A friend of mine died of liver disease after being told he’d only be considered for a transplant if he changed some of his behaviors. He refused and not long after died. I see no problem with that sort of medical decision, neither did he.
But what is the desired outcome you’re basing this decision on?
But what if the vaccinated person abuses their family, and the unvaccinated person runs a charity for the homeless?
Well stated. And also . . .
. . . this is compelling as well. As Chronos said above, to a large degree vaccine refusal is already an active choice to refuse treatment for a preventable disease. It’s not unprecedented to attach conditions to treatment when that treatment is in short supply.
THere a difference between triage in emergency, i.e, life-or-death right now, and a transplant list.
But, it’s nonetheless an interesting idea.
Screw the debate vax v. antivax.
Round everybody up, go down the line of everybody over the vax age and vaccinate them. Apparently there is no allergy issue because of type/manufacture so that is a nonissue. Screw religion, God can just deal with it. End of issue.
And yes I know that will never happen, but that is the doper what if I were the world emperor.
Say you have two equally critically ill people, resources for only one, and one is a Jehovah’s Witness who will refuse the blood transfusion which could save his life. Would you treat him first?
The unvaccinated by choice (not children, not those with medical issues) are putting others at risk. They may have to live with the consequences.
I would do whatever my guiding ethics board prescribes in that situation. My WAG is that it would be to treat the patient who is not refusing treatment, since triage is about categorizing cases strictly by level of need and expected outcome.
But that’s not really relevant here, is it? Unvaccinated patients aren’t refusing treatment. They have previously refused common-sense preventative measures.
The problem with these hypotheticals is that there isn’t really such a thing as “equally critically ill.” Triage is about assessing as many factors as you can before making a decision. Those factors should not be based on what got you into the hospital unless they’re relevant to survival, and at the moment they don’t appear to be relevant here.
If new data comes out that says critically ill vaccinated patients have a higher chance of recovery than unvaccinated, then all the above goes moot. Likewise if data suggests that critically ill unvaccinated patients pose a greater risk to other patients in the hospital than the vaccinated ones.
But as of now now, the only reason to deprioritize unvaccinated patients is as a form of justice, not as a matter of health. That’s not a position I’m comfortable taking.
One can see this issue is not entirely hypothetical since Texas ERs are now shutting down because they are overloaded. Seems to me that affects not only COVID patients but anyone else needing an ER as well.
I treat everyone based on their medical need, considering likely best outcomes AND available resources. If I had two covid patients (one vaxxed, one unvaxxed) needing to be put on a vent and only one vent available, the vaccinated one might well get the vent because their chances of recovering are better than the unvaxxed. But if I’ve got two vents, I’m tubing them both.
I swore to treat all equally to the best of my ability. And there’s no time to take all this BS before an ethics committee when you’re on the front lines. If you can even find an active ethics committee these days to review stuff.
Are doctors free to make these kinds of decisions now, as things stand currently? You grounded your rationale in likelihood of success, but what if you publicly stated that you put the vaxxed patient on the only available vent because you felt he deserved it more? Would that cause any problems for you? If so, I’d be in support of fixing that, so that medical providers could choose to prioritize the vaccinated without getting in trouble. I wouldn’t want to force them to do anything different, or make them liable for not booting an anti-vaxxer to make room for a vaccinated patient because we all just decided from our sofas that would be the way to go.
Along the lines of the transplant thing mentioned earlier, what about requiring vaccines for non-emergency medical care? Want to see your doc about something not immediately life-threatening? Get your jab first.
I am not going to refuse my patients necessary medical care based on whether they’re vaccinated or not. Especially urgent or emergent necessary care. And my patients don’t have the option of seeing someone else either.
However, I can see requiring patients to be fully vaccinated before qualifying for transplant listing. Transplants are precious, scarce resources and should go to those who show compliance with medical regimens.
I can see physicians excluding the non-vaccinated from their practice, but only for non-urgent/emergent things. One does not abandon their patients, one gives them the opportunity to find another provider first before cutting them off from care.
