That's not to say that it's unreasonable to question and philosophize the implications of a mandate. At the same time, barring a more effective plan, the implications of not having a mandate seem particularly horrific.
All the same, I do agree with you that if there is to be a mandate, that it's best to come from the federal government to create a uniform set of guidelines. I also agree that the patchwork of rules has been a mess.
This argument doesn't hold up. First, tying availability of medical care to the "right" behavior unconscionable at so many levels. In a developed country, do we really want to create a tier of disabled or unhealthy people that we've denied care to because we don't like their behavior (maybe dont answer that)
More practically, should you get interviewed at the ER intake and moved down in priority based on factors in your control that make you a higher risk? Smokers, sedentary people, the obese, lifestyle induced diabetics, people who don't go to the doctor regularly, you could probably compile a big list. What is so special about vaccines?
At the same time, there are several implications of that ideal that affect us very personally right now. At the moment, a large portion of the hospitals are full. By now, I'm sure we've read the news reports, but in case someone doesn't understand what that practically means, I'll offer the following. Full means a combination of no physical space and no staff to provide care. Now, the hospitals have done a good job of creating physical space to treat patients out of tents, portable buildings, conference areas, and cafeterias, but many of them really don't have anywhere else to go. Of course, those rooms don't mean a lot if there's not enough staffing of which there is not. Certainly, you can ask the existing staff to do more and they have. A normal ICU staffing ratio would be one nurse to either one or two patients depending on the level of care. The reason that the nursing ratio exists this way is that the care they provide requires that kind of attention. For example, they're required to titrate multiple medications, which means adjust the rate of the drips to achieve some kind of affect such as blood pressure. This can be fiddly given how sick the patients are and, to be clear, this is only one of the many tasks they provide. Current staffing ratios are something like three or four to one in the ICU, which is not standard of care, but where we're at.
As a result of this staffing and space conundrum, we're now at the point where the physicians are essentially being forced to choose who gets to die. My wife is an ICU physician. This week she's working days and is on night call. Last night, about every two hours, they called her because they need hospital beds and none are to be had. They had a heart attack come in who needed a stent. Normally, that would go to the ICU afterwards, but, again, no beds. When that went poorly, her job was to go through the charts and figure out who they were going to bump from the ICU to a step down unit. All of the patients there needed ICU level care. If the rare cases when this happened pre-COVID, they would transfer to another hospital. All of the hospitals for hundreds of miles are in the same situation, full, and we're in a very large metropolitan area. A good portion of these patients will likely die from this reduced level of care when they would normally live.
Now, my point in mentioning this is not to appeal to emotion and perhaps persuade someone to get the vaccine. We're well beyond that. It's more to help understand the consequences of our collective action.
At the moment, the hospitals are filled with with COVID patients. Around 99% of them are unvaccinated. Now, if we are going to treat everyone equally, which both you and I agree with, they get to go to the hospital to be treated. As a result, the hospitals are full. Since the hospitals are full, reduced care is given. Since reduced care is given, more people get to die of ailments unrelated to COVID. That is precisely why COVID differs from something like smoking or obesity. Hospitals are not full due to smokers nor obese people. They are full due to unvaccinated COVID.
Beyond that, I can assure you that the medical staff providing this kind of care are tired and they all want to quit. It's not just the sustained, long hours, it's the complete and utter unwillingness of the general public to take a very simple, preventative step. Further, they're frustrated that the public comes to them to save their life after they get sick, but derides, abuses, and slurs them prior to that point when they tell them precisely how not to be in that situation. Again, this is not to appeal to emotion. We're past that. Another consequence of the pandemic going on like this is that they can and will quit. This will exacerbate the existing hospital staffing shortages and they are not easy to replace because it takes about ten years of training to become an ICU physician.
Really, truly, I do not like medication mandates. I understand; if a vaccine now, what later? That's fine. However, then we're left with a crappy choice. Either get people vaccinated as quickly as possible or be left with a partially collapsed hospital system.
thank you for sharing the anecdote of your wife's work scenario.
But you differentiate between vaccinated and unvaccinated in Covid.
Do you do the same for the heart attack victim that did not get the ICU bed? Did he smoke? eat junk food?
Should we categorize this victim as well, and likewise give them different levels of treatment.
taking it further, should'nt we ban cigarettes and junk food -- can't think of anything good coming out of them - except that the timelines for its effects are a little longer than covid?
Should not refuse care. A lot of people have unhealthy lifestyles (eating lots of processed foods, sugary soda drinks, don’t exercise, smoke, …). We also don’t refuse healthcare to these people even if they make poor life choices.
Since many people on this site live and work in the USA, I would guess more likely than not plenty of people are obese here. You don’t magically become obese. Yet you deserve healthcare, since you pay taxes, pay for a health insurance, etc…
No we shouldn't, we don't turn people away who drove drunken with 200km/h and crashed.
I'd not mind a way to put folks further down the list if they choose to be unvaccinated or have folks have a special waiting room - but the ER is no time to figure out if someone chose to be unvaccinated or not. It would take up even more time and resources from an already strained system.
Hospital capacity being limited, should ill vaccine refusers be getting priority as they are getting right now?
What if you get super unlucky, and you get contaminated and severely ill despite vaccination? Will they kick an unvaccinated covid patient from the one respirator?
I've tried to rephrase the wording of the ethical dilemma I came up with to make it more neutral:
Imagine there's two covid patients coming into hospital at the same time: one vaccinated, one not. Both are in need of the same care, with the same urgency. Only one hospital bed is available. Which, if any, of these patients should receive priority in treatment?
Let’s say instead of “unvaccinated” that they’re actually wildly radioactive and suffering radiation poisoning. Should we treat that person, or turn them away because they could irradiate the ER?
