Medicine often prides itself
on not judging which patients deserve treatment on moral grounds based
on their character or past behaviors; they treat people simply as human
beings, not as "good" people or "bad" people, "deserving" people or
"undeserving" people. I think that there are some cases that is at
least arguably wrong and foolhardy rather than admirable --
cases where saving someone's life will allow them to go on hurting or
killing other people, even the doctors or nurses (and often especially
the nurses) who treat them. But I believe it is definitely
wrong in those cases when there are insufficient resources to treat
everyone and to save everyone. In at least those cases, triage
about whom to treat and try to save should take into account moral
elements about the person's relative responsibility for needing
treatment. Otherwise it is still a moral choice, but without moral
reasoning or a sound moral basis. Deciding not to use morality to
determine who can be and will be treated is itself a moral choice, one
which will allow people to be treated who should not be and prevent
people from being treated who should be. If news reports are accurate that in this late summer of 2021,
hospitals are being "overwhelmed" in terms of space and/or remaining
staff by patients with COVID who are willfully unvaccinated by choice --
whether motivated by politics or fear of scientific safety -- it is
morally wrong to use the resources they do have to save those patients
at the expense of letting patients die or be insufficiently treated who
need those resources because of medical conditions over which they had
no control or much less responsibility for causing. And it is
foolhardy for it to be acceptable to make or allow nurses, doctors, or
other providers to quit and give up their careers or suffer severe,
debilitating PTSD instead of making their work load more manageable so
that they do not have to quit or suffer. It is a morally
deplorable waste of resources of immense value to work a nurse or doctor
to exhaustion that makes him or her quit altogether when that could
have been prevented by making moral choices that would prevent their
exhaustion in the first place. It is not necessarily that willfully
unvaccinated people who could have been vaccinated but simply chose not
to be are undeserving of care; it is that they are less deserving of
care than someone who needs care through no fault of their own, and when
care cannot be provided for all, it should be provided to the more
deserving rather than the less deserving, assuming all the other
principles of triage are also met, such as that the more deserving
patient is likely to benefit from treatment so that treatment resources
are not simply being wasted. If medicine is not going to
make moral choices about whom to treat or treat first in normal
circumstances when resources are available to treat all, it should at
least make moral choices about whom to treat when not all can be treated
because there are not the resources available to treat all who will
need treatment. That means, in this particular
time of the COVID pandemic, when vaccines that would prevent or
ameliorate this are readily available to all who can reasonably take
them so they do not likely need hospitalization, hospitals need to
allocate ICU space and staff time for rest and respite, in order to
treat those with health problems not their fault instead of having to
turn them away because there the beds and staff are being used to treat
the people who are there because of their own poor choices. Now I realize some will say
this would be a slippery slope toward denying people treatment for
anything for which they bear some responsibility for their medical
predicament in normal circumstances, but that is not true, because we
are not talking about normal circumstances where treatment is available
for all who need it. Slippery slope arguments depend on ignoring
the conditions for which principles are made and on which they are
based. Making people have
to stop for a red light is not a slippery slope for making people have
to stop at green ones too. Letting people turn right at a red light
after a full stop is not a slippery slope to letting people run red
lights no matter what. All triage is based on limited ability to
treat all who need treatment, and triage is not a part of medical
practice when everyone can be treated sufficiently in a timely
fashion. I am talking about triage situations here. But yes,
I do also think a legitimate case can be made that moral culpability
elements should enter into treatment decisions in any limited resource
triage types of cases -- e.g., in an auto accident caused by a clearly
drunk driver, all else being equal, first treat/save the people he
injured before treating/saving him. And I realize
that there can be economic limitations that require basically what is
'financial triage' -- treating those who can pay -- for determining whom
to treat even apart from pandemic conditions. But that is a
different problem, even if it might involve some of the same moral
choices if it cannot be solved financially through something like
universal health insurance and through more medical schools and nursing
schools, better use of nurses, pharmacists, other medically
knowledgeable people, and their expertise, etc. I think it can be
solved financially and educationally, however. But it is a
different issue from the current acute resource emergency. In the current
crisis, which is what I am writing about here, it is morally ridiculous
for hospitals to admit they have to turn away car injury victims,
innocent cancer victims, and others who need surgery or cardiac care because
they need to use the resources for people who refused to take a
vaccine. No they don't. They need to turn away people who
refused to take the vaccine in order to have the resources for those who
need care through no (or much less) fault of their own. And it is
ridiculous to lose nurses or doctors who could be treating surgery
patients and other non-COVID patients because you allow total burnout of
nurses and doctors treating people with basically self-inflicted
life-threatening conditions. If there were no effective and safe
vaccine, none of what I say here would apply. But currently there
is, and so it does apply. Hospitals should reserve the number of
beds they are likely to need for non-COVID patients and simply tell
COVID patients they don't have room for them. Or if it is
impossible to isolate COVID from non-COVID patients in hospitals, than
one hospital in an area should be a designated non-COVID hospital while
the others fill up with COVID patients. But people who are dying
from willful ignorance should not unnecessarily cause innocent people to
die along with them or instead of them. Four final
points: 1) it is said that some people are innocent victims of
widespread misinformation and intentional "disinformation" (previously
called lies). But with COVID being a major news story
nearly every day on both local and national news, and with the amount of
death and near death there has been, one should at least be suspicious
of the claims that COVID is a hoax or not really dangerous, and that
local and national news organizations are fabricating all this and
creating false obituaries, pictures of ICUs with people intubated,
hiring hundreds of thousands of crisis actors to play victims and
families who lost a loved one, etc. One should at least ask their
doctor, if they have one, for medical advice about whether to get the
vaccine or not. Surely people bear some responsibility for blindly
accepting the misinformation and lies. 2) Some people
fear medical treatment, including vaccines. In many cases, that
is not unreasonable. But when the choice is between dying isolated
from loved ones and in the terrible way that COVID kills you or
worrying about the possible side-effects of a vaccine that so far seems
to be safe and effective for millions who have taken it, it is a case
where the devil you do know (COVID) is not better
than the devil you don't know (imagined possible, but so far hidden, or
actual but rare and not deadly, vaccine side-effects). 3) Some people
cannot take the vaccine for various medical reasons. They still
should, insofar as possible, socially distance themselves and wear
masks, to be as safe as possible as long as the disease is rampant and
not controlled by herd immunity. Ideally others would try to help
protect them through various measures to allow them to be socially
distanced, by being masked so as not to infect them, etc. but apparently
in this day and age, the decency of others cannot be counted on.
What I wrote above applies to those who could take the vaccine but
willfully choose not to. It does not necessarily apply to people
who cannot take the vaccine for sound medical reasons. However, it
does apply at least partially to those who cannot take the vaccine but
who willfully choose to ignore masking or social distancing to protect
themselves. If you cannot take the vaccine, but you just 'have' to
attend a crowded entertainment event unmasked or where most people are unmasked, then
you don't deserve to take an ICU away from someone with random cancer
or who was injured by a drunk driver. 4) I included
"Tough Love" in the title of this piece because I think that if those
who otherwise willfully choose not to take the vaccine know they stand a good
chance of not being treated at all if they do get COVID, they may be
inclined to change their mind and take the vaccine. And I don't believe it is unfair
coercion, or even coercion at all, to tell someone that you won't help
them or put your own life in danger if they are going to behave in a
foolhardy and dangerous way that makes them need help. |