Right, I’m against compelling you to prioritize the vaccinated. But I’m in favor of protecting you and other doctors if you did choose to. So, could you, if you wanted to?
Not in my setting, I’m in the public sector, and only see prison inmates. They don’t have the option of seeing someone else. As a result, I see people who are actively suing me, threatening to sue me, refuse to take any/all advice or direction I give.
I do have the ability to get rid of particularly oppositional patients, either by transferring them to another prison or having my collaborating Nurse Practitioner take them. But that’s reserved for the cases where the doctor-patient relationship is broken beyond repair. Even then I’ve given such individuals emergency care.
But honestly if I were in the private sector again I don’t believe I would refuse care to the vaccine refusers. I’ve converted enough contrarians over the years by being patient, non-accusatory, and honest with them at each opportunity than I have by being restrictive or punitive or confrontational.
Fair distinction, and again, I respect your perspective. So just to be clear, is it your understanding that a doctor working in the COVID wing of a hospital outside a prison could choose to put the vaccinated patient on the ventilator instead of the unvaccinated patient, on the basis that he felt the vaccinated patient deserved it more? Or only if it was a private hospital? Or…?
You haven’t seen all those reports that vaccinated people have a much better chance of survival and get considerably less sick?
So, while not getting the vaccine very likely contributed to landing in the hospital. If we ignore the reason someone ended up there and only look at the prognosis, the vaccinated person is less likely to need a vent, they’re not going to tie up a bed for nearly as long, they’re more likely to survive and they’re going to need less resources which allows the staff to take on more patients before become overwhelmed.
Note that we are specifically talking about vaccinated and unvaccinated critically ill patients. The vaccinated patient is far less likely to get to that point, but once they do - according to that article at least - their prognosis seems to be no better than an unvaccinated patient.
I will admit that I am taking the OP’s article at face value and haven’t done any of my own interwebz research on it.
I’d expect the physician to give the ventilator to the vaccinated patient on the basis of that patient having a better chance of surviving the infection. I believe that’s how the decision should be made in that case. I’d not expect an ethical physician to deny an available ventilator (or other needed treatment) solely on the basis of patient being unvaccinated.
Now if the doctor feels the patient won’t benefit from intubation or other rx, there’s no ethical barrier to denying care deemed futile.
Another factor: Not everyone in the hospital is there because of Covid-related reasons. Bringing in patients with a contagious disease into a hospital endangers, to some extent, all of those other patients. And bringing in patients who are more contagious endangers them more. As I understand it, unvaccinated Covid patients are more contagious than vaccinated ones, no? So there’s an argument that prioritizing vaccinated patients protects others, too.
Given that a considerable number of unvaxxed patients are desperately regretful about their poor decision when they are near intubation or in serious risk of death, I don’t like the idea of “Sorry but it’s too late, we ain’t helping ya.”
To be sure, if you have two patients who are in equally severe condition - one vaxxed and one unvaxxed - then I’ve got no problem with letting vaccination status be the tiebreaker. But if the unvaxxed is more desperate need of help than the vaxxed, then he/she should get priority.
I’m angry as hell at anti-vaxxers or people who are just ignorant and irresponsible, but there are unintended consequences of healthcare workers taking political or soapbox stands. I think it’s a dangerous road to go down. If we want to have a triage system and treat heart attack guy before treating anti-masker COVID victim, maybe I could go along with that. But healthcare workers treat stupidity all the time: trauma surgeons treat drunk drivers, drunk guys playing around with rifles, gang bangers who get shot up dealing drugs, high speed drivers, people who fall off their rooves…they chose that line of work.
Can the case me made that the best way to push people to get vaccinated is to withhold treatment if they refuse? That if they choose to refuse getting vaccinated then the hospitals will choose to not treat them. Still their choice but they need to understand their choice has consequences.
Ant-vaxxers are a threat to the community at large. People are dying because some refuse to get vaccinated. Is a doctor being un-ethical if they do what is best for the overall health of their community?