But is it defensible to deny urgently needed health care to punish a patient for not making healthy choices?
This question isn’t new and the answer has long been no. Many of those who need liver transplants ruined their original livers through overconsumption of alcohol. Treatment for lung cancer would rarely be needed if people didn’t smoke. Injured practitioners of extreme sports had safer recreational choices.
When patients like these are evaluated for health care, their priority depends on how serious their condition is, how urgently they need help and how well they are likely to do if they’re treated. What does not matter is culpability, blame, sin, cluelessness, ignorance or other personal failing. Doctors and hospitals are not in the blame and punishment business. Nor should they be. That doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn’t abandon it now.
Why as he so anti-vax? Because he thinks the virus isn’t a big deal, his distrust of vaccines in general and/or this vaccine in particular, influences from people he’s associated with, his moral or ideological belief, or something else?
The doctor in Alabama is not an emergency or urgent care physician. His decision has nothing to do with triage. Doesn’t he have the right to deny care of certain patients?
You’re right. We heard Facebook anecdotes quoted as facts. Our SiL’s cousin is an anti-vax nurse who thinks masks may kill people, so they believe her because she “got the rona” (never verified by a test) last year and it was just like a mild case of flu.
I spoke with a very astute Oxbridge-educated MD-PhD doc in Israel with lots of connections in London. He and his wife have already had their boosters. He believes the rapid drop-off in London after the Delta surge was artificial. He said the data suggests that Astra Zeneca has longer protection against Delta than Pfizer and that the UK got their AZ shots later than some other countries and hence there was relatively rapid drop-off but he thinks that after the AZ protection wanes, there will be a bigger surge.
With respect to the ethical issues and beyond:
Would it matter in the triage whether the individual in question was not only making a bad choice for him/herself, but recklessly choosing to endanger others and likely would continue to do so after treatment? They also expose healthcare workers to unnecessary risk. Some fraction of the anti-vaxxers try hard to persuade others not to get the vaccine and will remain anti-vax even after recovery from COVID. This by the way is the same experience, well-studied, of cult members who are told by their leader to sell all their stuff and that they will be transported by aliens to a better place (or the world will end for all of the non-believers or whatever). When the apocalyptic event (surprise, surprise) does not come to pass, their beliefs in the cult actually get stronger.
If an employee lies about being vaccinated and knowingly or unknowingly infects others, this strikes me as not only unethical but criminal.
I can’t wait to get back to business travel. About three years ago, I decided that the only people in my consulting firm who needed offices were admin staff and the professionals would be happier working from home (and traveling a lot of the time anyway). Several of the employees have younger and hence unvaccinated kids and are reluctant to fly. I’m not going to fly without my booster and have been deferring a couple of needed trips.
It is these vaccines in particular. He has no issues with Flu vaccine. From his own skewed research, and belief that his own age group “it was nothing” versus vaccines that have not been out long enough. If he had a choice he would have waited until around December. But for him to return to school he was forced to, (well he could have not gone back, so forced is a strong word). He is also ASD . I have posted in past here about his feelings. If Delta had not come along I would have been more comfortable with his initial wait and see decision. This is similar to why many others have not gotten vaccinated yet. yes FDA approval helps , but some still need more time and data, and even though millions upon millions have gotten the vaccine, there is not enough data for them to feel comfortable. In an anti-vax FB post I saw, the issues of Fertility are still brought up and how the study will continue to 2027. I am just showing what the other side thinks.
Back to my S
Keep in mind that until Delta (and the vaccines) came along, the idea was that the young mostly did not get sick ; this was a pandemic of the old. Delta seemed to have changed the narrative but how to convince a young person that thinks differently all they have been told for over a year is now different. (once again not my viewpoint but his). Oh and the greater good of others argument, is “let them get vaccinated” I know that this is selfish, but for ASD , brains are wired differently and empathy is not always there.
In any case I believe he has convinced himself that he has long term side affects from the vaccine. Time will tell. and We did JnJ because there was not a chance I would get him back for a 2nd shot.
just a few thoughts as I live in a regionally “purple” area in the midwest. Asking for suggestions at the bottom.
I have several different friend groups who have different thoughts. One group of friends is anti-vax, and their reasonings are mostly that they have immunity from having CV this past year. I’m not seeing this reason mentioned as much on these boards - but one showed me an article saying that actually having CV provides as much, or more, immunity than the vax. (true? not true? no idea).
i do know that our county of 500,000 has had a HUGE drop in the death rate of the elderly. I share this good new readily. the VAX has been a life saver. CV is present here now, but not like in the south or hot areas. I guess I’m just asking for ideas or backdoors on how to encourage them to get a vax when they feel naturally vaxxed now. Like others have mentioned here, shoving things in their face and meaness will not help in any way.
