on a bus, killing and injuring civilians around him. Somehow he was not killed by the explosion and he arrived at the hospital with his victims.

"Once they entered the hospital, everyone was treated equally. There was no sense of prioritizing the victims in relation to the person who caused the injury."

But the COVID-19 pandemic — which has overturned so many norms and assumptions — is now testing that principle....

 

[Shiloh]

Source: https://www.theatlantic.com/health/...inated-medical-care-hospitals-omicron/621299/

It’s a Terrible Idea to Deny Medical Care to Unvaccinated People
Omicron is pushing hospitals to their limit, but the medical system still has an ethical responsibility to all patients—no matter the choices they make.
By Ed Yong

More Americans are now hospitalized with COVID-19 than ever before. Their sheer numbers are overwhelming health-care workers, whose ranks have been diminished by resignations and breakthrough infections. In many parts of the country, patients with all kinds of medical emergencies now face long waits and worse care. After writing about this crisis earlier this month, I heard from a number of readers who said that the solution was obvious: Deny medical care to unvaccinated adults. Such arguments were aired last year, as the Delta variant crested, and they’re emerging again as Omicron spreads. Their rationale often goes something like this:

Every adult in the U.S. has been eligible for vaccines since April. At this point, the unvaccinated have made their choice. That choice is hurting everyone else, by perpetuating the pandemic and, now, by crushing the health-care system. Most of the people hospitalized with COVID are unvaccinated. It’s unethical that health-care workers should sacrifice for people who won’t take care of themselves. And it’s especially unethical that even vaccinated people, who did everything right, might be unable to get care for heart attacks or strokes because emergency rooms are choked with unvaccinated COVID patients.

To be clear, this debate is theoretical: Health-care workers are not denying care to unvaccinated patients, even though, ironically, many told me they’ve been accused of doing so by not prescribing ivermectin or hydroxychloroquine, which are ineffective against COVID but are often wrongly billed as lifesavers. Still, I ran this argument past several ethicists, clinicians, and public-health practitioners. Many of them sympathized with the exasperation and fear behind the sentiment. But all of them said that it was an awful idea—unethical, impractical, and founded on a shallow understanding of why some people remain unvaccinated.

“It’s an understandable response out of frustration and anger, and it is completely contrary to the tenets of medical ethics, which have stood pretty firm since the Second World War,” Matt Wynia, a doctor and ethicist at the University of Colorado, told me. “We don’t use the medical-care system as a way of meting out justice. We don’t use it to punish people for their social choices.” The matter “is pretty cut-and-dry,” Sara Murray, a hospitalist at UC San Francisco, added. “We have an ethical obligation to provide care for people regardless of the choices they made, and that stands true for our unvaccinated patients.”

Unlike vaccine mandates, which limit the jobs unvaccinated people can hold or the spaces they can enter, withholding medical care would be a matter of life or death. And in such matters, medical care should be offered according to the urgency of a patient’s need, not the circumstances leading up to that need. People whose actions endangered themselves, like smokers with lung cancer or drivers who crash while not wearing a seatbelt, still get treated. Those whose actions endangered others, like drunk drivers or terrorists, also get treated. “We are all sinners,” Carla Keirns, a professor of medical ethics and palliative medicine at the University of Kansas Medical Center, told me. “No one has made all the perfect decisions, and any of us could find ourselves in a situation where we are sick.” It is a fundamental principle of modern medicine that “everyone has an equal claim to relief from suffering, no matter what they’ve done or haven’t done,” Daniel Goldberg, a medical historian and public-health ethicist at the University of Colorado, told me....

 

[sharon sanders]

bump this