Medical care rationing: Should COVID vaccination status matter?

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

The ongoing wave of coronavirus cases driven by the Delta variant has stretched hospitals in hard-hit areas of the country to their limit. Some patients are arriving at overwhelmed emergency rooms only to be transported hundreds of miles away for care. Others have suffered complications and even died waiting for beds in intensive care units to open up.

COVID-19 cases are up nationwide, but the crush of hospitalizations is concentrated mostly in states with low rates of vaccination. Alabama, one of the least-vaccinated states, spent most of the last month with no ICU availability within its borders. Several other states have come close to or surpassed the level of hospitalizations they saw during the worst of the winter surge, when vaccines were not widely available.

Procedures for deciding which patients receive care first, known as triage, are a regular part of every hospital’s operations on a normal day. But those practices have buckled under the sheer volume of people in need of urgent medical attention in some hospitals. Earlier this month, Idaho’s Department of Health and Welfare activated crisis standards of care, an elevated form of triage reserved for “extraordinary circumstances of an overwhelming disaster or public health emergency” that gives hospitals more discretion to make life-and-death choices about which patients are treated.

Why there’s debate

Currently, no public health system is treating unvaccinated patients differently than vaccinated ones. But the dire situation in many of the country’s hospitals has led some in the medical field to raise an uncomfortable question: Should vaccination status be a factor in deciding who receives care when resources are scarce?

Most public health experts categorically reject the idea, which they say runs counter to core principles of their profession. “In medicine I know that you don't prejudice against someone because of their behavior,” Dr. Anthony Fauci told CNN. Others say that hospitals regularly treat people who make unsafe decisions — smokers with lung cancer and drunk drivers injured in accidents, for example — and that unvaccinated people should be no different.

Some left-leaning pundits, on the other hand, argue that people who choose not to get the vaccine also choose to accept the inherent risk that they could become sick or die of COVID. They say vaccinated patients who have made the right decisions for their health and the safety of their communities shouldn’t be denied care because others acted irresponsibly. A few bioethicists also believe there could be some room to account for vaccination status as part of triage decisions to consider a patient’s odds of survival.

What’s next

At the moment, conversations about deprioritizing unvaccinated COVID patients appear to be purely hypothetical. Some doctors' groups and medical journals have raised the debate, but no public health authority has announced plans to implement such a plan.

Perspectives

The reason someone is sick is not a consideration in medicine

“​​There is a sense that this time, we didn’t have to have this, and yet here we are again. So, the emotions are very understandable. But the mere fact that their behavior may have contributed to why people are sick and needing access to critical care resources is not a reason to discriminate [against] them by itself.” — David Magnus, bioethicist, to Time

Vaccinated people shouldn’t have to suffer because of others’ unsafe choices

“No one is going to yank a ventilator from an unvaccinated patient to treat a vaccinated one in desperate need of treatment, and that’s not what I’m endorsing. In the real world, these decisions are going to be made in split-second assessments upon arrival. My argument is that doctors aren’t acting unethically by putting a finger on the scale in favor of the vaccinated — they’re behaving rationally and justly.” — Ruth Marcus, Washington Post

Choosing not to get the vaccine means accepting elevated risk

“It’s a free country, and you can absolutely choose not to get the vaccine. But choices have consequences, and the willingly unvaccinated have made this consequence necessary.” — Trish Zornio, Colorado Newsline

Vaccination status may be one of many factors in clinical decisions about patient outcomes

“If being unvaccinated and having lung failure puts you at a worse chance of survival versus someone who just comes in with asthma and lung problems but are vaccinated. Many places would give priority to the vaccinated asthma patient as opposed to the unvaccinated lung failure patient. What they’re watching is outcome and likelihood of success.” — Art Caplan, bioethicist, to CNN

Sentencing someone to death because of their vaccination decision would be extreme

“Denial of access to ICU care for a COVID patient who needs it would effectively be assigning a death penalty to some people who may have made a mistake in their assessments of their own risk, or the risks of the vaccines, or even listening to misinformation or conspiracy theories. Death seems a pretty harsh penalty for such a mistake.” — William Allen, bioethicist, to TC Palm

Many unvaccinated people are themselves victims

“Even the people who resist vaccination because [they] think they’ll never get sick … those people have been lied to by leaders they trusted. Bad information is cheap; better information is expensive. And as ugly as the Covid numbers might be getting across the South, rage might be better directed at political leaders who are resisting basic public health measures instead of the people suffering as a result.” — Adam Rogers, Wired

Hospitals don’t deny medical care to others who make unsafe decisions

“Since when do we turn away patients — or saddle them with stiff additional costs — on the grounds that their own recklessness caused their sickness or injury? Are those prepared to slam the hospital door in the face of the unvaccinated prepared to do the same to the injured motorcyclist who wasn’t wearing a helmet? To the liver-transplant patient who drank to excess?” — Jeff Jacoby, Boston Globe

The emergency room is not the place for moral judgments

“We’ve turned a virus into a moral test. You can catch it even if you’ve masked, even if you’ve been vaccinated, but if you don’t mask up and get jabbed, you deserve to be sick.” — Karol Markowicz, New York Post

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Photo illustration: Yahoo News; photos: Mark Felix/AFP via Getty Images