I’m not going to drop them as friends over this. One of the women is a widower, who raised her kids on her own amidst tragedy; she’s one of the strongest, independent, caring, self sufficient women I know. Her elderly parents are vaxxed, she had CV, and she just thinks her immunity is enough. Would love thoughts on what you’ve all said to others who think they are naturally vaxxed.
Most of what I have read suggests that COVID-19 has a “vaccine effectiveness” against getting COVID-19 again similar to that of getting a COVID-19 vaccine (i.e. getting COVID-19 again is possible, though not that likely). Some antibody studies did find widely varying antibody responses among those who had COVID-19 (similar to one dose of vaccine).
Some antibody studies found that getting one dose of vaccine after recovering from COVID-19 resulted in a very strong antibody response in nearly all such people. So there is probably additional benefit to getting vaccinated even if one already has had COVID-19.
From the article: “The study of hundreds of Kentucky residents with previous infections through June 2021 found that those who were unvaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated.”
I’m not a medical ethicist nor am I a trained physician. Are you? These questions are interesting to ponder (especially when “doesn’t he have the right” isn’t clear as to which sort of “right” is being referenced - legal? professional? other?). However, like understanding the science behind the vaccines, understanding the professional ethics behind a medical judgement hopefully moves the conversation in an informed direction (IMO anyway).
The Op Ed does refer to situations where it may be permissible to require vaccination. This expert was answering the ethical question of rationing for triage care; an increasingly relevant issue given the ED and ICU capacity issue right now, and as personally experienced by one of our posters. As the author points out: The doctor-patient relationship requires trust, which patients are less likely to extend if they think their healers are sitting in judgment of them. Clinicians are not trained to assess culpability, or decide how much weight to give to extenuating circumstances, such as a dearth of information apart from Fox News. With life itself hanging in the balance, these are not decisions that should be made at the ICU door, if ever. . . . But if “sin” alone should not be a consideration for rationed care, does that mean a covid patient’s lack of compliance cannot be considered on any grounds? Two possibilities come to mind: instances when an unvaccinated person poses a threat to the health of the hospital staff or other patients; and instances when not getting vaccinated predicates a poorer health outcome.
One should read the rest, as the author then discusses these two possibilities. It’s a good op-ed (again, IMO).
That’s interesting what you are saying about AZ. I’ve also heard from some experts on this side of the pond that there will be additional surges and that the virus will just find who is vulnerable. Not the most hopeful message! But if I’m reading your post correct that’s a very strong case for boosters, correct? It might also suggest that timing of that second shot is an issue (AZ has you wait longer). Should future first-vaccinations time the shots differently? I do wonder . . .
Regarding your ethical point, the author clarifies that there may be reasons to triage based on vax status. In an ICU setting, those mostly involve suitability for the specified treatment. It can go either way there, and will depend on the facts on the ground at the time. Recall all the medical providers who were at risk of contracting HIV back a few decades ago? It was something like 1-2% infection rates in some localities. It lead to changes in best practices as opposed to medical personnel walk-outs, IIRC.
As mentioned by the op-ed author, it’s very hard to determine whether someone has absorbed the “correct” information in an ICU situation. Most are medical personnel are trained to heal, not to spend time discerning someone’s intentions or state of mind when they joined that cult.
Kind of agree about employees who lie about being vaxed. IMO, that would be grounds for termination at minimum. Whether it’s a criminal referral might be subject to circumstances about their behavior. For instance, someone who has a legitimate medical issue but didn’t get the exemption (yet) but who lied under pressure due to deadlines because they had been too swamped with work and family to visit their provider, and they take all other Covid precautions including masking and social distancing and they don’t eat with their colleagues till this is resolved . . . is that person a criminal? I think not. Again, it comes down to whether the vaccine is an appropriate “default” for a bunch of other life-altering decisions. Most simply aren’t trained in their professional capacities to make those judgements.
Regarding flying, we fly. This is a YMMV thing. We are comfortable flying and flew through the pandemic before any vaccine (ah - the legroom. No more . . . ). I, personally, would be in no more hurry to get a booster than I was in a hurry to get a vaccine. I can wait my legitimate turn and let others who need it more - including those in other countries - get their jab first. I’d have to see a lot more evidence that I would need something after eight months before even considering it. At this point, I seriously doubt I’d go less than a year. Bill Maher won’t consider it at all
The Op Ed is referring to rationing for triage care. The doctor in Alabama is brought up as a way to discuss whether denying care sends a powerful message.
The authors state:
“For non-urgent care where sufficient advance notice is given, requiring vaccination as a condition of continued service might also be defensible, particularly if the patient has access to alternatives.”
Under medical ethics the phrase “might also be defensible” means maybe, sometimes, it’s debatable. I don’t know if the doctor in Alabama is denying non-urgent care to the unvaccinated for punitive reasons, because of his own emotional or physical health, or because of the health and safety of his other patients and staff.
The authors of the Op-Ed clearly state that punitive reason (while satisfying to some degree) are unethical and I agree. The other reasons are debatable.
